Navigating Through Chaos: Change Nurses and Patient Safety A Grounded Theory Study

Navigating Through Chaos: Change Nurses and Patient Safety A Grounded Theory Study

Author: 
Heather L Cathro
Program of study: 
Ph.D./NUR
Abstract: 
Patient safety is a prominent issue in health care as evidenced by the staggering statistics of deaths and harm due to preventable medical errors. As front line clinical leaders, charge nurses (CNs) have key roles in keeping patients safe. There is a gap in knowledge of the specific actions and processes CNs implement to keep patients safe. This study attempted to narrow this gap by exploring actions and processes CNs implement to keep patients safe using a grounded theory design and generating a substantive theory that can inform CN job descriptions, serve as the basis for CN orientation and training, and empower CNs to promote patient safety in practice. This study utilized purposive sampling of CNs on medical-surgical units with data collected through 11 interviews and six observations. The substantive theory that emerged was Navigating through Chaos: CNs balancing multiple roles, maintaining a watchful eye and working with and leading the health care team to keep patients safe. This study contributes to the knowledge base of the CN role related to patient safety. Recommendations to maximize the potential of the CN role in promoting patient safety include clearly defining CN role responsibilities, addressing staffing shortages, and providing CNs with the necessary information to complete their work. The specific actions and processes identified in this study can be incorporated into course content on clinical nursing leadership. The substantive theory can also guide further research to study relationships between specific CN actions and processes and patient safety outcomes.
Dedication: 
This dissertation is dedicated to my parents, Doug and Lorraine Cathro, who have instilled the values of determination, hard work, and resiliency and to my beautiful daughter, Ella Lorraine, who makes me smile every day. This dissertation is also dedicated to the charge nurses who graciously shared their experiences, insight, and commitment to patient safety through their participation in this study. Your commitment to patients, staff, and your profession makes you true leaders in health care.
Acknowledgements: 
I would like to thank my chairperson, Dr. Anne Brett, for her timely feedback, straightforward advice, and for being my “cheerleader” and guide throughout this dissertation process. Also, I would like to thank my committee members, Dr. Sharon Beasley and Dr. Maureen Marzano, for their feedback and support. I am grateful for the support I received from the nursing research and nursing leadership departments where this study was conducted. I would also like to thank the charge nurses who participated in this study. Sharing your insights about the important work CNs do to keep patients safe and allowing me to observe you in action helps advance the knowledge of this vitally important role. Finally, I would like to acknowledge the support provided to me by my family and friends during my doctoral journey. I appreciate your understanding when I had to devote so much of my time to completing this degree.