Factors associated with patient safety competency and configurational pathways among master's nursing students: A cross-sectional study using PLS-SEM, NCA, and fsQCA.

AIM: To examine the associations of organizational support (OS), patient safety culture (PSCul), adverse event risk perception (AERP), self-efficacy (SE) and professional identity (PI) with self-reported patient safety competency (PSC) among master's nursing students, and to investigate the corresponding indirect associations, necessary-condition constraints and configurational pathways.

DESIGN

A cross-sectional online survey.

SETTING

Multiple regions of China.

PARTICIPANTS

A total of 326 master's nursing students with at least 3 months of clinical practice experience.

METHODS

Data were collected from June 2025 to February 2026 using convenience and snowball sampling. Partial least squares structural equation modelling (PLS-SEM) was used to estimate the direct and indirect associations between the study factors and PSC. Necessary condition analysis (NCA) was used to evaluate the necessary-condition constraints for attaining higher levels of PSC, whereas fuzzy-set qualitative comparative analysis (fsQCA) was used to identify configurations associated with high and non-high PSC.

RESULTS

OS, PSCul, AERP, SE and PI were each positively associated with PSC (β = 0.110-0.344, all P ≤ 0.005). OS, PSCul and AERP were also significantly associated with PSC indirectly through SE and PI (β = 0.040-0.104, all P ≤ 0.003). The structural model accounted for 59.2% of the variance in PSC. NCA showed that each antecedent represented a statistically significant necessary constraint (d = 0.105-0.246, P < 0.001). fsQCA identified four configurations associated with high PSC (solution consistency = 0.917; solution coverage = 0.648), with SE present as a core condition in all four configurations. Four distinct configurations were associated with non-high PSC (solution consistency = 0.888; solution coverage = 0.736), indicating configurational asymmetry.

CONCLUSIONS

PSC among master's nursing students was associated with organizational and individual psychological factors through multiple, asymmetric pathways. Nursing educators and clinical preceptors may combine supportive learning environments and a positive patient safety culture with efforts to strengthen SE, PI and AERP. However, given the cross-sectional design and reliance on self-reported data, these findings require further verification in longitudinal studies using multisource assessments.