“It isn’t an adverse event”: junior nurses’ perceptions of adverse events and attribution of causes

Adverse events during hospitalization remain a widespread global issue, with studies consistently highlighting significant variation in incidence and severity across countries and healthcare settings, particularly among frontline nursing staff. The purpose of this study is to examine junior nurses’ perceptions of adverse events and how they attribute their causes. The findings emphasize the importance of understanding how junior nurses differentiate reportable incidents from acceptable deviations in clinical practice. A qualitative narrative inquiry was conducted with nine junior registered nurses from various regions in China who had experienced adverse events, recruited through purposive sampling. In-depth, semi-structured online interviews were conducted, focusing on participants’ personal experiences with adverse events, their interpretations of adverse event definitions, and perceived causes. Additionally, four nurse managers were interviewed to provide supplementary perspectives. All interviews were transcribed and analyzed using thematic analysis. Two main themes emerged —“It is not an adverse event” and “It is bound to happen,” each encompassing several sub-themes. Junior nurses did not strictly adhere to the formal hospital definitions of adverse events. Their personal classification of an incident as an adverse event depended mainly on the actual harm caused to the patient and the perceived preventability of the incident. Many minor errors or near misses were not considered adverse events if no harm occurred. The second theme reflected a sense of inevitability: participants attributed adverse events largely to system-level factors such as workload, staffing shortages, faulty equipment, or management deficiencies. In contrast, nurse managers fully endorsed official definitions and primarily attributed adverse events to individual nurses’ mistakes, viewing most incidents as preventable with appropriate care. These findings highlight the need for open dialogue between junior nurses and managers to bridge differing perspectives, enhanced education on adverse event definitions, and a supportive patient safety culture that addresses systemic issues while fostering transparent reporting. Policies should recognize their frontline insights as valuable complements to managerial perspectives, ensuring a shared understanding that strengthens reporting practices and improves patient safety.