Medication reconciliation (MR) involves the accurate transfer of medication information across the continuum of care. The aim of this study was to measure nurses perceptions of patient safety, medication safety and current MR practice at transition points in a patient's hospital stay. Surveys were distributed to 111 nursing staff in three general medicine units at Capital Health District, Nova Scotia, in August 2005. A total of 39 nurses (35% response rate) completed the survey. "Teamwork within units" was the safety culture dimension with the highest positive response (98.1%), while the processes of handoffs and transitions received the lowest positive response (42.8%). Key areas identified for improvement relative to the current level of MR practice include institutional patient safety systems (e.g., low confidence in existing systems and procedures), inconsistent practices (e.g., wide variation in whether community pharmacists are contacted to verify medication profiles), lack of communication (e.g., between healthcare professionals) and staffing resources (e.g., MR is perceived as a very time-consuming process). Addressing these challenges prior to implementing a formalized MR program should help to ensure success of the project. The insights gained through the use of this survey may prove valuable to other Canadian healthcare organizations that are implementing MR services.