Predictors of adverse event reporting intention among primary care nurses: a multi-center study in China

The reporting of adverse events (AEs) is essential for improving patient safety. However, there is limited evidence regarding the reporting intentions of nurses in primary healthcare institutions, particularly in resource-constrained settings. This study aimed to investigate the predictors of AE reporting intention among nurses in China’s primary care sector. A multi-centre, cross-sectional survey was conducted from December 2023 to August 2024 with 607 nurses from 48 primary healthcare institutions in Chongqing, China. Validated instruments were used to assess AE reporting intention, reporting cognition, and perceived barriers to reporting. Data were analysed using descriptive statistics, non-parametric tests, Spearman correlation, and multiple linear regression. Nurses demonstrated a high overall intention to report AEs (mean = 13.44 ± 3.32, on a scale of 0–15). However, nurses reported a significantly higher intention to use informal reporting channels (e.g., reporting to a supervisor) than formal, written mechanisms. The final multiple linear regression model (Adjusted R² = 0.333, p < 0.001) identified reporting cognition as the strongest positive predictor of reporting intention (β = 0.522, p < 0.001). A cumbersome reporting process was a significant negative predictor (β = -0.107, p = 0.005), whereas a punitive culture was not a statistically significant predictor in the final model. In the context of China’s primary healthcare system, nurses’ intention to report adverse events is driven more by their cognitive ability to identify an event and the simplicity of the reporting process than by the fear of punishment. To enhance patient safety, institutional strategies should prioritise improving nurses’ cognitive skills for event recognition and streamlining reporting systems to reduce procedural burdens.