Degree Name

PhD (Doctor of Philosophy)



Date of Award


Committee Chair or Co-Chairs

Katherine Christine Hall

Committee Members

Lisa Haddad, Kevin Harris, Kenneth Phillips


Safety culture has been demonstrated to be a key factor in high-reliability organizations (HROs), yet healthcare has not achieved a safety culture as seen in HROs despite decades of effort. Student nurses are enculturated into their profession during their pre-licensure education. This period offers an excellent opportunity to teach students the values, norms, and practices of safety culture. However, little is known about the state of safety culture in schools of nursing.

The purpose of this study was to examine the state of patient safety culture as perceived by students in pre-licensure nursing programs in the US using a modified version of the Hospital Survey on Patient Safety Culture (HSOPSC). The School of Nursing Culture of Safety Survey (SON-COSS), the modified instrument created for this study, was administered electronically to a sample of pre-licensure nursing students (N=539) drawn from membership in the National Student Nurses Association (NSNA).

The SON-COSS was found to maintain its reliability and validity for use in pre-licensure nursing students. Perceptions of patient safety culture ranged from 81.6% to 23% positive for the 10 dimensions of patient safety culture measured by the SON-COSS. The highest percent positive dimensions for this study were Faculty Support for Patient Safety (81.6%), Teamwork Within Groups (78.3%), and Faculty Expectations and Actions Promoting Patient Safety (68.6%). The lowest percent positive dimensions for this study were Frequency of Events Reported (47.3%), Communication Openness (34%), and Nonpunitive Response to Error (23%). Participants in this study perceived patient safety culture significantly lower for eight of the 10 dimensions measured by the SON-COSS compared to aggregate national data from the HSOPSC (AHRQ, 2016). Only Faculty Support for Patient Safety (81.6%) was significantly higher than the corresponding dimension in the HSOPSC.

The results of this survey indicate that students recognize the importance of safety to their faculty, but they do not perceive the presence of a just culture, an essential prerequisite for a culture of safety. This study provides a reliable and valid instrument to measure safety culture in schools of nursing and baseline data to understand the state of safety culture in this population.

Document Type

Dissertation - unrestricted


Copyright by the authors.