Background and Objective:
Residents of nursing homes (NHs) are a highly vulnerable group and at risk of adverse events. Knowledge of patient safety culture (PSC) is essential to ensure patient safety and guide effective improvements. However, research on the variability of PSC in NHs is still scarce. This study explored whether and how PSC differed among NH staff (managers, nurses, direct care, support and administrative staff) in the Autonomous Province of Trento (Northeastern Italy).

Methods:
The Nursing Home Survey on Patient Safety Culture (NHSPSC) was administered to the staff of 25 NHs (2368 beds) in June 2019. Linear mixed models were used for the score analyses of the 12 NHSPSC domains, with each domain score as response variable and staff type as the fixed effect of interest.

Results:
Overall, 1224 employees participated in the survey (mean facility response rate: 59%, range 31-90%). The majority (61.7%) of respondents were direct care staff. The mean aggregate NHSPSC score for all staff type was 3.54/5.00 (±SD 0.58) (64.5±14.6% using a 0-100 scale). There was a statistically significant difference in 9/12 domain scores between staff categories. We detected that: managers and administrative staff had higher scores than other staff types in 9/12 domains; support staff had the lowest scores in almost all domains (10/12); the domain with the highest score was ‘Handoffs and Transitions’ for managers and administrative staff (mean 82.5±17.1%) and ‘Feedback and Communication about Incidents’ for nurses, direct care and support staff (mean 76.2±20.1%); and the domain with the lowest score was ‘Staffing’ for all staff categories (mean 49.6±18.3%). In 10/12 domains and overall NHSPSC scores, a statistically significant reduction was evident for the support staff category compared to the others.

Conclusions:
There are differences in PSC between different professions in NHs, which need to be addressed to build a positive PSC.