1. Thompson, Debra N. PhD, RN, CNAA-BC
  2. Hoffman, Leslie A. PhD, RN, FAAN
  3. Sereika, Susan M. PhD
  4. Lorenz, Holly L. MSN, RN
  5. Wolf, Gail A. PhD, RN, FAAN
  6. Burns, Helen K. PhD, RN, FAAN
  7. Minnier, Tamra E. MSN, RN, FACHE
  8. Ramanujam, Rangaraj PhD


Objective: This study compared nursing staff perceptions of safety climate in clinical units characterized by high and low ratings of leader-member exchange (LMX) and explored characteristics that might account for differences.


Background: Frontline nursing leaders' actions are critical to ensure patient safety. Specific leadership behaviors to achieve this goal are underexamined. The LMX perspective has shown promise in nonhealthcare settings as a means to explain safety climate perceptions.


Methods: Cross-sectional survey of staff (n = 711) and unit directors from 34 inpatient units in an academic medical center was conducted.


Results: Significant differences were found between high and low LMX scoring units on supervisor safety expectations, organizational learning-continuous improvement, total communication, feedback and communication about errors, and nonpunitive response to errors.


Conclusion: The LMX perspective can be used to identify differences in perceptions of safety climate among nursing staff. Future studies are needed to identify strategies to improve staff safety attitudes and behaviors.