Safety culture and systems thinking for predicting safety competence and safety performance among registered nurses in Saudi Arabia: a cross-sectional study.

Background: Medical errors are a worldwide concern and the contribution of nurses' safety competence and performance to these errors is a high priority. It has been over 20 years since the first report of the need to address medical errors. New approaches are needed for enhancing safety competence and performance.

Aims: This study explored the relationships among systems thinking, educational level, safety culture, safety competence and safety performance among registered nurses working in medical and surgical units in Saudi Arabia.

Methods: A correlational cross-sectional design with a convenience sample of 84 registered nurses was used.

Results: Systems thinking predicted 16% of safety knowledge ([2, 81] = 7.61,  = 0.001), while safety culture, baccalaureate education and completion of safety training predicted 19% of safety skill ([3, 78] = 2.80,  = 0.001). A safety culture that promoted learning from mistakes predicted 15% of safety performance measured based on nurses' self-report of the number of errors in the past 3 months ([3, 75] = 2.86,  = 0.008).

Conclusions: Professional development including systems thinking and safety training are the necessary next steps for nurses. In addition, policy changes facilitating organisations to support learning from mistakes will contribute to reducing medical errors.