Journal of Public Health

, Volume 21, Issue 2, pp 145–153 | Cite as

Factors causing or influencing nursing errors as perceived by nurses: findings of a cross-sectional study in German nursing homes and hospitals

  • Henning Cramer
  • Hermann Pohlabeln
  • Monika Habermann
Original Article



Nurses constitute an important group in identifying and preventing errors and risks in health care, but research on their perception of errors is scarce. This paper presents results of a representative study on health care errors, focusing on factors causing and influencing the occurrence of errors as perceived by nurses.

Subject and methods

The cross-sectional research design comprised descriptive and correlational parts. The sample consisted of 1,100 nurses employed at 30 hospitals and 46 nursing homes in Germany. Data were collected in 2008/2009 using a questionnaire listing 21 factors that can potentially cause or influence errors. Participants could choose up to three factors they deem the most important. Differences between the two settings and variables which might have an influence on the perception of error-causing factors were analyzed using cluster-adjusted methods.


High workload, staff shortage and excessive labour topped the list. Hospital nurses more often chose “workload” and “interruptions” while nursing home nurses more often ranked “lack of knowledge” and “lack of motivation” as the most important. There are some significant variables such as years of professional experience and migration background that could affect nurses’ perception.


The findings support other studies, pointing to workload issues and below-optimum work processes producing errors. Inter-sectoral differences suggest the necessity of sector-specific support in education and on-going training as well as risk and quality management.


Hospital Nursing Nursing error Nursing home Patient safety Resident safety 


Conflict of interest

The authors declare that they have no conflict of interest.


This research was funded by the German Federal Ministry of Education and Research, Grant Number 01GT0607.


