How Do Nurses Navigate the Challenges of Risk Management? Results from a Cross-Sectional Survey in Southern Italy

Background and Objectives: Clinical risk management is essential to patient safety. Nurses are strategically positioned to identify unsafe conditions, near misses, and adverse events. This study assessed nurses' knowledge of selected clinical risk management definitions, perceptions of patient safety, and self-reported experience of patient-safety event reporting in a cardiovascular hospital in Southern Italy. Methods: A cross-sectional anonymous survey was conducted among registered nurses using a structured questionnaire. Knowledge was measured through a 0-4 index based on correct answers regarding safety culture, near miss, sentinel event, and incident reporting. Perceived overall patient safety was analyzed as an ordinal outcome, and ever reporting of patient-safety events as a binary outcome. Multivariable regression models explored associated factors. Results: The study included 88 nurses; 75.0% were female, and the median age was 47 years (IQR 37-54). Overall, 77.3% reported previous updating on risk management. The median knowledge index was 3 (IQR 2-4), and 62.5% answered at least three of four items correctly. Patient-safety culture domains received high importance scores, with medians ranging from 9 to 10. Overall patient safety was rated as good, very good, or excellent by 63.6% of respondents, and 61.4% had reported at least one patient-safety event. Knowledge was associated with gender and years of professional experience. Higher perceived safety was associated with perceived technological adequacy and patient confidence in care. Conclusions: Beyond the setting-specific findings, the study illustrates how combining factual knowledge, perceived safety, reporting experience, and locally relevant process indicators may support organizational diagnosis and help identify areas requiring more focused quality-improvement assessment.