Iran Journal of Nursing

1. Introduction
Patient safety is one of the main components of service quality in the health system. Due to the nature of their work, nurses play an essential role in maintaining and promoting safety. Meanwhile, patient safety is critical, especially in the emergency department, because emergencies are highly prone to endanger patient safety due to their complexity and dynamic environment. In maintaining patient safety, the competence of human resources, especially nurses, as the front line of the health system is of particular importance. 
Assessing the competence of nurses is essential to ensure the safety of care and identify areas in need of promotion and determine the educational needs of nurses. Competence is multidimensional and dynamic. Patient safety competence in nurses refers to the knowledge, skills, and attitudes about patient safety required to provide safe health care. Lack of knowledge of emergency nurses about safety components and lack of standards for assessing the competence of nurses in emergency departments are among the obstacles to implementing patient safety in emergency departments. 
Studies on nurses’ competency levels in patient safety in emergency departments have shown conflicting results. The information about patient safety competence in emergency nurses is not yet clear. Accordingly, this study aims to investigate the competence of emergency nurses in the field of patient safety in educational-medical centers of Iran University of Medical Sciences in 1398.
2. Method
This cross-sectional study was performed on 183 emergency nurses of educational hospitals from those affiliated with the Iran University of Medical Sciences during 9 months (June to March 2019) selected by a continuous method based on inclusion criteria. Data were collected as a self-report using the Patient Safety Competency Self-evaluation (PSCSE) to analyze the data in line with the research objectives of descriptive statistics (absolute and relative frequency, mean and standard deviation) and inferential statistics (including independent t-test, one-way analysis of variance, Pearson correlation coefficient, and regression analysis) and to check normality. The Kolmogorov-Smirnov test performed variables. The collected data were analyzed by SPSS software v. 22 16, and the significance level will be considered less than 0.05.
3. Results
The Mean±SD of nurses’ clinical competency scores was (139.35±17.83). The Mean±SD scores of knowledge were (18.04±3.35), the attitude was (51.33±6.20), and skill was (69.96±11.08). In the dimension of factor knowledge, “concept of error and cause analysis” had the highest Mean±SD (3.08±0.65). In terms of attitude, the factor of “improving patient safety/prevention strategy” had the highest Mean±SD (3.88±0.60), and the characteristic of “error disclosure and reporting” had the lowest Mean±SD (3.27±0.54). In the skill dimension, the “infection prevention” factor had the highest Mean±SD (3.59±0.66), and the “error-related relationship” factor had the lowest Mean±SD (2.90±0.70). 
The results showed that patient safety knowledge in untrained nurses compared to the base (trained) decreased by 1.392 points and increased the score by 0.238 per year of the knowledge age. In addition, based on the standard coefficient, the period with a coefficient of 0.387 had the most significant effect on knowledge about patient safety. Also, based on the results, only the constant value variable, graduation university, these variables in the presence of each other in the regression model has a significant effect on the attitude. Increase Based on the regression analysis results, none of the demographic variables are related to emergency nurses’ skills in patient safety. They were not statistically significant. None of the demographic variables had a significant relationship with the total competency score of emergency nurses in terms of patient safety.
4. Conclusion
The level of clinical competence of emergency nurses regarding patient safety was relatively favorable. Considering the importance of patient safety in the hospital and the role of nurses in safety and in the quality of care that patients are treated by, especially in the emergency room, the results of the assessment of clinical competence of nurses are recommended to encourage that nurses’ competence in patient safety is measured periodically. Following the evaluation results and determination of educational needs, appropriate measures should be taken by the hospital nursing officials and managers for the direction and professional development of nurses. Also, according to the results of this study, it is recommended to create a basis for more use of the experiences of experienced nurses in university hospitals in training novice nurses regarding patient safety so that these nurses can act as role models for nurses by transferring their experience and knowledge to them, which can be done through the development of leadership processes for novice nurses by experienced nurses in educational and medical centers. Due to the low scores of error disclosure to the patient and error reporting to the authorities, it is necessary to provide an opportunity for nurses to report errors without worrying about the delay of disclosure and reporting and to establish and institutionalize a patient safety culture in medical centers. Educational Therapy Measures should be taken to use the reported error to promote patient safety training. It is necessary to create an ethical culture at the community level regarding the benefits of disclosing errors to the patient and the family so that nurses can report errors with less concern and have the family in the process of error recovery.

Ethical Considerations
Compliance with ethical guidelines
Ethical code was obtained from the University Ethics Committee Iranian Medical Sciences (IR.IUMS.REC.1398.523).

Funding
The study is sponsored by Iran University of Medical Sciences.

Authors' contributions
Organizing ideas, obtaining financial support, preparing intervention protocols and educational contents, analyzing data and interpreting results, and preparing initial drafts: Tahereh Najafi Ghezeljeh; Preparation of initial design, preparation of intervention protocol and educational contents, data collection, data analysis and interpretation of results and preparation of initial draft: Tayebeh Mohammad Beigi; Interpreting the results and preparing the initial draft of the article: Sahar Kiwanlou; Data analysis and interpretation of results and preparation of initial draft: Shima Haghani. All authors participated in the finalization of the article.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
We would like to thank all the nurses and head nurses working in the educational and medical centers under the auspices of Iran University of Medical Sciences who helped us in carrying out this study.

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