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Hospital nurse managers are in the middle. Their supervisors expect that they will monitor and discipline nurses who commit errors, while also asking them to create a culture that fosters reporting of errors. Their staff nurses expect the managers to support them after errors occur. Drawing on interviews with 20 nurse managers from three tertiary care hospitals, the study identifies key exemplars that illustrate how managers monitor nursing errors. The exemplars examine how nurse managers: (1) sent mixed messages to staff nurses about incident reporting, (2) kept two sets of books for recording errors, and (3) developed routines for classifying potentially harmful errors into non-reportable categories. These exemplars highlight two tensions: the application of bureaucratic rule-based standards to professional tasks, and maintaining accountability for errors while also learning from them. We discuss how these fundamental tensions influence organizational learning and suggest theoretical and practical research questions and a conceptual framework.

This chapter comments on organizational learning research produced by scholars who studied or taught at Stanford University during the last third of the 20th century. Challenging classical learning models, Stanford scholars have demonstrated how cognitive and social processes attenuate connections between environmental action and the lessons learned from it. They have demonstrated how goals change over time as a partial function of prior performance and the importance of temporal processes in learning rates. They have shown how rules and routines encode only imperfectly lessons learned from organizational action. Their research has deepened and enriched our understanding of organizational learning.