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Patient safety has been a longstanding nursing priority in health care. Recent statistics indicate that approximately 10% of hospital admissions experience harm, with 70% of errors being preventable (Balas, Scott, & Rogers, 2004; Landrigan, 2010; Rafter et al., 2015). Keeping patients safe is deeply ingrained in nursing education and is explicitly emphasized as a foundational professional value. More recently, new knowledge has shifted the emphasis of this competency. Traditionally, patient safety was translated as an individual nurse responsibility. New awareness has emerged about the vital importance of the health care system in helping nurses to keep patients safe (Institute of Medicine, 2000).
The enduring, time-honored tradition of patient safety focused on the responsibility of nurses keeping their patients safe, often with the end goal of an individual nurse mastering the discrete skills necessary for care processes and procedures (e.g., maintaining asepsis and medication administration) (Harmer & Henderson, 1955). Modern nursing models incorporate these skills as vital elements within nursing practice, but they also emphasize that nursing is a more complex, multifaceted phenomenon. Focusing on the individual nurse or provider for patient safety suggests blame and a tendency to punish—a systems approach is required to ensure uniform approaches to maximum reporting and a fair analysis of contributing gaps in patient safety.
Quality and Safety Education for Nurses (QSEN) defines the patient safety competency as: “minimizes risk of harm to patients and providers through both system effectiveness and individual performance” (Cronenwett, 2007, p. 128). The QSEN competency definition expands the competency to include both individual and system foci. When examining nurses' understanding of updated components of patient safety, it is helpful to consider the requisite knowledge, skills, and attitudes (KSAs) that are needed in today's practice. QSEN operationalizes the patient safety competency into KSAs for the continuing education of nurses. Perhaps most notable in QSEN's KSAs for patient safety is the explicit inclusion of just culture and an appreciation for complex systems. QSEN KSAs for the patient safety competency are listed in Table 1.
The Role of Just Culture
A vital part of improving patient safety is accurate tracking of adverse events and near-misses. If errors are not reported, targeted improvements are hard to implement. Nurses' underreporting of errors is a well-documented phenomenon, with fear of...