Hospitals that Care Use Nurse Preceptors and a "Culture of Fairness" to Improve Nursing Care

Studying error management and organizational learning to improve nursing care

Investigators at the Kenan-Flagler Business School at the University of North Carolina at Chapel Hill surveyed nurses to find out which co-workers they consulted when confronted with complex treatment situations, including those involving error. The research aimed to shed light on the role of personal characteristics, leadership and organizational culture in encouraging organizational learning and error management.

Key Findings:

  • Nurses were more likely to seek informal consults from co-workers whom they believed had relevant experience, whose knowledge they viewed as accessible, and with whom they had a trusting relationship.
  • Nurses perceived co-workers who served as nurse preceptors as both having greater expertise and being more accessible, and thus were more likely to consult those co-workers for help.
  • Nurses were more likely to consult with others if their units had a positive "procedural justice climate": that is, nurses felt they were treated fairly, and that decisions were made in a consistent, transparent and ethical manner.

Key Conclusions:

  • Hospitals can use nurse preceptors to "signal" to part-time nurses, floaters, contract and new employees—who tend to have fewer trusting relationships with co-workers—that someone is available to consult with them on complex situations, including errors.
  • Hospitals can encourage organizational learning and error management by creating a culture of fairness—one that encourages free exchange of information—and a positive procedural justice climate.