The “Tenure Paradox” in Patient Safety Culture Among Nurse Managers: A Cross-Sectional Study

Objective: Nurse managers (NMs) play a pivotal role in shaping unit-level safety climates. The relationship between their professional experience and safety perception remains underexplored. This study assesses how NMs perceive patient safety culture and isolates the demographic and organizational predictors of these perceptions. Background: While frontline nurses’ views are well-documented, NMs’ perspectives, particularly regarding how tenure influences safety awareness, are often limited. Understanding this dynamic is essential for identifying organizational gaps in hospital administration. Methods: The authors employed a descriptive, cross-sectional design, including 125 NMs from a tertiary hospital complex in Istanbul, Türkiye, between September and October 2024. Data were collected using the Patient Safety Culture Scale. Multiple regression analysis was applied to determine the explanatory power of key variables, including tenure, training, and reporting habits. Results: Participants reported a moderate-to-high mean safety culture score (3.02 ± 0.52). While general perceptions were positive, the domain of “Adverse Event and Error Reporting” received the lowest ratings. The regression model ( R 2 =0.37, P <0.001) indicated a significant divergence. While safety training positively influenced scores, longer tenure in the same unit was associated with lower safety perceptions. Conclusion: These findings suggest a “tenure paradox,” where prolonged exposure to the same clinical environment may lead to reduced sensitivity or the “normalization of deviance” among NMs. Healthcare organizations should prioritize leadership rotation and targeted refreshment programs rather than assuming experienced managers inherently maintain high safety vigilance.