Nursing Home Senior Managers and Direct Care Staff: Are There Differences in Their Perceptions of Safety Climate?

Objectives: Improving nursing home safety is important to the quality of resident care. Increasing evidence points to the relationship between actual safety and a strong safety climate, i.e., staff agreement about safety norms. This national study focused on Veterans Health Administration nursing homes (Community Living Centers [CLCs]), assessing direct care staff and senior managers' agreement about safety norms.

Methods: We recruited all 134 CLCs to participate in the previously validated CLC Employee Survey of Attitudes about Resident Safety. To assess whether safety climate domains (7) differed by management level and by direct care staff occupation, we estimated multilevel linear regression models with random effects clustered by CLCs, medical center, Department of Veterans Affairs 2017 integrated service network (n = 20), and region.

Results: Of the 5288 individuals we e-mailed, 1397 (25.7%) completed surveys, with participation from 56 CLCs or 41.8% of 134 CLCs. In our analysis of 1316 nurses, nursing assistants, clinicians/specialists, and senior managers, senior managers rated co-worker interactions around safety (P < 0.0013) and overall safety in their CLC (P < 0.0001) more positively than did direct care staff. In contrast, on these same two domains, direct care groups had similar perceptions, though differing significantly in safety priorities, safety attitudes, and senior management commitment to safety.

Conclusions: In this national sample of nursing homes in one of the largest integrated U.S. healthcare systems, direct care staff generally perceived weaker safety processes than did senior managers, pointing to future targets for interventions to strengthen safety climate.