INTRODUCTION
Reporting adverse events and critical incidents within the scope of nursing care represents a key determinant of the quality and safety of provided care. There is no healthcare facility where an error, risky situation, or adverse event has never occurred. In healthcare, mistakes can happen even to the most experienced professionals because working with people is full of unpredictable situations. The nursing profession is characterized by work associated with stress, time pressure, high psychological and physical burden, which naturally increases the risk of adverse events occurring.
The greatest barrier in clinical risk management is not the occurrence of the error itself, but the rigid response mechanisms to it. In practice, we still encounter the fact that reporting adverse events evokes fear in healthcare workers – fear of blame, stigmatization within the team, and potential labor law consequences. This defensive strategy of the staff prevents the recording and analysis of adverse events and critical situations, thereby blocking the process of learning from mistakes and stagnating the level of care quality.
Nurses should perceive the reporting of critical situations primarily as patient protection. The nurse is in the closest contact with the patient, continuously monitors their condition, and is often the first to detect a complication, error, or potential risk. Reporting such an event should not be perceived as an admission of one’s own incompetence, but as a professional and responsible step.
However, it is necessary to emphasize that despite human error, many adverse events arise as a result of systemic problems – staff overload, insufficient communication within the team, lack of material and technical equipment, or unclearly set work procedures. Recording and analyzing these situations allows for the identification of weak points in the work environment and subsequently the adoption of preventive measures.
The basic prerequisite for optimizing this state is building a safety culture, where nurses do not have to fear speaking openly about situations that have occurred. An environment based on trust, psychological safety, support, and mutual respect leads to a greater willingness to report events and at the same time supports team cooperation. In this process, the nursing manager plays a strategic role, who should emphasize that the goal of reporting is not to find a culprit, but to improve the quality of provided care.
The effectiveness of the adverse event reporting system is directly proportional to the quality of the feedback provided. Healthcare workers should see that reported events lead to real changes, for example, adjusting procedures or increasing safety measures.
Reporting adverse events and critical situations in nursing represents one of the fundamental pillars of patient safety and the quality of provided care. In contemporary healthcare, emphasis is placed on error prevention, systematic risk assessment, and creating a safe work environment (Hulková, Kilíková, 2025; Kilíková, Katriňáková, Štefanová, 2025).
OBJECTIVE
To determine the attitude of nurses from the generational cohort “Z” toward reporting adverse events and critical situations in nursing.
SAMPLE AND METHODS
The study, conducted from January to March 2026, used a mixed-methods research approach with a convergent parallel design (Grešš Halász et al., 2025), where quantitative and qualitative data are collected simultaneously, analyzed separately, and integrated at the end. The research sample consisted of 43 Generation “Z” nurses. Within the qualitative line, the method of semi-structured interviews and focus groups was used. Quantitative data were obtained through a non-standardized checklist with items evaluated on a 7-point Likert scale. In the checklist, nurses marked the rating of criteria: 1-insufficient; 2-below average; 3-average/satisfactory; 4-good; 5-very good; 6-excellent/outstanding; 7-expert/excellent. Schifferdecker, Reed (2009) and Rao, Shiyanbola (2022) also recommend the use of mixed methods in healthcare research, where data obtained from semi-structured interviews or focus groups can be combined with quantitative data. Descriptive statistics (mean, standard deviation, median, mode, minimum, maximum values) and frequency were used to process the quantitative data. Data from interviews from eight focus groups were processed using content analysis (Renfro, Hohmeier, 2022). An inventory of data content was created from the responses – the collected data were summarized in a template summary. After reading the responses and color-coding recurring expressions, domains/categories were established: 1. attitude toward reporting adverse events and critical situations; 2. attitude toward identifying risks and errors; 3. attitude toward assuming responsibility. The obtained data are presented in overview tables and a summary of findings in the integration of quantitative and qualitative data according to the established categories in the results section.
RESULTS
The results indicate that monitoring adverse events is an integral part of improving quality in nursing. Reporting adverse events and critical situations in nursing reveals weak points in the team’s operational and communication processes. Constructive analysis of reported events is a prerequisite for implementing systemic changes that prevent their recurrence, increase patient safety, and transform the organizational culture towards justice and openness.
