Melanie Murray

New graduate registered nurses’ (NGRNs) transition to practice with limited clinical experiences and skills. The related anxiety and stress predispose new graduate nurses to increased risk of contributing to preventable errors or adverse events. This risk, together with the new graduate’s fledgling ability to manage clinical deterioration, potentially compromises quality and safety of patient outcomes. A longitudinal mixed methods design was used to develop an understanding of new graduate registered nurses’ patient safety knowledge and actions within the first year of nursing registration and offer important insights into NGRNs’ transition with a patient safety focus. New graduate registered nurses employed in graduate nurse programs at two Australian metropolitan hospitals were invited to participate. Data collection activities took place from August 2016 to February 2018. A closed-ended questionnaire, a modified version of the “Medical students’ questionnaire of knowledge, skills, and attitudes regarding patient safety”, was delivered at three time points during the graduate program to monitor the evolution of the NGRNs’ knowledge, feelings and attitudes regarding medical errors and patient safety over time. Qualitative data was collected by semi-structured one-on-one interviews to gain a deeper appreciation of the NGRNs knowledge of patient safety and challenges of integrating this knowledge into their clinical practice. Quantitative data were analysed using ANOVA One-way analysis of variance, or General Linear Model for repeated measures to measure vi difference, if any, between the time points. Qualitative data analysis was guided by Braun and Clark’s six steps of thematic analysis. Quantitative results were categorised into the four subcategories of knowledge of medical error; knowledge of actions regarding medical error; attitudes to compromised patient safety; and intentions regarding patient safety prior to analysis. Thematic analysis revealed five main themes: patient safety and insights; time management; making a mistake; experiential learning; and transition. Although confidence was low, participants intend to communicate, support, and intervene, when faced with compromised patient safety situations. However, self-reported knowledge of medical error and knowledge of actions regarding medical error decreased over the three time points. Medical errors and time management persist as stressors to the NGRNs early months of transition to the registered nurse role. New graduates reported moderate knowledge of safety and quality issues, however, their questioning of their own abilities overshadowed growth in their involvement in patient safety.