Safety Competency, Certification, and Practical Drift

Safety is one of the top priorities in transport nursing because of the unpredictable nature of moving critically ill or injured patients by air or ground. The purpose of this study was to determine the relationship between certification status and the transport nurse's self-rated safety competency. Safety competency was measured with an adapted version of the 22-item Critical Care Nursing Competence Questionnaire for Patient Safety (C3Q-safety) scale. To adapt the C3Q-safety scale for transport nursing, we matched the 22 items with the Air and Surface Transport Nurses Association safety standards. Then, 5 transport nursing experts reviewed the 22 items for face validity and relevance to Air and Surface Transport Nurses Association safety standards. The C3Q-safety scale assesses 4 safety factors: decision making, collaboration, nursing intervention, and principles of nursing care. This was a cross-sectional survey with 432 respondents; t-tests and linear regression were used to examine the data. Our findings indicated a lack of relationship between certification status and safety competency. However, we found that more experienced transport nurses had lower safety competency scores (β = -0.150, P = .037). Practical drift (ie, the failure to follow established rules and regulations, which leads to deviations from policies and procedures) may explain why experienced nurses scored lower. The practice implications of this work include the need for a robust safety culture with a focus on nonpunitive reporting and the use of simulation for reducing possible errors and limiting practical drift.