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* 3. People support one another in this unit.

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* 4. We have enough staff to handle the workload.

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* 5. Staff in this unit work longer hours than is best for patient care.

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* 6. We are actively doing things to improve patient safety.

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* 7. When a lot of work needs to be done quickly, we work together as a team to get the work done.

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* 8. In this unit, people treat each other with respect.

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* 9. This unit relies too much on temporary, float, or PRN staff

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* 10. Staff feel like their mistakes are held against them.

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* 11. When an event is reported, it feels like the person is being written up, not the problem.

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* 12. When one area in this unit gets really busy, others help out.

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* 13. After we make changes to improve patient safety, we evaluate their effectiveness.

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* 14. We work in “crisis mode” trying to do too much, too quickly.

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* 15. When staff make errors, this unit focuses on learning rather than blaming individuals. 

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* 16. We have patient safety problems in the unit.

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* 17. Our procedures and systems are good at preventing errors from happening.

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* 18. In this unit, there is a lack of support for staff involved in patient safety errors.

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* 19. My supervisor/manager seriously considers staff suggestions for improving patient safety.

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* 20. In the past 12 months, how many event reports have you filled out and submitted?

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* 21. We are given feedback about changes put into place based on event reports.

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* 22. Staff will freely speak up if they see something that may negatively affect patient care.

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* 23. Staff feel free to question the decisions or actions of those with more authority.

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* 24. In this unit, we discuss ways to prevent errors from happening again.

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* 25. Staff are afraid to ask questions when something does not seem right

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* 26. When a mistake is caught and corrected before reaching the patient, how often is this reported?

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* 27. When a mistake reaches the patient and could have harmed the patient, but did not, how often is this reported?

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* 28. How many times have you not reported a safety issue, when you should have?

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* 29. How would you rate your unit/work area on patient safety?

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* 30. Management promotes patient safety.

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* 31. Hospital management seems interested in patient safety only after an adverse event happens

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* 32. My supervisor, manager, or clinical leader takes action to address patient safety concerns that are brought to their attention

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* 33. When transferring patients from one unit to another, important information is often left out

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* 34. Important patient care information is often lost during shift changes.

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* 35. During shift changes, there is adequate time to exchange all key patient care information

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* 36. How long have you worked in this hospital

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* 37. How long have you worked in your current unit?

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* 38. Typically, how many hours per week do you work in this facility?

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* 39. In your staff position, do you typically have direct interaction or contact with patients?

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* 40. Any Additional comments

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