Measuring employee safety culture in rural nursing home settings: A literature review

Yulin Wang, Barbara Millet

Research output: Chapter in Book/Report/Conference proceedingChapter


A strong safety culture is critical for healthcare settings, where the impact of potential errors is high. Research efforts have explored assessment to measure culture, to monitor workplace health, to measure progress on implementing improvement efforts, and to proactively identify new initiatives for improvement. This research, however, is targeted mostly for urban healthcare settings. Adoption of these assessment instruments may not be feasible given the unique challenges faced in rural healthcare settings due to factors, such as (1) a large proportion of aging patients living in rural areas, (2) rural nursing homes serving as major care units, and (3) issues with staff shortage and low technological access. The main objective of this review was to identify existing healthcare employee safety culture instruments and to explore the applicability of using such tools in rural nursing homes. A systematic literature review was conducted to identify tools that allow measurement of employee safety culture in rural nursing home settings. We reviewed studies published between 1987 to February 2012 and searched CINAHL, Medline and PubMed databases. Search keywords included, but were not limited to, “employee safety”, “safety culture”, “healthcare”, “rural healthcare”, and/or “nursing homes”. Thirty-five articles met the selection criteria with 8 instruments identified in the review. These instruments have been predominately developed for measuring safety culture, safety climate, or employee perception of work safety in urban hospital settings. However, measuring safety culture may be significantly influenced by factors such as the type of healthcare center, the associated job titles for the healthcare employees, and rurality. This review found no existing tool that can be directly used to measure safety culture in rural healthcare settings and even less for rural nursing homes. Future research is needed in developing an instrument that measures employee safety culture with aims at improving safety for employees of rural nursing home.

Original languageEnglish (US)
Title of host publicationAdvances in Human Aspects of Healthcare
PublisherCRC Press
Number of pages12
ISBN (Electronic)9781439870228
ISBN (Print)9781439870211
StatePublished - Jan 1 2012
Externally publishedYes


  • Employee safety
  • Nursing homes
  • Rural healthcare
  • Safety climate
  • Safety culture

ASJC Scopus subject areas

  • Engineering(all)


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