Clinical nurses' patient safety competency, systems thinking and missed nursing care: A cross-sectional survey

Aim: The aim of this study was to examine the relationships among patient safety competency, systems thinking and missed nursing care. Background: Patient safety competency and systems thinking are important nurse attributes that promote patient safety. Missed nursing care is known to negatively impact patient safety. However, how nurses' patient safety competency and systems thinking relate to missed nursing care is unknown. Methods: A cross-sectional survey design was used to collect data from nurses practicing in two general hospitals in South Korea. Data were collected between 3 March and 17 April 2020. Questionnaires were distributed to nurses providing direct care in general and specialty units. Patient safety competency, systems thinking and missed nursing care were measured using reliable and valid instruments. A total of 432 complete sets of data were used in final analysis. Results: Higher patient safety competency of nurses was associated with lower missed nursing care. Systems thinking partially mediated the relationship between knowledge of patient safety competency and missed nursing care, and attitudes of patient safety competency and missed nursing care. Conclusions: The knowledge, skills and attitudes sub-scales of patient safety competency showed somewhat different effects in the relationship between missed nursing care and systems thinking, suggesting that each attribute may tap into a separate aspect of patient safety.