Cover: Nursing Home Patient Safety Culture Perceptions Among US and Immigrant Nurses

Nursing Home Patient Safety Culture Perceptions Among US and Immigrant Nurses

Published in: Journal of Patient Safety, Volume 16, Issue 3, pages 238–244 (September 2020). doi: 10.1097/PTS.0000000000000271

Posted on Feb 8, 2022

by Laura M. Wagner, Barbara L. Brush, Nicholas G. Castle, John Engberg, Elizabeth A. Capezuti

Patient safety is a global concern, yet little is known about how and whether perceptions of patient safety culture (PSC) vary by nurses' countries of origin and preparation. This is particularly important in American nursing homes (NHs), which are increasingly hiring non-US born and prepared nurses to fill staffing needs.


This study compared the PSC perceptions of foreign and domestic born and trained nurses working in urban NHs in 5 states to analyze how nurses' PSC perceptions corresponded to their personal and professional characteristics.


We distributed 3539 surveys to registered nurses and licensed practical/vocational nurses employed in 98 urban NHs across 5 states with higher percentages of internationally prepared nurse workers. Respondents' perceptions of their workplace safety culture were measured with the NH Survey on PSC survey from the Agency for Healthcare Research and Quality (AHRQ) and examined 12 dimensions of PSC. A total of 1629 returned surveys indicated a 46% returned rate.


Results from 1133 analyzed surveys indicated that nurses born and educated abroad exhibited more favorable PSC perceptions in their workplaces, followed by nurses born abroad and educated in the United States. Nurses born and educated in the United States demonstrated the lowest perceptions of workplace PSC overall (P < 0.001).


Although foreign born and trained nurses report higher PSC perceptions than domestically born and educated nurses, further research is needed to understand why these differences occur.

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