1. Safety Attitude Survey (SAQ) Tool Validation for Senior Nursing Students and First Year Registered Nurses
Lora K. Ott PhD, RN
Jan Wachter, SCD, MBA, CIH, CSP, CQE, CRE
Indiana University of Pennsylvania
Indiana, PA

2. Our Project
Ultimate aim: To describe the safety climate attitudes of nurses at two time points
1) as pre-licensure senior students and
2) the same nurses during their first year in practice as RNs

3. Step one – Tool Validation
The purpose of this study is to validate the SAQ as a tool to measure safety attitudes in the undergraduate nursing student population. The specific aims of this study are:
Specific Aim 1: To determine the validity and reliability of the SAQ in the undergraduate nursing student population.
Specific Aim 2: To determine the validity and reliability of the adapted SAQ in first year registered nurses.

4. Why the SAQ? Strong Original Psychometrics:
Developed Bryan Sexton, Eric Thomas, and Bob Helmreich
Funded by the Robert Wood Johnson Foundation & the AHRQ
Sexton, J., Helmreich, R., Neilands, T., Rowan, K., Vella, K., Boyden, P. &
Thomas, E. (2006) The Safety Attitudes Questionnaire: psychometric properties,
benchmarking data, and emerging research. BMC Health Services Research.
6(44) doi: /
“Six cross-sectional surveys of health care providers
(n = 10,843) in 203 clinical areas (including critical care units, operating rooms, inpatient settings, and ambulatory clinics) in three countries
(USA, UK, New Zealand). “

5. Why the SAQ? continued Validated around the World:
Jeong HJ, Jung SM, An EA, Kim SY, Yoon H, et al. (2015) Development of the Safety Attitudes Questionnaire - Korean Version (SAQ-K) and its Novel Analysis Methods for Safety Managers. Biom Biostat Int J 2(1): DOI: /bbij
Elsous, A., Akbarisari, A., Rashidian, A., Aljeesh, Y., Radwan, M., et al. (2017) Psychometric Properties of an Arabic Safety Attitude Questionnaire (Short Form 2006) Oman Medical Journal 32:2,
Smits M, Keizer E, Giesen P, Deilkås ECT, Hofoss D, et al. (2017) The psychometric properties of the ‘safety attitudes questionnaire’ in out-of-hours primary care services in the Netherlands. PLOS ONE 12(2): e

6. Why the SAQ? continued Validated in Various Hospital Settings:
Just a few - ICU, ED, Ambulatory, Long Term Care, Labor and Delivery
Select Bibliography of published work:
Validated in Medical Students:
Assessing Medical Students’ Perceptions of Patient Safety: The Medical Student Safety Attitudes and Professionalism Survey
Joshua M. Liao, MD, Jason M. Etchegaray, PhD, S. Tyler Williams,
David H. Berger, MD, MHCM, Sigall K. Bell, MD, and Eric J. Thomas, MD, MPH

7. SAQ

8. Content Analysis Consensus – Student SAQ

10. First Year RNs - SAQ

11. Senior Nursing Students
Demographics
Senior Nursing Students
N=142
First Year Nurses
N=81
Sample without missing data
N=137
N=67
Gender Male
Female
14 (10%)
128 (90%)
9(11%)
72 (89%)
Clinical Site ICU
Management
Community
Psychiatric
Adult health
89 (63%)
5 (4%)
23 (16%)
Primary Work Area
Adult
Pediatrics
Both
59 (73%)
2 (.02%)
16 (20%)
4(.05%)

12. Reliability and Factorability
Senior Nursing Students
First Year Nurses
Cronbach’s Alpha
.902
35 Items
.945
41 items
Kaiser-Meyer-Olkin (KMO)
.803
.758
Bartlett’s Test of Sphericity
p= .000

13. Scale Factors compared to Original SAQ
Senior Nursing Students SAQ (15-35 numbering differs from original)
First Year
Nurses SAQ
(15-35 numbering differs from original)
Teamwork Climate
items 1-6
1-3, 7, 11,15-18, 29,
Teamwork/Safety Climate
1, 3, 7, 8, 13, 14, 16-18, 24, 28, 32, 38
Job Satisfaction
items 15-19
15-18
(loaded as teamwork factor)
Job Support - 5, 10, 15, 19,
34, 39, 40
Perceptions of Management
items 24-29
9, 10, 23-28, 30, 35
25-27, 29-31, 33
good original factor match
Safety Climate
items 7-13
4, 5, 8, 12, 32
Staffing - 19, 34
Working Conditions
items 30-32
All items fell under teamwork and perceptions of management
2, 4, 9, 11, 12, 35-37
Stress Recognition
items 20-23
19-22
Exact original factor match
20-23
Unscaled Items
14, 33 – 36
Physician/Nurse Collaboration – 6, 33, 34

