The Role of Surveillance in the Association Between the Nurse Work Environment and Patient Safety Culture

Nursing surveillance has been identified as a core clinical process through which organizational conditions may influence patient safety; however, its explanatory role in the relationship between the nurse work environment and patient safety culture is not well established. This study examined whether nursing surveillance practices account for part of the association between the nurse work environment and patient safety culture in medical-surgical units. Cross-sectional data were drawn from 1,597 medical-surgical nurses who participated in the RN4CAST-Australia 2018 survey. The nurse work environment was measured using the Practice Environment Scale-5, nursing surveillance using a validated 16-item scale assessing the frequency of patient assessment practices for early detection of deterioration, and patient safety culture using a validated short form of the Hospital Survey on Patient Safety Culture. Structural equation modeling was used to estimate direct associations between the nurse work environment and patient safety culture and indirect associations via nursing surveillance. A more favorable work environment was directly associated with a more positive patient safety culture and more frequent surveillance practices. More frequent surveillance was also directly associated with a more favorable patient safety culture. In addition, the nurse work environment was indirectly associated with patient safety culture through increased surveillance. These findings suggest that nursing surveillance represents a specific, actionable mechanism linking work environment conditions to patient safety culture. Efforts to improve patient safety may therefore require both structural enhancements to the work environment and targeted strategies to strengthen proactive nursing surveillance.