Patient Safety Competencies, Clinical Learning Environment and Unfinished Care From the Perspective of Nursing Students: A Multinational Study

AIM: To assess perceived patient safety competencies among nursing students and to examine their associations with their perceptions regarding clinical learning environment and unfinished nursing care. DESIGN: An international comparative cross-sectional study. METHODS: A total of 1442 nursing students from the Czech Republic, Italy, Slovakia, and Türkiye participated between February and December 2025. Data were collected using the Health Professional Education in Patient Safety Survey, the Clinical Learning Environment, Supervision and Nurse Teacher scale, and the Unfinished Nursing Care Survey for Students. Descriptive statistics, non-parametric tests, Spearman correlations, and multivariate general linear modelling were applied. RESULTS: Students reported significantly higher patient safety competencies in clinical compared with academic settings (p ≤ 0.001). Significant cross-country differences were observed across all competency domains (p ≤ 0.001). Perceived patient safety competencies were positively correlated with the overall quality of the clinical learning environment (r = 0.356-0.420; p < 0.001) and negatively correlated with unfinished nursing care (r = -0.107 to -0.171; p < 0.001). Multivariate analysis demonstrated that pedagogical atmosphere, premises of nursing care, supervisory relationship, and particularly the role of the nurse teacher were significant predictors of patient safety competencies. CONCLUSION: The development of nursing students' patient safety competencies is closely linked to the quality of clinical learning environments. Strengthening educational and organisational conditions within clinical placements may play an important role in preparing future nurses for safe clinical practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Improving the quality of clinical learning environments, strengthening supervision, and addressing unfinished nursing care may support the development of nursing students' patient safety competencies and contribute to safer patient care. REPORTING METHOD: The study was carried out according to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.