Quantitative analysis of the obtained data (Table 1) demonstrated specific tendencies in the attitudes of Generation “Z” nurses toward reporting adverse events and critical situations in nursing practice. Respondents considered taking personal responsibility for their own actions (x̄ = 5.53 out of max. 7; sd = 1.08) to be the most significant aspect of this attitude, followed by reporting errors caused by one’s own fault (x̄ = 5.25 out of max. 7; sd = 0.96) and the ability to identify risks and errors (x̄ = 4.95 out of max. 7; sd = 1.11). Conversely, the lowest level (median = 4) was recorded for the item focused on reporting adverse events caused by colleagues. The found low level of willingness to apply a critical attitude toward colleagues’ errors raises the question of professional conformity of the youngest cohort of nurses. This phenomenon can be interpreted as a manifestation of fear of interpersonal conflicts in the workplace, or as respect for the established culture of silence and potential professional deformation among older nurses.
Table 1 Attitude of Generation “Z” nurses toward reporting adverse events and critical situations in nursing
| Criteria | x̄ | sd | xm | s2 | min. | max. | Q1 | Q2 | Q3 | mod(x) |
|---|---|---|---|---|---|---|---|---|---|---|
| Reporting of adverse events and critical situations (general attitude) | 4.81 | 1.52 | 5 | 2.33 | 1 | 7 | 4 | 5 | 6 | 5 | | Reporting of adverse events and critical situations that you caused | 5.25 | 0.96 | 5 | 0.93 | 4 | 7 | 4 | 5 | 6 | 5 | | Reporting of adverse events and critical situations of your colleagues | 4.07 | 1.16 | 4 | 1.36 | 1 | 7 | 3 | 4 | 5 | 5 | | Identification of risks and errors | 4.95 | 1.11 | 5 | 1.25 | 2 | 7 | 4 | 5 | 6 | 6 | | Taking responsibility for one's own actions | 5.53 | 1.08 | 6 | 1.17 | 2 | 7 | 5 | 6 | 6 | 6 |
Legend: n – number of respondents, x̄ – arithmetic mean, sd – standard deviation, x__m – median, min. – minimum value, max. – maximum value, mod__(x) – mode, Q1–Q3 quartiles; s² – variance
Table No. 2 presents the data in an organized manner and shows the frequency distribution of individual values, thus confirming the above results. 27 nurses (n=43) stated that they report adverse events and critical situations in nursing without fear. 25 nurses reported an error they had caused during their practice. The table also shows that nurses gave the highest ratings in the criteria "Taking responsibility for one's own actions" and "Identification of risks and errors".
Table 2 Frequency Table
| element | frequency | cumulative frequency | relative frequency | cumulative relative frequency | |||||
|---|---|---|---|---|---|---|---|---|---|
| Reporting of adverse events and critical situations (general attitude) | |||||||||
| 4 | 17 | 17 | 0.386 | 0.386 | |||||
| 5 | 27 | 44 | 0.613 | 1 | |||||
| Reporting of adverse events and critical situations that you caused | |||||||||
| 3 | 2 | 2 | 0.045 | 0.045 | |||||
| 4 | 25 | 27 | 0.568 | 0.613 | |||||
| 5 | 17 | 44 | 0.386 | 1 | |||||
| Reporting of adverse events and critical situations of your colleagues | |||||||||
| 3 | 11 | 14 | 0.255 | 0.325 | |||||
| 4 | 12 | 26 | 0.279 | 0.604 | |||||
| 5 | 14 | 40 | 0.325 | 0.930 | |||||
| Identification of risks and errors | |||||||||
| 4 | 11 | 15 | 0.255 | 0.348 | |||||
| 5 | 12 | 27 | 0.279 | 0.627 | |||||
| 6 | 14 | 41 | 0.325 | 0.953 | |||||
| Taking responsibility for one's own actions | |||||||||
| 5 | 12 | 18 | 0.279 | 0.418 | |||||
| 6 | 18 | 36 | 0.418 | 0.837 | |||||
65% of respondents have a positive attitude towards reporting adverse events and report such situations without fear. In Table No. 3 we present selected responses.
