Patient safety in nursing education: Contexts, tensions and feeling safe to learn Alison Steven a, ⁎, Carin Magnusson b, 1 , Pam Smith c, 2 , Pauline H. Pearson d, 3 a Faculty of Health and Life Sciences, Northumbria University, Coach Lane Campus (West), East Benton, Newcastle upon Tyne NE7 7XA, United Kingdom b Centre for Research in Nursing and Midwifery Education, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, Surrey GU2 5TE, United Kingdom c Nursing Studies, School of Health in Social Science, Edinburgh University, Teviot Place, EH8 9AG, United Kingdom d Faculty of Health and Life Sciences, Coach Lane Campus, Northumbria University, Coach Lane, Benton, Newcastle upon Tyne NE7 7XA, United Kingdom summary article info Article history: Received 13 December 2012 Received in revised form 10 April 2013 Accepted 28 April 2013 Available online xxxx Keywords: Students Education Nurses Mentors Patient safety Emotional safety Education is crucial to how nurses practice, talk and write about keeping patients safe. The aim of this multisite study was to explore the formal and informal ways the pre-registration medical, nursing, pharmacy and physiotherapy students learn about patient safety. This paper focuses on findings from nursing. A multi-method design underpinned by the concept of knowledge contexts and illuminative evaluation was employed. Scoping of nursing curricula from four UK university programmes was followed by in-depth case studies of two programmes. Scoping involved analysing curriculum documents and interviews with 8 programme leaders. Case-study data collection included focus groups (24 students, 12 qualified nurses, 6 service users); practice placement observation (4 episodes = 19 hrs) and interviews (4 Health Service managers). Within academic contexts patient safety was not visible as a curricular theme: programme leaders struggled to define it and some felt labelling to be problematic. Litigation and the risk of losing authorisation to practise were drivers to update safety in the programmes. Students reported being taught idealised skills in university with an emphasis on ‘what not to do’. In organisational contexts patient safety was conceptualised as a complicated problem, addressed via strate- gies, systems and procedures. A tension emerged between creating a ‘no blame’ culture and performance management. Few formal mechanisms appeared to exist for students to learn about organisational systems and procedures. In practice, students learnt by observing staff who acted as variable role models; challenging practice was problematic, since they needed to ‘fit in’ and mentors were viewed as deciding whether they passed or failed their placements. The study highlights tensions both between and across contexts, which link to formal and informal patient safety education and impact negatively on students' feelings of emotional safety in their learning. © 2013 Elsevier Ltd. All rights reserved. Introduction Improving patient safety is a global concern. In 2001 the UK National Patient Safety Agency (NPSA) was established followed by the World Alliance for Patient Safety in 2004 (WHO, 2004). However UK inquiries continue to highlight safety issues; children's heart surgery at Bristol (Kennedy, 2001); the Maidstone and Tonbridge Wells investigation into Clostridium difficile (Healthcare Commission, 2007); and the recent inquiry into care provided by Mid Staffordshire National Health Service (NHS) Foundation Trust (Francis, 2013; Hornett, 2012). Issues included: teamwork, workplace culture, leadership, communication, staffing levels, training, difficulties in reporting concerns; and information mon- itoring. The increased profile of patient safety resulted in numerous campaigns and collaborations across UK universities, the NHS and beyond (Slater et al., 2012; Burston et al., 2011). Developments include the Safer Patients' Initiative (Health Foundation, 2011a), Scottish patient safety programme and research network (Haraden and Leitch, 2011), and patient safety research centres. Thus considerable research and development have been stimulated in areas including, adverse events (Jordan, 2011), medication issues (Wulff et al, 2011), non- technical skills (Gordon et al, 2012; White, 2012), organisational factors (Dodds and Kodate, 2011) and human factors (WHO, 2009). Despite some progress, unnecessary patient harm remains a key issue for nursing and health care (Health foundation, 2011b; Jordan, 2011). Education is recognised as playing a major role in developing safe, high quality, nursing and health care (Francis, 2013; Mansour, 2012; Slater et al, 2012; Pearson and Steven, 2009). However a recent review of evidence on perceptions of patient safety in pre-registration and Nurse Education Today xxx (2013) xxx–xxx ⁎ Corresponding author. Tel.: +44 191 2156483. E-mail addresses: alison.steven@northumbria.ac.uk (A. Steven), c.magnusson@surrey.ac.uk (C. Magnusson), pam.smith@ed.ac.uk (P. Smith), pauline.pearson@northumbria.ac.uk (P.H. Pearson). 1 Tel.: +44 1483 684552. 2 Tel.: +44 131 651 3921. 3 Tel.: +44 191 215 6472. YNEDT-02510; No of Pages 8 0260-6917/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nedt.2013.04.025 Contents lists available at SciVerse ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/nedt Please cite this article as: Steven, A., et al., Patient safety in nursing education: Contexts, tensions and feeling safe to learn, Nurse Education Today (2013), http://dx.doi.org/10.1016/j.nedt.2013.04.025