A cross exploratory analysis between nursing working conditions and the occurrence of errors in the northeast region of Brazil

In healthcare settings, the occurrence of errors significantly impacts the reputation and reliability of healthcare organizations, leading to economic and social consequences. These errors result in increased healthcare service costs and pose risks to the physical and emotional well-being of patients, potentially causing temporary, permanent, and in severe cases, fatal harm. (Gama et al., 2022). The Theory of Human Error defines error as an unintentional act, typical of human nature, which results from a planned action in which the result does not achieve what was expected. In systems with greater complexity and little control, such as the world's health systems, error is considered a phenomenon that has a higher risk associated with the performance of work (Reason, 2009). The incidence of human errors in the nursing profession is highly dependent on the working conditions experienced by healthcare professionals and the environment to which patients are exposed (Forte et al., 2017). The proposed study is focused on exploring the relationships of these environments has on the occurrence of error in the Brazilian Nursing field.

In the area of nursing, work takes on different meanings and values for each professional category, increasing the precariousness of work, which can contribute to errors in the delivery of care (Araújo-dos-Santos et al., 2018). Working conditions are directly related to factors that interfere with the performance of a task (prescribed/planned work) or activity (executed action) (Silva-Santos et al., 2018). Dysfunctional working conditions can be caused by management disorganization, lack of resources, and excessive work without mental or physical care for workers. It is necessary to explore whether the association between errors and working conditions is aggravated by the external responsibilities of different nursing professions (Silva-Santos et al., 2018).

Nursing professionals worldwide total 27.9 million, with over 80 % situated in countries comprising half of the global population. In the Americas, there are 8.4 million professionals, constituting approximately 30 % of the global total, with 87 % concentrated in Brazil, Canada, and the United States, representing about 57 % of the region's population (Oliveira et al., 2020). Studies have shown that errors made by healthcare teams are the third leading cause of death among North Americans, leading this to be recognized as a global challenge for public health (Valle et al., 2017; WHO, 2017). In low- and middle-income countries, available evidence suggests that 134 million errors occur in hospitals annually, contributing to the occurrence of 2.6 million deaths (OPAS, 2019). In Brazil, around 148 people die every day due to errors in public and private hospitals, according to the 2nd Yearbook of Hospital Care Safety in Brazil (Couto et al., 2018).

In Brazil specifically, nursing, encompassing nurses and nursing technicians and assistants, comprises nearly 70 % of the total workforce, divided as 17 % nurses and 53 % nursing assistants and technicians. The categories and respective duties of nursing professionals are regulated by Law 7498/86. This division is marked by a hierarchy of power relations, which can be perceived by the organization of the work process, the different economic importance of each function and the unique number of responsibilities carried out by each professional (Melo et al., 2015). The nurse is responsible for managing the work of other team members; provide special care, defined by legislation as their exclusive competence; in addition to mastering knowledge related to the exercise of nursing care work, evaluating the needs of each patient; the nurse technician is responsible for assisting the nurse in planning assistance activities, caring for patients in serious condition, preventing and implementing comprehensive assistance programs; The nurse assistant is responsible for assisting in preparing the patient for consultations, exams and treatments, in addition to carrying out prescribed treatments, providing hygiene, food, comfort and safety care (Brazil, 1987).

Many of the known errors in the nursing field are based on the structural failure of the complex health service system. Structural gaps allow for many types of errors, from individualized actions to basic organization (Giddens, 2009). However, even in the face of better working conditions, nursing workers will be constantly exposed to error, as this is inherent to human nature. The occurrence of errors in healthcare work is a challenge that needs to be faced. The fragmented work process causes disorganized management, unequal division of work and increases error rates in the nursing work process, in addition to the high rate of errors on the individual level. This structural error-producing condition will continue to occur until the organization's employers view error as a moral phenomenon that has contributing factors other than the employee (Damascena et al., 2022). From these initial considerations the following question arises: “Is there an association between errors made by nursing workers and working conditions?” Answering this question can produce relevant information for managers and leaders of health systems to understand which working conditions contribute to increasing or reducing errors in health services and supporting discussions about the regulation of nursing work where interventions can be proposed.

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