Medical errors are a continuing issue for healthcare organizations and can lead to patient harm or death. To bring about organizational learning and therefore reduce medical errors, information must successfully flow through an organization. Nurse managers play an essential role as the conduit of information between frontline staff and the organization. The primary purpose of this study is to describe the decision-making process of how nurse managers actively select and transmit information on patient safety concerns. A qualitative constructivist grounded theory approach was used. Nineteen unit-level nurse managers, working full-time in an acute care hospital with a minimum of one-year experience were recruited through professional nursing organizations and snowball recruitment. Semi-structured, conversational, one-on-one interviews were conducted via Zoom or phone call, per the participant's preference. An initial interview guide based on the STOPS framework was used. Participants reported that after they acquired patient safety information, they quickly assessed whether or not the issue was severe and relevant. Then they prioritized the information based on the degree of the severity and relevance, the information source and type, and whether they needed feedback, guidance, or support. The prioritization step determined what mode and how frequently the message was forwarded. Although severity was a consistent consideration on whether to forward information, nurse managers struggled to define the concept. This study suggests that when a patient safety issue is on the extremes of the severity and relevance spectrum the decision-making process is clear. Whether to forward the information that was not on the extremes is less clear and more varied among nurse managers. This part of the decision-making process was inconsistent among nurse managers and has the potential for information to get lost. At the time of the interviews, COVID-19 had created an influx of patients into hospitals, which strained healthcare systems and providers. Nurse managers are in a position where they have insight on how COVID-19 has affected patient safety and can communicate that to their staff and into the organization. Therefore, a secondary thematic analysis of the data was conducted concerning the effects of COVID-19 on patient safety. Nurse managers identified several risks to patient safety that were exacerbated and created by COVID-19. Worsening staffing shortages have negatively affected staff psychological well-being, compelled nurses to work beyond their skill set, and necessitated providing only the mere essentials of nursing care. Burnout and patient isolation have also compounded patient safety concerns. But in the chaos and confusion, nurse managers were able to see some positives that resulted from the pandemic, such as improved teamwork, vigilance, and learning new skills, which can be used to better weather the next pandemic.


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Graduation Date





Cook, Christa


Doctor of Philosophy (Ph.D.)


College of Nursing



Degree Program





CFE0008966; DP0026299





Release Date

May 2022

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)