Certified nursing assistants' perceptions of nursing home patient safety culture: is there a relationship to clinical outcomes?

J Am Med Dir Assoc. 2009 Jan;10(1):11-20. doi: 10.1016/j.jamda.2008.06.004. Epub 2008 Sep 25.


Objectives: The main objective of this study was to examine whether certified nursing assistants' (CNAs') perceptions of patient safety culture (PSC) were correlated with clinical outcomes (rates of falls, pressure ulcers, and daily restraint use) in a random sample of nursing homes. An additional objective was to describe facility-level and CNA-level characteristics that were associated with CNA PSC scores.

Design: We conducted a secondary data analysis using data that adapted the Hospital Survey of Patient Safety Culture (HSOPSC) for nursing homes. The HSOPSC data were merged with data from the Minimum Data Set (MDS), Online Survey Certification and Reporting (OSCAR) system, and Area Resource File (ARF).

Participants and setting: CNAs from a random sample of 72 nursing homes in 5 randomly selected states during the first 2 quarters of 2005.

Measurements: The relationships between clinical outcomes and CNA PSC scores were evaluated. The relationships between CNA PSC and facility characteristics, such as profit status and bed occupancy, and CNA characteristics such as education and tenure were also assessed. Data were analyzed using Poisson, multinomial logistic, and linear regression, and generalized estimating equations (GEE); descriptive statistics were compiled for demographic data.

Results: Of 2872 CNAs, 1579 completed the survey, for a 55% response rate. Results of regression analyses suggest that higher (more developed and more desirable) CNA PSC scores were associated with increased reporting of falls (B = 0.015; P = .000). Facilities with higher total CNA PSC scores were more likely to report moderate restraint use, whereas facilities with lower CNA PSC scores were more likely to report high restraint use (B = 0.172; P = .017). CNA PSC scores were not associated with differences in pressure ulcer rates.

Conclusions: This study represents an important step in the evaluation of CNA PSC in nursing homes and shows that a relationship exists between PSC and selected clinical outcomes. Future work on nursing home PSC and additional clinical as well as workforce outcomes is indicated.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Certification
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Nursing Assistants / psychology*
  • Nursing Homes / standards*
  • Organizational Culture*
  • Outcome Assessment, Health Care*
  • Pressure Ulcer
  • Safety Management*
  • United States