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Journal of Nursing Care Quality

March 2011, Volume 26 Number 1 , p 69 - 77


  • Diane Randall Andrews PhD, RN
  • Joyce Burr MSN, RN
  • Angeline Bushy PhD, RN, FAAN


The perceptions of staff nurses on factors affecting patient care quality and safety have received little attention in the literature. Narrative analysis of comments provided by 106 staff nurses working in a medical-surgical setting revealed that nurses experienced contradictions and unmet expectations related to their professional role. The consequence was feelings of powerlessness, isolation, and low self-esteem, which affected nursesʼ perceived ability to provide quality patient care and ensure patient safety. This perceived inability to act in a professionally autonomous manner on behalf of patients, in turn, influenced nursesʼ professional self-concept. Recommendations are offered to enhance nursesʼ professional self-concept through staff development and policy changes.

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