  1. Advisory Council for the Concerted Action in Health Care (2003) Report 2003: health care finance. User Orientation and Quality, Bonn, GermanyGoogle Scholar
  2. Armitage G, Knapman H (2003) Adverse events in drug administration: a literature review. J Nurs Manag 11:130–140PubMedCrossRefGoogle Scholar
  3. Arndt M (1994) Nurses' medication errors. J Adv Nurs 19:519–526PubMedCrossRefGoogle Scholar
  4. Balas MC, Scott LD, Rogers AE (2004) The prevalence and nature of errors and near errors reported by hospital staff nurses. Appl Nurs Res 17:224–230PubMedCrossRefGoogle Scholar
  5. Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL (2002) Medication errors observed in 36 health care facilities. Arch Intern Med 162:1897–1903PubMedCrossRefGoogle Scholar
  6. Becker A, Beck U (2010) Personalausstattung und Ergebnisqualität. Schwest Pfleg 49:74–79Google Scholar
  7. Benner P, Malloch K, Sheets V, Bitz K, Emrich L, Thomas MB, Bowen K, Scott K, Patterson L, Schwed K, Farrell M (2006) TERCAP: creating a national database on nursing errors. Harv Health Policy Rev 7:48–63Google Scholar
  8. Blegen MA (2006) Patient safety in hospital acute care units. Annu Rev Nurs Res 24:103–125PubMedGoogle Scholar
  9. Carlton G, Blegen MA (2006) Medication-related errors: a literature review of incidence and antecedents. Annu Rev Nurs Res 24:19–38PubMedGoogle Scholar
  10. Department of Health (2005) A safer place for patients: learning to improve patient safety. Department of Health, LondonGoogle Scholar
  11. Federal Statistical Office (2005) Pflegestatistik 2003: Pflege im Rahmen der Pflegeversicherung—Deutschlandergebnisse. Federal Statistical Office, Wiesbaden, GermanyGoogle Scholar
  12. Federal Statistical Office (2010) Demografischer Wandel in Deutschland, Heft 2: Auswirkungen auf Krankenhausbehandlungen und Pflegebedürftige. Federal Statistical Office, Wiesbaden, GermanyGoogle Scholar
  13. Federal Statistical Office (2011a) Hospital statistics: basic data. Federal Statistical Office, Wiesbaden, GermanyGoogle Scholar
  14. Federal Statistical Office (2011b) Pflegestatistik 2009: Pflege im Rahmen der Pflegeversicherung—Deutschlandergebnisse. Federal Statistical Office, Wiesbaden, GermanyGoogle Scholar
  15. German Coalition for Patient Safety (2008) Patient safety agenda 2008. German Coalition for Patient Safety, Witten, GermanyGoogle Scholar
  16. Gladstone J (1995) Drug administration errors: a study into the factors underlying the occurrence and reporting of drug errors in a district general hospital. J Adv Nurs 22:628–637PubMedCrossRefGoogle Scholar
  17. Görres S, Bomball J, Schwanke A, Stöver M, Schmitt S (2010) “Imagekampagne für Pflegeberufe auf der Grundlage empirisch gesicherter Daten”: Einstellungen von Schüler/innen zur möglichen Ergreifung eines Pflegeberufes—Ergebnisbericht. University of Bremen, BremenGoogle Scholar
  18. Habermann M, Foraita R, Cramer H (2012) Categories of errors and error frequencies as identified by nurses: results of a cross-sectional study in German nursing homes and hospitals. J Public Health. doi: 10.1007/s10389-012-0531-x
  19. Handler SM, Perera S, Olshansky EF, Studenski SA, Nace DA, Fridsma DB, Hanlon JT (2007) Identifying modifiable barriers to medication error reporting in the nursing home setting. J Am Med Dir Assoc 8:568–574PubMedCrossRefGoogle Scholar
  20. Henneman EA, Blank FSJ, Gawlinski A, Henneman PL (2006) Strategies used by nurses to recover medical errors in an academic emergency department setting. Appl Nurs Res 19:70–77PubMedCrossRefGoogle Scholar
  21. Hoff T, Jameson L, Hannan E, Flink E (2004) A review of the literature examining linkages between organizational factors, medical errors, and patient safety. Med Care Res Rev 61:3–37PubMedCrossRefGoogle Scholar
  22. Hyrkas K, Parker S (2006) Safety in health care today: more than just freedom from errors and accidents? J Adv Nurs 56:220–222PubMedCrossRefGoogle Scholar
  23. Inoue K, Koizumi A (2004) Application of human reliability analysis to nursing errors in hospitals. Risk Anal 24:1459–1473PubMedCrossRefGoogle Scholar
  24. Institute of Medicine (2000) To err is human: building a safer health system. National Academy Press, Washington, DCGoogle Scholar
  25. Isfort M, Weidner F, Neuhaus A, Kraus S, Köster VH, Gehlen D (2010) Pflegethermometer 2009. Eine bundesweite Befragung von Pflegekräften zur Situation der Pflege und Patientenversorgung im Krankenhaus. Deutsches Institut für angewandte Pflegeforschung, Köln, GermanyGoogle Scholar
  26. Ito H, Yamazumi S (2003) Common types of medication errors on long-term psychiatric care units. Int J Qual Health Care 1:207–212CrossRefGoogle Scholar
  27. Jeffe DB, Dunagan WC, Garbutt J, Burroughs TE, Gallagher TH, Hill PR, Harris CB, Bommarito K, Fraser VJ (2004) Using focus groups to understand physicians' and nurses' perspectives on error reporting in hospitals. Jt Comm J Qual Saf 30:471–479PubMedGoogle Scholar
  28. Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S (2007) Drug-related problems in hospitals: a review of the recent literature. Drug Saf 30:379–407PubMedCrossRefGoogle Scholar
  29. Lang TA, Hodge M, Olson V, Romano PS, Kravitz RL (2004) Nurse-patient ratios: a systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. J Nurs Adm 34:326–337PubMedCrossRefGoogle Scholar
  30. Meurier CE, Vincent CA, Parmar DG (1997) Learning from errors in nursing practice. J Adv Nurs 26:111–119PubMedCrossRefGoogle Scholar
  31. Mitchell P (2002) Nursing is essential to improving patient safety. J Adv Nurs 38:109–110PubMedCrossRefGoogle Scholar
  32. Montgomery VL (2007) Effect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit. Pediatr Crit Care Med 2(Suppl):S11–S16CrossRefGoogle Scholar
  33. Reason J (1995) Understanding adverse events: human factors. Qual Health Care 4:80–89PubMedCrossRefGoogle Scholar
  34. Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF (2004) The working hours of hospital staff nurses and patient safety. Health Aff 23:202–212CrossRefGoogle Scholar
  35. Sanghera IS, Franklin BD, Dhillon S (2007) The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK Intensive care unit. Anaesthia 62:53–61CrossRefGoogle Scholar
  36. SAS Institute Inc. (2008) SAS (Version 9.2). SAS, Cary, NCGoogle Scholar
  37. Scott-Cawiezell J, Vogelsmeier A (2006) Nursing home safety: a review of the literature. Annu Rev Nurs Res 24:179–215PubMedGoogle Scholar
  38. Wakefield DS, Wakefield BJ, Uden-Holman T, Borders T, Blegen M, Vaughn T (1999) Understanding why medication administration errors may not be reported. Am J Med Qual 14:81–88PubMedCrossRefGoogle Scholar
  39. Weir C, Hoffman J, Nebeker JR, Hurdle JF (2005) Nurse's role in tracking adverse drug events: the impact of provider order entry. Nurs Adm Q 29:39–44PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Henning Cramer
    • 1
  • Hermann Pohlabeln
    • 2
  • Monika Habermann
    • 3
  1. 1.SelmGermany
  2. 2.BIPS - Institute for Epidemiology and Prevention ResearchUniversity of BremenBremenGermany
  3. 3.Centre for Nursing Research and CounsellingHochschule Bremen, University of Applied SciencesBremenGermany

Personalised recommendations