Measuring and improving the culture of safety are essential to safety improvement activities. AHRQ developed the Nursing Home Survey on Patient Safety Culture to specifically assess safety climate in this setting, where nursing home residents are vulnerable to a host of safety issues including medication errors. This study mirrored prior research in documenting an overall poor level of safety culture in a sample of 40 nursing homes. Administrators and managers had a more positive perception of safety culture than did frontline personnel, also similar to prior research. Suboptimal communication between nurses and physicians has been implicated as a driver of poor safety climate in nursing homes.