Table 3 Reporting of adverse events and critical situations (general attitude)
| Respondent | Responses |
|---|---|
| R2 | "In the workplace where I work, it is necessary to strengthen the safety culture so that reporting of adverse events and errors is perceived as a tool for improving the quality of care, not as a source of concern or fear. Direct, honest communication about errors can be a significant step towards increasing patient safety and supporting healthcare staff. It is important to work in an environment where an error is not perceived as a personal failure of an individual, but as an opportunity to improve the work system. Even less serious events that are recorded can bring valuable insights for improving the work system in the department. What would particularly help in the departments is more mutual support and understanding among colleagues and from superiors. A nurse should have the option to report an error anonymously, and the situation that occurred should be discussed calmly, without unnecessary emotions and comments. Instead of looking for someone to blame, attention should focus on what can be improved in the future. Admitting an error should not mean a loss of trust, but should be perceived as a sign of responsibility. Reporting an error is often psychologically demanding for a nurse, especially a young or beginning one. However, if she feels support from colleagues and management, even a bad experience can become an opportunity to learn and improve so that the situation does not recur. A healthy work environment can lead to higher quality of care, greater staff satisfaction, and above all, increased patient safety. Reporting an error should not mean that I have failed as a nurse. Rather, it should be understood as a correct and responsible response to a situation that helps protect the patient." |
| R3 | "I consider the reporting of adverse events and critical situations in nursing to be a very important part of safe healthcare. When working with patients, situations can sometimes occur that cannot be completely predicted, or errors arise, for example, from inattention, stress, or heavy workload. That is precisely why, in my opinion, it is important to talk openly about such situations and to record them properly. I think that reporting adverse events should not be perceived as something negative or as a way to punish a healthcare worker. Rather, it should serve as an opportunity to learn from the error and improve the functioning of the healthcare facility. If an error is reported, its cause can be analyzed and measures taken to prevent a similar situation from recurring in the future. Personally, I think admitting one's own error is not always easy. A person may fear the reaction of superiors or colleagues. Nevertheless, I consider it correct for a healthcare worker to be able to take responsibility for their actions. In my opinion, such an approach is a sign of professionalism and also contributes to greater trust among members of the healthcare team. It is similar in the case of a colleague's error. It is important to approach such a situation sensitively and professionally. The goal should not be to find someone to blame, but primarily to protect the patient and strive to prevent similar situations in the future. Communication among healthcare workers and a supportive environment where people are not afraid to point out a problem also play a major role. I also consider the ability to identify potential risks and errors before an adverse event occurs to be very important. This could involve, for example, checking the correct patient identity, correct medication administration, or thorough communication among healthcare professionals. Such preventive steps can significantly contribute to increasing patient safety. Taking responsibility for one's own actions is, in my opinion, one of the basic conditions in nursing. Healthcare workers have a great responsibility because they work with people's health and lives. It is therefore important to follow professional procedures, act responsibly, and in the event of an error, try to resolve the situation in the best possible way." |
| R12 | "As a nurse, I perceive the reporting of adverse events and critical situations as an integral part of my professional responsibility. Patient safety is my priority, and therefore I consider the timely and truthful reporting of errors, extraordinary situations, or risks to be a key tool for improving the quality of provided healthcare. I do not view adverse events as an opportunity to find a culprit, but as a chance to learn, analyze the causes, and prevent their recurrence. I am convinced that an active approach to reporting adverse events contributes not only to patient protection but also to the protection of healthcare workers and to building trust in the healthcare system." |
We also investigated the attitude of nurses from Generation Z towards reporting their own errors and adverse events they had caused (Table No. 4). 74% of nurses in our sample stated that they would report an adverse event they had caused. Through interviews and focus groups, we analyzed the most common reasons that led nurses to admit and report their errors.
Despite their age and short length of practice, nurses are aware that patient safety is paramount, and they perceive error reporting as a fundamental ethical and professional duty of a nurse, which we consider a manifestation of their personal maturity and professional sophistication. And since team cohesion and social bonds are very important for Generation Z, another reason is the culture of open communication in the workplace and maintaining trust within the team.
