Work

The mediating role of the work environment between error culture management and clinical errors: A cross-sectional multicentre study

Year: 2026

Type: article

Abstract: BACKGROUND: Clinical errors stemmed from intricate relationships between organizational, environmental, and individual factors. Although it was widely acknowledged that safety culture and error culture management improved patient safety, little is known about how these elements affected nurses' working environments and error occurrence. OBJECTIVES: To investigate the relationship between the safety attitude, error culture management, errors and work environment variables, including stress, workload, and interpersonal conflicts. METHODS: A cross-sectional multicenter study was conducted on 636 nurses dedicated to direct patient care in Italian healthcare organizations. Safety attitude, work-related stress, interpersonal conflicts, error culture management and clinical errors were collected through a survey composed of validated scales. To verify the hypotheses under study, descriptive analysis and structural equation modeling were performed. RESULTS: Error culture management significantly influenced error occurrence. Interpersonal conflicts and workload increased clinical errors. The work environment mediated the relationship between error culture management and errors. Stress had a non-significant mediator role. An unexpected positive correlation was found between safety attitude and errors, without any mediation. CONCLUSION: Strong error culture management, a positive nursing environment, and team collaboration prevented clinical errors. Enhancing the work environment and fostering positive interpersonal relationships contributed to patient safety. Further longitudinal studies could assess specific interventions to enhance safety and the quality of nursing care. REPORTING METHOD: We adhered to STROBE guidelines for cross-sectional research. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.

Source: Applied Nursing Research

DOI: 10.1016/j.apnr.2026.152063