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Effects of Learning Climate and Registered Nurse Staffing on Medication Errors

Chang, YunKyung; Mark, Barbara

doi: 10.1097/NNR.0b013e3181ff73cc

Background: Despite increasing recognition of the significance of learning from errors, little is known about how learning climate contributes to error reduction.

Objectives: The purpose of this study was to investigate whether learning climate moderates the relationship between error-producing conditions and medication errors.

Methods: A cross-sectional descriptive study was done using data from 279 nursing units in 146 randomly selected hospitals in the United States. Error-producing conditions included work environment factors (work dynamics and nurse mix), team factors (communication with physicians and nurses' expertise), personal factors (nurses' education and experience), patient factors (age, health status, and previous hospitalization), and medication-related support services. Poisson models with random effects were used with the nursing unit as the unit of analysis.

Results: A significant negative relationship was found between learning climate and medication errors. It also moderated the relationship between nurse mix and medication errors: When learning climate was negative, having more registered nurses was associated with fewer medication errors. However, no relationship was found between nurse mix and medication errors at either positive or average levels of learning climate. Learning climate did not moderate the relationship between work dynamics and medication errors.

Discussion: The way nurse mix affects medication errors depends on the level of learning climate. Nursing units with fewer registered nurses and frequent medication errors should examine their learning climate. Future research should be focused on the role of learning climate as related to the relationships between nurse mix and medication errors.

YunKyung Chang, PhD, MPH, RN, is Postdoctoral Fellow; and Barbara Mark, PhD, RN, FAAN, is Sarah Russell Frances Distinguished Professor, University of North Carolina at Chapel Hill School of Nursing.

Accepted for publication September 28, 2010.

This study was funded by the National Institute for Nursing Research (grant no. 5R01 NR003149), the American Nurses Foundation (2006 Southern Nursing Research Society/ANF scholar), and the Sigma Theta Tau International, Alpha Alpha Chapter Small Research Grant Program.

Corresponding author: YunKyung Chang, PhD, MPH, RN, #7460 Carrington Hall, Chapel Hill, NC 27599 (e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.