Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Jane M. Georges, PhD, RN, Chairperson; Joseph F. Burkard, DNSc, CRNA, Member; Kathleen M. Stacy, PhD, APRN, Member


Bullying, Healthy Environment, Leadership, Patient Safety, Staff satisfaction, Staff Turnover


A healthy working environment has been an area of interest for occupation health providers. There is anticipation that a safe working environment improves patient safety, which is associated with reduction in clinical nurse errors. Issues with medication errors and poor working environment pose a greater risk to patient safety. The aim of this qualitative study was to provide a broad understanding on nurses’ perceptions on the processes that influence a healthy working environment and the impacts of a healthy working environment on patient safety. An interpretive grounded theory methodology was used in this study to evaluate nurses’ perceptions in acute care settings. The study was carried out in a large city of Southern California and the participants consisted of a community-based purposive population of registered nurses (RNs) in a telemetry. A total of 10 participants with three years working experience in surgical units were recruited and tiered scheduled approach was used for the analysis and refinement of interview questions. The participants were all female registered nurses with three years working experience in acute care settings. The majority of the nurses had a bachelor’s degree (44%), masters degree (22%) and 11 % had associate degree. Grounded theory method was used to identify the relevant themes from the interview responses. The transcripts revealed nurses’ perceptions on the process that facilitate a healthy working environment and HWE impacts on patient safety. The findings of the study showed that communication, teamwork and collaboration within healthcare environment are the most important factors for the development of a healthy working environment. The findings also showed the influence of a health care working environment on medication errors. Nurses reported that lack of communication, nurse shortages and micromanagement increases the chances of medical errors. Nurses reported that effective communication with the nurse leaders, managers and patients provide a stress-free working environment that result in a better care for patients. Enough nursing staff as well as teamwork and collaboration also influences patient safety.

Document Type

Dissertation: Open Access