14. Scale Factors compared recap
Original SAQ
Senior Nursing Students SAQ (15-35 numbering differs from original)
First Year
Nurses SAQ
(15-35 numbering differs from original)
Teamwork Climate
Teamwork/Safety Climate
Job Satisfaction
Job Support
Perceptions of Management
Safety Climate
Working Conditions
Stress Recognition
Physician/Nurse Collaboration
Staffing

15. Senior Nursing Students
Comparison of Means
Independent sample t-test on question means with statistical difference
Questions
Senior Nursing Students
M (SD)
First Year RNs p=
Q2 - In this clinical area, it is difficult to speak up if I perceive a problem with patient care.
2.55 (.935)
2.19 (1.126)
.011
Q4 – I have the support I need from other personnel to care for patients.
4.17 (.663)
4.47 (.709)
.002
Q5 – It is easy for personnel here to ask questions when there is something that they do not understand.
4.18 (.701)
4.49 (.760)
Q8 – Medical errors are handled appropriately in this clinical area.
3.84 (.721)
4.58 (.788)
.000
Q9 – I know the proper channels to direct questions regarding patient safety in this clinical area.
3.85 (.743)
4.43 (.688)

16. Q16n/15s – Working here is like being part of a large family.
Questions
Senior Nursing Students
M (SD)
First Year RNs p=
Q12 – I am encouraged by my colleagues to report any patient safety concerns I may have.
3.99 (.647)
4.48 (.673)
.000
Q 14 – My suggestions about safety would be acted upon if I expressed them to management.
3.48 (.778)
3.90 (1.06)
.001
Q16n/15s – Working here is like being part of a large family.
3.45 (.927)
4.06 (.885)
Q17n/16s – This ia good place to work.
3.87 (.761)
4.15 (.910)
.017
Q18n/17s – I would be proud to work in this clinical area.
3.97 (.816)
4.40 (.866)
Q19n/16s – Morale in this clinical area is high.
3.76 (.786)
3.27 (1.11)
Q20n/19s – When my workload becomes excessive, my performance is impaired.
3.60 (1.0)
3.96 (1.21)
.016
Q24/23s – The unit management supports my daily efforts.
3.66 (.695)
3.99 (1.03)
.005
Q32n/27s – I get adequate, timely info from the unit management about events that might affect my work.
3.50 (.76)
4.04 (.968)

17. Q37n/31s – Trainees in my discipline are adequately supervised.
Questions
Senior Nursing Students
M (SD)
First Year RNs p=
Q34n/28s – The level of staffing in this clinical area are sufficient to handle the number of patients.
3.66 (1.02)
2.98 (1.26)
.000
Q37n/31s – Trainees in my discipline are adequately supervised.
3.87 (.651)
4.16 (.934)
.007
Q38n/32s – I experience good collaboration with nurses in this clinical area.
4.23 (.657)
4.44 (.592)
.018
Q39n/33s – I experience good collaboration with staff physicians in this clinical area.
3.75 (.827)
3.96 (.839)
.075
Q40n/34s – I experience good collaboration with pharmacists in this clinical area.
3.26 (.929)
4.01 (1.07)

18. Future Research
Longitudinal Study to follow students through their first year of practice
and possibly beyond.
Explore innovative pedagogy to bridge the transition to practice
reality gap.
Explore innovative pedagogy to increase collaboration between
nursing students and management/physicians.

19. References
Elsous, A., Akbarisari, A., Rashidian, A., Aljeesh, Y., Radwan, M., et al. (2017) Psychometric Properties of an Arabic
Safety Attitude Questionnaire (Short Form 2006) Oman Medical Journal 32:2,
Jeong HJ, Jung SM, An EA, Kim SY, Yoon H, et al. (2015) Development of the Safety Attitudes Questionnaire - Korean
Version (SAQ-K) and its Novel Analysis Methods for Safety Managers. Biom Biostat Int J 2(1): DOI:
/bbij
Sexton, J., Helmreich, R., Neilands, T., Rowan, K., Vella, K., Boyden, P. & Thomas, E. (2006) The Safety Attitudes
Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Services
Research. 6(44) doi: /
Smits M, Keizer E, Giesen P, Deilkås ECT, Hofoss D, et al. (2017) The psychometric properties of the ‘safety attitudes
questionnaire’ in out-of-hours primary care services in the Netherlands. PLOS ONE 12(2): e
Liao, J., Etchegaray, J., Williams, T., Berger, D., Bell S. & Thomas, E. (2014) Assessing Medical Students’ Perceptions of
Patient Safety: The Medical Student Safety Attitudes and Professionalism Survey, Academic Medicine, 89(2):343-
351.