Table 4 Reporting of adverse events and critical situations you have caused
| Respondent | Answers |
|---|---|
| R16 | "I rate the criterion for reporting adverse events in whose occurrence I would personally be involved as 6. In the case of my own error, I consider it my professional duty to immediately admit the situation and report it to the head nurse and the attending physician. I would apply such a procedure, for example, in the case of incorrect medication administration, an administrative error in documentation, or insufficient implementation of preventive measures, e.g., in the area of pressure ulcer prevention. I am aware that a nurse bears personal professional, moral, and legal responsibility for her actions. Admitting one's own mistake can be associated with psychological discomfort, feelings of failure, or fear of negative evaluation. Despite this, I perceive it as a sign of professional maturity, not as a sign of failure. Concealing an error could lead to a deterioration of the patient's health condition, a loss of trust within the team, and a recurrence of a similar situation in the future. With the chosen rating, I express that I am fully aware of my responsibility, I am capable of reflecting on my own errors, and in the event of their occurrence, I will prioritize patient safety over personal comfort. At the same time, I am aware of the emotional difficulty of such situations and the natural stress associated with them, which I do not, however, consider an obstacle to the professional resolution of the incident." |
| R18 | "I think admitting a mistake is often difficult, especially in a healthcare environment where high professionalism and precision are expected from healthcare workers. Nevertheless, I consider it very important that healthcare workers are able to openly admit a mistake they have made. Reporting such an event can help to react quickly and minimize possible adverse consequences for the patient. It also allows for analyzing and assessing the cause of why the error occurred and learning from it. I think every person can make a mistake, but what is important is to approach it responsibly. A professional approach means taking responsibility for one's actions, trying to rectify the situation, and avoiding similar situations and errors in the future." |
| R20 | "Admitting one's own mistake is not easy – it is often accompanied by feelings of shame or fear of criticism from colleagues or superiors. It is completely natural to fear the reaction of those around you, because no one wants to appear unreliable. However, concealing the problem can have much worse consequences. Conversely, openness shows professionalism and responsibility." |
| R24 | "During my time working in healthcare so far, even though it has been a relatively short period, I have encountered several situations that could be described as adverse events that I caused. These experiences have shown me that errors can occur despite my efforts to work responsibly and precisely. At the same time, I realized how important it is to pay sufficient attention to patient identification, checking medical documentation, and adhering to standard operating procedures. I always reported the incidents that occurred to a senior colleague or the head nurse. I consider it important that every nurse is able to admit their mistake and inform their superior or colleagues about it. Open communication and transparency are, in my opinion, essential for ensuring patient safety. A mistake should not be perceived merely as an individual failure, but also as an opportunity for others to learn and improve the system of nursing care delivery." |
We were also interested in the attitude of Generation Z nurses towards reporting errors and adverse events caused by their colleagues (Table No. 5). Only 39% of nurses would report an error caused by a colleague if the colleague did not admit the mistake themselves. From the identified reasons, we can infer the fears of Generation Z nurses about disrupting interpersonal relationships and the atmosphere within the team. Younger nurses also fear the social stigma of being labeled a "snitch" or "informer"; they want to avoid their actions being interpreted by older or other colleagues as putting themselves above others or lecturing others. Generation Z nurses experience a strong internal conflict between professional duty (to protect the patient) and loyalty to the team and colleagues. Nurses directly state that reporting a colleague's mistake is psychologically and emotionally "even harder" for them than admitting their own error. This represents a very strong internal barrier for Generation Z nurses.
Table 5 Reporting of adverse events and critical situations of your colleagues
| Respondent | Answers |
|---|---|
| R5 | "Reporting adverse events or critical situations of my colleagues I perceive as a sensitive part of working relationships within the team. I think that in such a situation, it is important to maintain a professional yet empathetic approach. Personally, I would try to be a support for my colleague and encourage her to take responsibility for the situation and report it herself. Open communication and mutual support within the team can help manage such a situation without unnecessary blaming, which could disrupt interpersonal relationships in the workplace and negatively affect the working atmosphere and team cooperation." |
| R6 | "Regarding reporting situations involving colleagues, I think it's a bit different and more sensitive. Relationships on the ward are important, we all know and respect each other, and no one wants to come across as someone who snitches on others. I wouldn't want that either. But I gradually realized that there is a difference between snitching and acting responsibly. If I see something that could endanger a patient, I simply point it out to the specific colleague the situation concerns. I noticed that a colleague had mistakenly prepared an infusion for the wrong patient – before it was administered, I tried to handle it sensibly – I spoke with the colleague in question; if it were more serious, I would take it further. I always try to act as a support, not as someone who needs to appear as someone who wants to lecture others." | | R9 | "I assess the reporting of adverse events and critical situations involving my colleagues as insufficient. This attitude reflects my internal conflict between professionalism – reporting adverse events – and loyalty to my colleagues. Such reporting would be viewed negatively by