Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Lori Candela

Second Committee Member

Jessica Doolen

Third Committee Member

Diane Thomason

Fourth Committee Member

Richard Tandy

Number of Pages



Quality health care and optimal health outcomes begin by assuring patient safety. This is a shared responsibility of all health care providers. However, nurses have a fundamental obligation to assure patient safety, given their constant presence with patients requiring care. Patients who are cared for by nurses with insufficient or outdated patient safety education and knowledge can and often experience costly and catastrophic outcomes (Institute of Medicine (IOM), 2011). Medical errors now rank as the third leading cause of death in the United States and cost over 17.1 billion dollars/year (Makary & Daniel, 2016; Andel, Davidow, Hollander & Moreno, 2012). A shocking report issued in 2010 by the Society of Actuaries indicated that when years of lost productivity were calculated with the direct costs, the total costs were near one-trillion dollars per year (Shreve et al., 2010).

National health organizations have been calling for improvements in patient safety practices and in patient safety education for years (IOM, 2011; QSEN, 2014; The Joint Commission, 2014). To date, no solid consensus on how to effectively accomplish this has been determined. This has prompted many in health care to look at what other industries are doing to assure employee and consumer safety.

Years ago, the airline industry adopted the use of the Crew Resource Management (CRM) training program and noted improvements in several key safety categories (Sculli & Sine, 2011). More recently, CRM has been adapted as Nursing Crew Management (NCRM) training and it has shown promise with improving patient safety in some health care settings. However, its' use with nursing students, who will soon be entering practice is lacking in the literature (Aebersold, Tschannen, & Sculli, 2013).

The purpose of this quasi-experimental, two group, pre and post-test pilot study was to determine if NCRM training could make a significant improvement in patient safety self-efficacy in nursing students. The self-efficacy aspect of Bandura’s Social Learning Theory was used to inform the study.

The sample consisted of 46, final semester baccalaureate nursing students. A four-hour, NCRM training was provided to the experimental group. The Health Professional Education in Patient Safety Survey (H-PEPSS) was used as a pre and posttest to gauge the self-efficacy related to patient safety of both groups. The H-PEPSS includes 7 categories related to safety including understanding humans and environments, communication, working in teams, clinical safety, managing safety risks, disclosing adverse events and maintaining a culture of safety. Data was analyzed using 2 x 2 factorial analysis of variances for each of the seven categories on the H-PEPSS. Significant differences were found between the control and experimental groups posttest scores on all of the H-PEPSS categories except clinical safety.

Results of the study indicated that NCRM training can positively impact patient safety self-efficacy in nursing students. Recommendations include repetition of the study with larger groups using different educational delivery mechanisms. Nurse academic administrators and faculty are encouraged to consider if inclusion of the NCRM training would be helpful as part of a larger effort to develop student knowledge and skills related to working with health care teams to provide safe patient care.


Crew Resource Management; Nursing Education; Nursing Students; Patient Safety; Safety; Self-Efficacy


Education | Nursing

File Format


Degree Grantor

University of Nevada, Las Vegas




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