Nurse reported patient safety in low-resource settings: A cross-sectional study of MNCH nurses in Nigeria

Purpose: Repeated international studies demonstrate the critical role of nursing and the associations between patient safety and nurse staffing and the nurse practice environment in high resource countries, yet nurse reported patient safety studies are sparse in Sub-Saharan Africa. This study explored nurse reported patient safety in Nigeria and examined the extent that patient safety is associated with nurse staffing levels and the nurse practice environment. Methods: A cross-sectional study of 27 public health facilities in Nigeria used anonymous nurse surveys (N= 222) to examine associations between nurse staffing, the nurse practice environment and nurse reported safety. Descriptive statistics and generalized linear mixed models (GLMM) were used to account for clustering of nurses within facilities. Results: Of the 222 nurse participants, 26% reported patient safety as poor/fair. Nurses who cared for greater than 20 patients had higher percentages of poor/fair patient safety. With the GLMM models adjusted for type of facility and nurse staffing, the nurse practice environments had the strongest association with patient safety. As the nurse practice environment score increased, nurses were nearly three times more likely to rank patient safety as excellent/good OR = 2.9 (1.5, 5.7). Conclusions: The taxonomy used globally with nurse safety research was comparable in Nigeria. Enhancing the nurse practice environment could offer opportunities to improve nurse reported patient safety in public health facilities in Nigeria. Further research is needed to better understand nurse reports of worse patient safety in secondary level health facilities and facilities with worse nurse staffing.