colleagues and would result in significant problems within the team and a disruption of interpersonal relationships. I realize that patient safety should be the priority. In the future, I consider it important to work on changing this attitude. We should mainly focus on shortcomings in practice that we can improve, rather than on finding the person who caused the adverse event." | | R31 | "Reporting events caused by colleagues can be a sensitive and challenging situation because mutual trust and cooperation are important in the work team. On the other hand, patient safety and the quality of provided care are always the top priority. If an error or critical situation occurs that could endanger the patient, it needs to be addressed and, if necessary, reported. At the same time, it is appropriate to maintain a professional approach, communicate openly with the colleague, and try to handle the situation constructively. The goal should not be blame or conflict, but improving work procedures, preventing similar errors, and protecting the patient." | | R33 | "I perceive reporting adverse events and critical situations concerning my colleagues as a very sensitive topic. Honestly, I think it is even harder than admitting one's own mistake. Good relationships, cooperation, and trust are important on the ward, and one does not want to come across as someone who 'tattles' or creates tension in the team. At the same time, however, I realize that the patient is at the center of our work. If it were a situation that could endanger their safety, I should act professionally and not let personal sympathies influence me. I do not think the goal of reporting should be to blame a specific person, but rather to solve the problem and prevent its recurrence. It is important that such situations are handled objectively and not aggressively. That mistakes are seen as an opportunity for learning and not as a reason for punishment or ridicule." | | R41 | "Concealing an error could have serious consequences and could further endanger the patient. Therefore, I think it is better to admit the mistake, try to resolve it, and learn from it for the future. The situation is somewhat more complicated, in my opinion, when it involves a colleague's mistake. Honestly, I think I would not like to report my colleagues' mistakes because good relationships at work are very important. The healthcare team must cooperate, and trust among colleagues is very necessary in this job. Rather, I think everyone should be able to admit their own mistake and take responsibility for it. If it were a less serious situation, I would probably first try to talk to the colleague and point out the mistake so they become aware of it and can address it. On the other hand, I realize that there are also situations that can be serious and can directly endanger the patient. In such a case, I would consider it my duty to report such an event, even if it could disrupt relationships at the workplace. Patient safety should always be the most important thing. Even if it could be unpleasant and could cause tension among colleagues, a healthcare professional should be able to make the decision that is correct from the perspective of patient protection." |
The personal attitude of Generation "Z" nurses towards the identification of risks and errors is related to their experience and courage to express their opinion. 65% of nurses have a positive attitude towards the identification of risks and errors and consider identification a sign of professionalism and responsibility. In Table 6 we present selected responses.
Table 6 Identification of risks and errors
| Respondent | Responses |
|---|---|
| R9 | "I think my ability to identify risks and errors is very good. This is also thanks to the calm, patient approach of my colleagues at work, who don't mind answering all my questions about various procedures and situations. At work, I also encounter that we all consult together and make sure that what we are doing is correct, if it involves a procedure that is not performed very often." |
| R12 | "It is my duty to actively seek out potential risks and prevent them. I do not perceive errors as a personal failure, but as a signal to analyze their causes and improve the work system. I am convinced that systematic identification of risks and errors, preventive measures, and also continuous education are essential for patient protection, the quality of provided care, and the professional growth of a nurse." |
| R15 | "I perceive risk identification as a basic form of prevention. I try to pay attention to details, such as fall risks or ambiguities in documentation. I consider early detection of a risk before an event occurs to be the highest level of safety. My attention is directed towards factors such as overload or communication noise, which could lead to a critical situation." |
| R26 | "I think it is important to be able to recognize possible risks before an error occurs. If we carefully check our work and cooperate with members of the healthcare team, we can prevent many problems." |
| R33 | “I perceive the identification of risks and errors as an important part of a nurse’s work. I do not think it is only about large and serious mistakes, but often also about small details that one must notice in time. In practice, I realized that many situations can be caught before they become a problem – for example, an incorrectly labeled medication, unclearly written documentation, or a change in the patient’s condition. At the same time, I think the ability to identify risks comes mainly with experience. As a student, I was sometimes unsure whether I was overreacting or whether the situation was really risky. Gradually, however, I found that it is better to ask or to point something out than to ignore it. In my opinion, it is important to be attentive, to notice connections, and not to be afraid to express one’s opinion or to ask about the reason why something is the way it is. Identifying risks is not about finding faults in others, but about trying to prevent problems and protect the patient. Overall, I think that reporting adverse events is a sign of professionalism, responsibility, and respect for the patient, even though it is sometimes unpleasant and challenging.” |
The last evaluated criterion was related to taking responsibility for one’s actions (Table No. 7). Up to 86% of Generation “Z” nurses subjectively highly rate the ability to take responsibility in the event of causing an adverse event or critical situation in nursing practice.
