A Safety Framework: Empowering Faculty to Build a Culture of Safety

Background Prelicensure nursing curricula lack a defined safety framework for clinical education, leaving faculty with minimal guidance on how to model and teach foundational safety concepts. Nursing accrediting bodies identify psychological and physical safety as institutional priorities, emphasizing the need to equip future clinicians with foundational safety competencies early in their training. The purpose of this quality improvement project was to develop the ABCs of Prevention (Awareness, Body, Communication) and 4Rs of Intervention (Remove, Report, Record, Reflect) safety framework for clinical nursing education, provide faculty education and resources to support its application in teaching, and assess the impact of the education on faculty confidence in teaching safety to prelicensure nursing students. Methods This pre/post quality improvement project was conducted through a single nursing college system at multiple campuses in multiple states. Prelicensure nursing faculty were recruited across all campuses and voluntarily participated in a multimodal educational intervention consisting of an asynchronous online module and 1 live synchronous virtual session, offered at 7 different times. Faculty confidence was measured before and after the intervention using an anonymous modified Health Professional Education in Patient Safety Survey (H-PEPSS); mean ratings, percent change, and effect sizes were calculated for independent pre- and posteducation groups. Results Pre-education surveys were completed by 47 faculty and posteducation surveys by 27 of the 1392 faculty to whom the intervention was made available. Mean confidence ratings improved on all items except 1 reverse-scored item, across all 6 safety competency domains measured by the modified H-PEPSS: culture of safety, communication, human and environmental factors, teamwork, managing safety risks, and recognizing, responding to, and disclosing adverse events. Most items showed medium to large effect sizes. Conclusion Faculty education on a structured safety framework was associated with improved perceived confidence across key patient safety competencies. Findings support the integration of explicit safety frameworks into nursing faculty development and nursing curricula with the potential to strengthen the culture of safety in prelicensure clinical education. Generalizability may be limited by the single-institution design, suggesting a need for replication across diverse nursing education settings.