Safety Culture in Healthcare Settings

Posted on by Bonnie Rogers, DrPH, and David Weissman, MD


As of 2019, more than 18 million people, 11.5 % of the United States workforce, were employed in healthcare settings. Everyday healthcare workers face hazardous work conditions due to exposures to infectious agents and hazardous drugs and chemicals. Examples include:

  • Influenza
  • Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)
  • Mycobacterium tuberculosis
  • Antineoplastic agents
  • Surgical smoke
  • Disinfectants
  • Physical agents like radiation
Photo © Getty Images

Healthcare workers also perform risky tasks and experience harmful psychosocial conditions such as:

  • Heavy lifting
  • Repetitive tasks
  • Violence and bullying
  • Shift work with odd hours
  • Long work hours
  • Fatigue

These work environments create substantial stress and stress-related adverse outcomes that can result in:

  • Anxiety
  • Depression
  • Suicide
  • Disruption of work-life balance

The Healthcare and Social Assistance Sector industries reported 806,200 work-related injuries and illness in pandemic year 2020. This was a 40% increase over 2019 representing approximately 30% of the total of 2,654,700 injuries and illnesses for all industries that year. These numbers represent the vital importance of understanding and implementing effective safety practices for healthcare workers in all settings.

Safety culture is not a slogan. Practicing safety must be a joint effort with management and workers to develop policies and procedures to identify, monitor, mitigate, and eliminate work-related hazards. Non-fatal injuries, illnesses, and disabilities continue to go unrecognized within an uneven safety culture. To address this need, a group of clinicians and experts in occupational safety and health developed the Safety Culture in Healthcare Settings training course. Safety and health professionals, labor representatives, educators, and researchers provided extensive input into the course. It provides science and evidence-based information to increase knowledge about work-related hazards and prevention strategies. Safety Culture in Healthcare Settings addresses six competencies:

  1. Describe the importance of safety culture in health care settings.
  2. Identify common work-related risk and hazards.
  3. Explain strategies to prevent/control work-related injury/illness.
  4. Identify leadership strategies that lead to continuous improvement of safety culture for health care workers.
  5. Describe the Occupational Safety and Health Act as legal framework for worker safety and health.
  6. Describe ethical principles of safe working that guide health team members’ professional practice.

The course also offers continuing education credits free of charge.

Safety culture should be a priority in all healthcare settings. Recognizing the known risks and taking appropriate action to prevent hazards is a responsible first step. Taking this course can help accomplish this important responsibility.


Bonnie Rogers, DrPH, COHN-S, LNCC, FAAN, is an adjunct professor at the University of North Carolina and Co-Chair of the NORA Healthcare and Social Assistance Sector committee member.

David Weissman, MD, is the Director for the NIOSH Respiratory Health Division and Co-Chair of the NORA Healthcare and Social Assistance Sector committee member.

Posted on by Bonnie Rogers, DrPH, and David Weissman, MD

7 comments on “Safety Culture in Healthcare Settings”

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    Really health care worker are main role performing person in the healthcare industry their are many decision are they taking and maintaining the safety health care setting it will be very appreciable Thanks for sharing this information with us Keep sharing

    I appreciate the opportunity to share my perspective as a healthcare worker, as an older worker, and as someone who now spends my work hours trying to make the bedside a safer place for the next generation of healthcare workers.

    I am sorry to say that I spent many years contributing to an unsafe and unhealthy workplace. As a nurse in emergency and critical care medicine, I considered it routine to go through 12-hour shifts without any real break. We ate on the run like toddlers, grabbing bites here and there to make it to shift change. We joked about our 13-hour bladders, but we weren’t really kidding. We created a workplace culture that accepted unsafe staffing, unfair work practices, and the exploitation of people like me, who were eager to be invaluable.

    I have helped children make it to another birthday, get adults successfully weaned from the ventilator, and helped others die with as little pain and fear, as much dignity, as we could make possible. I have cried in locker rooms, stairwells, and way too many trips home. I have also been hit, bitten, threatened, and exposed to pathogens too numerous to count. I have bathed and turned patients three times my size and lifted many from chair to bed who were sure they could stand on their own. The sheer physicality of bedside care is staggering. Patient safety has been emphasized and championed. Staff safety has not.

    I also didn’t know what I didn’t know. I had been a nurse for 28 years when I took care of the first Ebola patient. Twenty-eight years at the bedside and I never knew there were different levels of gowns. I knew nothing about air exchanges, permeability of textiles, or the fluid resistance of masks. Fit testing was, and is, rare, and I didn’t know that was a problem.

    I see the staff shortages. I understand leaving the bedside. I am not surprised enrollment in nursing schools is down. I also hear the complaints about people just not being willing to work these days, and I think that is just not true. We should not have worked the way we did. We should not have tolerated the staffing, the hours, the injuries, illnesses, or threats that we did. Healthcare is an industry that will never be remote or outsourced, but it must be made healthier and safer. As our population ages, more workers will be needed in both acute and long-term care, and we don’t have them. We desperately need a true assessment of the risks these workers face from injuries, ergonomics, noxious and infectious exposures, workplace violence, stress and burn-out. We need a “culture of safety” to mean something for workers, not just patients.

    I know without improvements in funding, little progress can be made, so I hope that others will understand the critical needs there are to advance worker health and safety.

    Thank you for all you do as a nurse and for sharing your heartfelt experience. Healthcare workers play a critical role in the health of society. Your personal experience is an example of how nurses who serve on the frontlines of healthcare delivery are routinely at risk for exposure to a range of hazards, both physical and those causing stress and burnout. Furthermore, the burden of occupational injury and illness for healthcare workers, including nurses, is likely to increase. Several healthcare occupations are projected to be among the fastest growing in coming years, including in settings such as home health care, increasing the number of workers at risk. Our aging population will likely increase the workload on healthcare workers. This, combined with budgetary stresses, has the potential to exacerbate stress and burnout. Increasing prevalence of obesity in the population will increase musculoskeletal hazards related to patient handling. New infectious agents will continue to emerge. These and other changes mean that occupational safety and health challenges faced by healthcare workers will only increase in coming years.

    We agree that actions at the organizational level, including development and promotion of strong organizational safety culture, are needed now and in the future to protect the safety and health of nurses and other healthcare workers. The training course referenced in this blog Safety Culture in Healthcare Settings is designed to improve healthcare worker knowledge about work-related hazards and address organizational strategies to promote a safe and healthy work environment. NIOSH also developed the Impact Wellbeing campaign to provide healthcare leaders with the tools to build an environment that supports healthcare worker well-being. The National Academy of Medicine (NAM) Well-Being initiative provides healthcare systems with seven priority areas needed to develop a healthy and equitable healthcare workforce. Under each priority, the initiative lists goals and actors needed for success at each level of healthcare. Much work is needed to make the healthcare profession safer and healthier for workers. Thank you for contributing to this important conversation!

    Hi Jill
    Thank you for your comments reflecting your nursing experiences over the years. As a nurse I agree with the need for a strong safety culture that is active not just words. Many thanx for your continued service.

    The importance of a robust safety culture in healthcare settings cannot be overstated. A safety culture is not just a set of protocols or procedures; it is a mindset ingrained in every aspect of healthcare delivery. In environments where patient well-being is paramount, fostering a culture that prioritizes safety enhances the quality of care and reduces the risk of adverse events.

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Page last reviewed: September 27, 2023
Page last updated: September 27, 2023