Table 7 Taking responsibility for one’s actions
| Respondent | Answers |
|---|---|
| R5 | “I consider taking responsibility for one’s actions to be a very important part of a professional approach. Every nurse should be aware that her decisions and actions can affect the patient’s health and safety. Therefore, it is important to approach one’s work responsibly, conscientiously, and with an emphasis on adhering to professional procedures.” |
| R10 | “I consider taking responsibility for one’s actions to be a very important part of the work. Every person should stand by what they do and try to perform their work as best as possible. I try to work conscientiously, follow the rules, and think about how my decisions and actions can affect others. If I made a mistake, I consider it right to admit it, learn from it, and try to correct it. Such an approach helps build trust among colleagues and contributes to the work team functioning better and more efficiently.” |
| R12 | “I consider taking responsibility for one’s actions to be one of the fundamental pillars of professional nursing practice. As a nurse, I am aware that every decision, intervention, procedure, or possible error I make has a direct impact on the patient’s health and safety. Therefore, I always act in accordance with professional standards, current legislation, and the code of ethics. I do not perceive taking responsibility as a threat, but as a manifestation of professionalism and respect for the patient, colleagues, and the nursing profession itself. For me, responsibility means not only the diligent fulfillment of work duties, but also the ability to admit a mistake, learn from it, and take measures to correct it.” |
| R15 | “I perceive responsibility as the foundation of professional maturity. I try to act in such a way that I can always stand behind my decisions. It is not only about bearing the consequences of an error, but especially about daily conscientious preparation and adherence to professional standards that minimize risks for the patient in advance.” |
| R20 | “I consider responsibility for one’s own actions to be the basis of trust between the healthcare professional and the patient. Patients rely on us to make thoughtful decisions focused on their safety. I realize that patient safety depends not only on technologies or medications, but also on my approach to work – on concentration, communication with the team, and the willingness to learn from past experiences. When we are open and responsible, we build a stronger relationship where patients feel they are in good hands. Ultimately, it is about all of us contributing to a system that protects lives and minimizes unnecessary risks.” |
Integration of quantitative and qualitative data according to defined categories
1. Attitude towards reporting adverse events and critical situations The sample of nurses from the generational cohort “Z” declared a high level of acceptance of reporting adverse events and critical situations in nursing practice (x̄ = 4.81 out of max. 7; sd = 1.52). 65% of nurses in our set have a rational and responsible attitude towards reporting adverse events and report such situations without fear.
2. Attitude towards the identification of risks and errors The sample of nurses from the generational cohort “Z” subjectively believes that they possess the ability to identify risks and errors when providing nursing care (x̄ = 4.95 out of max. 7; sd = 1.11). 65% of nurses in our set consider this a manifestation of professionalism and responsibility.
3. Attitude towards taking responsibility The research sample of Generation Z nurses declared a high level of subjective responsibility for their own actions related to adverse events (x̄ = 5.53 out of max. 7; sd = 1.08). Up to 86% of nurses stated that they would take responsibility in the event of causing an adverse event or critical situation in nursing practice.
DISCUSSION
A transparent and functional reporting system enables the systematic collection of data, its analysis, and the subsequent adoption of corrective and preventive strategies. This minimizes the likelihood of recurrence of similar situations and simultaneously promotes a safety culture based on openness, responsibility, and a non-punitive approach to errors. For these reasons, reporting adverse events can be considered a significant tool for the continuous improvement of the quality of provided nursing care, as well as an essential prerequisite for the professional and ethically responsible performance of the nursing profession.
