Aims To identify the levels of teamwork and its relationship with the occurrence and reporting of adverse events among Iranian nurses. Background Strengthening teamwork is emphasized worldwide for enhancing quality care and patient safety. Methods This study applied a cross‐sectional survey design. A total of 327 Iranian nurses from eight teaching hospitals participated in a self‐administered survey using simple random sampling. The Teamwork Perceptions Questionnaire was used to measure the teamwork. The frequency of occurrence and reporting of adverse events were measured with two questions. Data were analysed using descriptive analyses, independent t tests and logistic regression analysis. Results The mean teamwork score was 3.81 out of 5. Among the nurses, 48.0% had experienced adverse events in the past 6 months and 79.8% reported having an appropriate performance in adverse events reporting. Teamwork was significantly associated with lower occurrences of adverse events and better adverse events reporting. Specifically, nurses with higher situation monitoring (odds ratio (OR) = 0.47), mutual support (OR = 3.18) and team leadership (OR = 2.09) scores were more likely to report adverse events. Nurses with higher situation monitoring scores were less likely to experience the occurrence of adverse events (OR = 0.38). Conclusions Nurses’ perception of teamwork was moderate to high. Teamwork was associated with the occurrence and reporting of adverse events. Further study is needed to identify the effects of teamwork training on the learning outcomes, including teamwork, occurrence and the reporting of adverse events among nurses. Implicatios for Nursing Management Nursing managers should consider multiple educational strategies including structured teamwork training to improve staff nurses’ teamwork competency. Administrative initiatives and quality improvement projects are needed to increase nurses’ performance in the reporting of adverse events through an accreditation process.

Aims:To assess systems thinking level and its relationship with occurrence and reporting of adverse events in Iranian nurses.Background: Systems thinking has recently emerged as an important element of patient safety and quality improvement in health care systems. It helps health care professionals to understand the different elements of health care systems, the interrelatedness and interdependencies of these elements in the health care systems.Methods: This cross-sectional survey was carried out in 10 teaching hospitals in Tehran, Iran. A total of 511 nurses were selected using simple random sampling.Systems thinking was measured using the validated Systems Thinking Scale. Data analysis was performed by descriptive analyses, independent t test and logistic regression analysis. Results:The average score for total systems thinking was a mean of 49.45 (SD = 12.10; range 0-80). In total, 67.5% of participants reported the experience of the occurrence of adverse events leading to harm to patients, and 65.2% of them responded as having appropriate adverse events reporting behaviours. Nurses who had higher scores in systems thinking were found to be more likely to report adverse events (odds ratio = 1.07; 95% CI = 1.05-1.09), whereas they were less prone to experience adverse events (odds ratio = 0.97; 95% CI = 0.95-0.98). Conclusion:Our results indicated that the nurses' systems thinking level was moderate. Systems thinking had a significant role in preventing the occurrence of adverse events as well as improving the reporting of adverse events. Therefore, it is recommended to enhance the competency of nurses' systems thinking to prevent the occurrence of adverse events and to improve the reporting of adverse events.Implications for nursing management: Nursing managers need to focus on the systems thinking weaknesses and the occurrence and the reporting of adverse events in policymaking, practice and research. Also, systems thinking should be integrated with the health care system for preventing the occurrence of adverse events and