Patient Safety Competency Among Operating Room Nurses: Associations With Safety Attitudes, Systems Thinking and Burnout in a Multicentre Cross-Sectional Study.

AIM: To assess self-reported patient safety competency among operating room nurses in tertiary hospitals in Jiangsu Province, China, and to examine its associations with safety attitudes, systems thinking and burnout dimensions. DESIGN: A multicentre cross-sectional study. METHODS: Operating room nurses were recruited from six tertiary general hospitals in Jiangsu Province, eastern China. Data were collected between January and May 2025 using standardised self-report questionnaires measuring patient safety competency, safety attitudes, systems thinking and burnout. Statistical analyses included descriptive statistics, group comparisons, Pearson correlation analyses and linear mixed-effects modelling, with hospital included as a random intercept. Conventional multiple linear regression was performed as a sensitivity analysis. RESULTS: Of the 512 operating room nurses invited, 443 were included in the final analysis. The mean total patient safety competency score was 156.40 (SD 25.70). In the primary mixed-effects model, nurses with no more than 5 years of operating room experience had lower patient safety competency scores than those with more than 20 years of experience (B = -10.185, 95% CI -15.974 to -4.395; p < 0.001). Permanent employment (B = 5.469, 95% CI 0.696-10.242; p = 0.025), participation in patient safety training (B = 8.320, 95% CI 4.033-12.606; p < 0.001), and higher safety attitudes (B = 0.683, 95% CI 0.565-0.801; p < 0.001) were associated with higher scores. Sensitivity analyses retaining clinically and theoretically relevant covariates and accounting for hospital fixed effects supported these associations. Findings for marital status, systems thinking, personal accomplishment and the burnout dimensions varied across model specifications. CONCLUSIONS: Self-reported patient safety competency among operating room nurses was associated with occupational characteristics, safety attitudes, systems thinking, and personal accomplishment. These associations may inform future research and programme development, but prospective studies are needed before predictive or causal conclusions can be drawn. IMPLICATIONS FOR NURSING PRACTICE: The findings identify nurses with limited operating room experience as a priority group for competency development and suggest attention to equitable access to patient safety education and supportive safety practices across employment groups. Prospective studies using observed safety behaviours and patient outcomes are needed to evaluate the practical relevance of these findings. PATIENT AND PUBLIC CONTRIBUTION: No patients or members of the public were involved because the study focused on nurses' professional competency and collected data only from operating room nurses. Patients and the public were not involved in the study design, conduct, analysis, interpretation or reporting.