Several authors have addressed various attributes of health and nursing care safety in the conditions of the Slovak Republic. Kilíková, Karoľová (2026) examined the perception of thirteen attributes of safe healthcare in a sample of 411 nurses. The authors revealed in nurses
reserves in understanding the risks of harm to patient health due to underestimating the importance of safe healthcare policy. Hulková, Kilíková, Tupá (2025), in their study focused on assessing the contribution of peer review evaluation in nursing to key attributes of quality and safety, found that nurses consider patient identification to be the most significant. Kilíková, Katriňáková, Štefanová (2025) analyzed the attitudes of 200 nurses towards risk factors for the occurrence of adverse events. They found that the most significant risk factor for the occurrence of adverse events was nurse fatigue and exhaustion. Kurucová, Kalánková, Žuffová, Žiaková (2022) focused their study on evaluating the safety culture of hospitalized patients by nurses using The Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire in six hospitals in Slovakia. The highest percentage of positive responses was recorded in the dimensions of teamwork within the unit, feedback and communication, education, and continuous improvement. A significant negative predictor of the perception of the degree of patient safety was a higher number of reported adverse events in the last year.
Our study was focused on nurses of the generational cohort "Z" and their attitude towards reporting adverse events and critical situations in nursing. Based on the analysis of quantitative and qualitative data, we can conclude that this generation of nurses takes responsibility for their own errors and reports adverse events and critical situations they cause. Up to 65% of nurses in our sample report such situations without fear. According to Wu et al. (2024), non-reporting of adverse events can lead to a false sense of safety because it creates the impression that there are fewer risks than actually occur. The author team conducted a study with 943 nurses to analyze nurses' attitudes towards reporting adverse events. 56.5% of nurses caused an adverse event and 56.6% of nurses reported adverse events. The authors analyzed factors influencing nurses' attitudes towards reporting adverse events. The results showed that the higher the level of education, the more positive the attitude towards reporting. The second contributing factor was the organizational culture – the introduction of a non-punitive reporting system, or the introduction of a reward system for reporting adverse events.
Zhao et al. (2025) state that in low- and middle-income countries, according to the WHO, approximately 134 million adverse events and 2.6 million related deaths occur annually. More than 50% of nurses have encountered an adverse event. The financial costs related to adverse events caused by nurses in Ireland amount to 92.26 million dollars annually for the healthcare system. The authors confirm that although the incidence of adverse events is high, the rate of reporting adverse events is generally low worldwide, which remains a major challenge in patient safety management. In New Zealand, the rate of adverse events was as high as 91%. In Vietnam, 34% of healthcare workers admitted that they did not report adverse events.
The aim of the study by Longti et al. (2024) was to examine nurses' perception of the risk of adverse events and analyze the factors that influence it. Nurses' perception of adverse events (n=1084) positively correlated with organizational support and the leadership behavior of nursing managers. Research showed that nurses who have experienced adverse events in nursing have a significantly higher perception of the risk of adverse events than those who have not experienced them. The authors emphasize that adverse nursing events damage the hospital's reputation.
Utilization of Study Results in Nursing Practice
By understanding the attitudes of Generation "Z" nurses towards reporting adverse events in nursing, nursing managers can significantly influence patient safety and team stability.
Generation Z emphasizes psychological safety, open communication, technological efficiency, and the meaningfulness of their work. If they fear punishment or do not see the point in bureaucratic reporting, nurses of this generation would rather conceal an adverse event or consider leaving the profession. Generation Z is sensitive to an authoritarian approach and the threat of punishment. The role of managers is to build a culture of non-blame, where a young nurse can freely express her opinion or point out a mistake by an older colleague or doctor.
Limitations of the Study
The presented study exhibits several methodological limitations. Due to the sample, the obtained results cannot be broadly generalized to the entire generation of nurses; their validity is limited to the respondents participating in the research. Despite the partial size of the sample, however, the presented data provide a relevant summary overview of the current state of the studied phenomenon in clinical practice. The findings also correspond with the literature and provide the necessary empirical support for the development of theoretical foundations. The research results can be considered acceptable, while the identified relationships represent a significant basis for initiating constructive changes in nursing management, the direct performance of nursing care, and nurse education.
CONCLUSION
Reducing the incidence of adverse events in healthcare is an urgent problem worldwide. Effective management of reporting adverse events and critical situations represents a key determinant of the quality and safety of nursing care. The identification and subsequent in-depth analysis of these incidents enables the detection of systemic deficiencies in clinical practice, work organization, or interprofessional communication. The implementation of targeted corrective measures serves to prevent the recurrence of errors, optimizes work processes, maximizes patient safety, and contributes to building a transparent culture of safety and fairness in the workplace.
