title: Third year nursing students' viewpoints about circumstances which threaten safety in the clinical setting.
abstract: BACKGROUND
  Evidence emphasizes that learners, educators, clinicians, programs, and organizations share the responsibility for establishing and maintaining safety throughout undergraduate nursing education. Increased knowledge about students' perceptions of threats to safety in the clinical setting may guide educators' efforts to promote the development of safe novice practitioners while preserving patient safety.
  
  
  OBJECTIVE
  The purpose of this study was to describe third year nursing students' viewpoints of the circumstances which threaten safety in the clinical setting.
  
  
  METHODS
  Using Q methodology, 34 third year Bachelor of Science in Nursing students sorted 43 theoretical statement cards. Each card identified a statement describing a threat to safety in the clinical setting. These statements were generated through a review of nursing literature and consultation with experts in nursing education. Centroid factor analysis and varimax rotation identified viewpoints regarding circumstances that most threaten safety.
  
  
  RESULTS
  Three discrete viewpoints and one consensus perspective constituted students' description of threatened safety. The discrete viewpoints were labeled lack of readiness, misdirected practices, and negation of professional boundaries. There was consensus that it is most unsafe in the clinical setting when novices fail to consolidate an integrated cognitive, behavioral, and ethical identity. This unifying perspective was labeled non-integration.
  
  
  CONCLUSIONS
  Third year nursing students and their educators are encouraged to be mindful of the need to ensure readiness prior to entry into the clinical setting. In the clinical setting, the learning of prepared students must be guided by competent educators. Finally, both students and their educators must respect professional boundaries to promote safety for students and patients.
authors.affiliation: School of Nursing, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada. Electronic address: pmontgomery@laurentian.ca.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Montgomery
authors.affiliation: School of Heath Sciences and Emergency Services, Cambrian College of Applied Arts and Technology, 1400 Barrydowne Road, Sudbury, Ontario, P3A 3V8, Canada. Electronic address: Laura.killam@cambriancollege.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Killam
authors.affiliation: School of Nursing, Laurentian University, 935 Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada. Electronic address: smossey@laurentian.ca.
authors.forename: Sharolyn
authors.initials: S
authors.lastname: Mossey
authors.affiliation: School of Heath Sciences and Emergency Services, Cambrian College of Applied Arts and Technology, 1400 Barrydowne Road, Sudbury, Ontario, P3A 3V8, Canada. Electronic address: heerschap.corey@gmail.com.
authors.forename: Corey
authors.initials: C
authors.lastname: Heerschap
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D002983:Clinical Competence; D004508:Education, Nursing, Baccalaureate / Q000379:methods*; D005163:Factor Analysis, Statistical; D006801:Humans; D061214:Patient Safety; D013338:Students, Nursing / Q000523:psychology
keywords: Clinical education; Nursing students; Q methodology; Safety