Award Date
12-1-2024
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
First Committee Member
Jennifer Vanderlaan
Second Committee Member
Kathryn Woeber
Third Committee Member
Nirmala Lekhak
Fourth Committee Member
Ian McDonough
Number of Pages
107
Abstract
Purpose: This three-manuscript approach provided a progressively built overview of Assignment Despite Objection as a construct used by nurses to document their perceptions of unsafe staffing events and as an unstudied concept in the staffing outcomes literature.
Background: All nurses have an ethical, legal, and professional responsibility to refuse or object to assignments they believe are unsafe for their well-being or their patient’s safety. Assignment Despite Objection being the only widely used construct nurses use to document these perceptual details. No studies have focused on Assignment Despite Objection as a construct or concept, leaving a complete gap in understanding its efficacy, practical utility, and accuracy as a measure of unsafe staffing events.
Methods: Each study’s results helped to elucidate a foundational view of Assignment Despite Objection. Study one, a qualitative descriptive study, identified content patterns associated with various nurse, patient, and work environment characteristics found on Assignment Despite Objection forms. Studies two and three used a quantitative descriptive design and secondary data. The unit of observation and analysis was the unit level. Statistical analyses included repeat linear regression, Poisson regression, and descriptive tests.
The study setting was the University Medical Center of Southern Nevada, a 541-bed integrated academic health system in Las Vegas, Nevada. The sample comprised 864 patient encounters over 17 medical-surgical and critical care nursing units and 511 Assignment Despite Objection submissions that met inclusion criteria between the second quarter of the calendar year 2017 and the third quarter of 2023.
Results: Content patterns involving nurse, patient, and work environment characteristics were identified, including narrative information, resourcing, and workload details. There is a positive association between Assignment Despite Objection and adverse patient safety events. The severity and reasons for Assignment Despite Objection, strongly predicted the overall incidence of medical emergency response team requests, patient transfer needs, and patient mortality.
Implications: Assignment Despite Objection offers a reasonable and accurate mechanism for nurses to identify and document unsafe staffing events. These findings guide pragmatic interventions and reinforce the need for granular research at the unit and shift levels using the voice of clinical nurses as expert stakeholders.
Keywords
failure to rescue; labor unions; nurse staffing; nurse-patient assignment; patient safety; unsafe staffing events
Disciplines
Health and Medical Administration | Medicine and Health Sciences | Nursing
File Format
File Size
1657 KB
Degree Grantor
University of Nevada, Las Vegas
Language
English
Repository Citation
Fox, Debra F., "The Assignment Despite Objection Construct: Its Efficacy and Utility in Measuring Nurse-Perceived Unsafe Staffing Events and Associated Outcomes" (2024). UNLV Theses, Dissertations, Professional Papers, and Capstones. 5173.
http://dx.doi.org/10.34917/38330385
Rights
IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/