Author: doc. PhDr. Viera Hulková, PhD., MPH Faculty of Healthcare, Alexander Dubček University of Trenčín in Trenčín
LIST OF BIBLIOGRAPHIC REFERENCES
Grešš Halász, B. et al. _Základy výskumu v zdravotníctve. Učebnica pre vysoké školy. Košice : UPJŠ., 2025. s. 61-63. ISBN 978-80-574-0488-0 (e-publikácia).
Hulková, V., Kilíková, M., Tupá, M. Prínos peer review hodnotenia v ošetrovateľstve na zvýšenie bezpečnosti pacientov a predchádzanie nežiadúcich udalostí – pilotná štúdia. Prohuman. 2025. [online]. Dostupné: https://www.prohuman.sk/osetrovatelstvo/prinos-peer-review-hodnotenia-v-osetrovatelstve-na-zvysenie-bezpecnosti-pacientov
Hulková, V., Kilíková, M. Bezpečnosť zdravotnej a ošetrovateľskej starostlivosti. Bratislava : Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety, n.o. 2025.159s. ISBN 978-80-8132-314-0 (print). ISBN 978-80-8132-315-7 (pdf). Dostupné: https://prohuman.sk/osetrovatelstvo/bezpecnost-zdravotnej-a-osetrovatelskej-starostlivosti
Kilíková, M., Karoľová, Ľ. Perception of safe healthcare attributes by nurses. Prohuman. 2026. [online]. Available: https://www.prohuman.sk/osetrovatelstvo/percepcia-atributov-bezpecnej-zdravotnej-starostlivosti-sestrami
Kilíková, M., Katriňáková, T., Štefanová, M. Factors influencing the occurrence of adverse events in institutional healthcare. Prohuman. 2025. [online]. Available: https://www.prohuman.sk/osetrovatelstvo/faktory-ovplyvnujuce-vznik-neziaducich-udalost-v-ustavnej-zdravotnej-starostlivosti
Kurucová, R., Kalánková, D., Žuffová, A., Žiaková, K. Patient safety culture in selected Slovak hospitals: a cross-sectional study. Kontakt. 2022; 24(4): 273-278. https://doi.org/10.32725/kont.2022.041
Longti, L. et al. Nurses’ Risk Perception of Adverse Events and Its Influencing Factors: A Cross-Sectional Study. J of health Care Organization, provision and financing. 2024; 61: 1-8. https://doi.org/10.1177/00469580241263876
Schifferdecker, K.E., Reed, V. A. Using mixed methods research in medical education: basic guidelines for researchers. Med Educ. 2009; 43:637-644. https://doi.org/10.1111/j.1365-2923.2009.03386.x
Rao, D., Shiyanbola, O.O. Best practices in mixed methods for pharmacy and health services research. In DESSELLE S. P., GARCÍA-CÁRDENAS V., ANDERSON C., ASLANI P., CHEN T. F. (Eds), Contemporary Research Methods in Pharmacy and Health Services.(E-book). [online]. USA : Elsevier Academic Press. 2022. p. 407-420. ISBN 978-0-323-91888-6. https://doi.org/10.1016/C2021-0-00184-X
Renfro, CH.P., Hohmeier, K.C. Rapid turn-around qualitative analysis applications in pharmacy and health services research. In DESSELLE S. P., GARCÍA-CÁRDENAS V., ANDERSON C., ASLANI P., CHEN T. F. (Eds), Contemporary Research Methods in Pharmacy and Health Services.(E-book). [online]. USA : Elsevier Academic Press. 2022. p.397-405. ISBN 978-0-323-91888-6. https://doi.org/10.1016/C2021-0-00184-X
Wu, F., Wang, X., Chen, S., Li, H., Xie, H. Nurses' adverse event reporting attitudes and related factors: a cross-sectional study in maternal and child specialized hospitals in China. Front. Public Health. 2024; 12:1434387. https://doi.org/10.3389/fpubh.2024.1434387
Zhao, X., Zhao, L., Li, G., Yang, W., Wang, H., Yang, Y. Reducing Nurses' Barriers to Reporting Adverse Events Using a WeChat-Based Cognitive Load Training Platform: An Open-Label, Randomized Controlled Trial. Risk Manag Healthc Policy. 2025; 18:947-961. https://doi.org/10.2147/RMHP.S482233
