| Description |
The cost of medication errors is burdensome to patients, institutions, and frontline providers. Nurses are accountable for and vulnerable to institutional safe medication practices and make this responsibility their highest priority; yet, contextual factors relevant to nurses' work encompassing medication administration are not well understood. The aim of this ethnographic study was to identify and describe nurses' work in the context of medication administration, errors, and organizational safety. Using nonparticipant observation (92 hours) and 37 unstructured interviews with nurses, administrators, and pharmacist in a mid-sized hospital in the United States, I found the nature of nurses' work characterized by: 1) chasing a standard of care, 2) prioritizing practice , and 3) renegotiating routines. These characteristics were inextricably linked to organizational structures, the medication management system, competing obligations, and shifting of priorities. Data were divided into two articles: 1) Nurses' Work in the Context of Medication Administration: Untenable Expectations provides a thick description of everyday experiences on the unit, medication administration, and the potential for errors. From these data, I present an emerging theoretical model. 2) The Paradox of Safety in Medication Management is a microanalysis of the medication use process with a specific focus on patterns of medication errors in the hospital, and the role of the pharmacists as a "stop-gap" between the physicians and patients in the recognition and interception of medication errors. These results enhance our understanding of why present efforts targeting the reduction of medication errors may be ineffective. |
