In a 6-month retrospective study of nurse performance behaviors, safety culture, productivity, and error reporting of medical-surgical nurses in 6 medical-surgical units across 2 hospitals in a regional health system, researchers at Indiana University School of Nursing report that a significant number of the nurses indicated high levels of motivational inhibition and are significantly less likely to be willing to report errors on nursing units. In the months where units reported significantly fewer nurses' direct care hours worked (decreased staffing), there was a greater number of reported medication errors among nurses. In addition, the more direct care hours that nurses worked on the units, the lower their motivational drive and the approach behaviors used toward patients on the units and the lower their perceptions of safety culture on the nursing units.

Most nurses were "adaptive" in cognitive decision making and preferred single tasking rather than multitasking, as well as lower levels of complexity. Nursing unit managers who were perceived to consistently engage in actions and behaviors promoting safety on the units supported significantly higher levels of nurses' error reporting. Findings validated the influential effect of nursing unit work environment and leadership upon nurses, safety culture, productivity, and frequency of reporting on nursing units.