Safety Culture and Job Satisfaction and their Associations with Adverse Event Reporting Attitudes among Nurses in Indonesian Community Health Centers

Adverse event reporting is essential for identifying system weaknesses, promoting organizational learning, and improving patient safety. However, evidence on the relationships among patient safety culture, job satisfaction, and attitudes toward adverse event reporting in primary care settings remains limited, particularly in Indonesian community health centers. This study examined the relationships among patient safety culture, job satisfaction, and attitudes toward adverse event reporting among nurses working in Indonesian community health centers.

This cross-sectional study involved 359 nurses from 44 community health centers in Malang, Indonesia. Data were collected using the Safety Attitudes Questionnaire (SAQ), the Job Satisfaction Survey (JSS), and the Reporting of Clinical Adverse Events Scale (RoCAES), and analyzed using descriptive statistics and path analysis.

Patient safety culture was positively associated with job satisfaction (β = 0.447, p < 0.001). Job satisfaction was positively associated with adverse event reporting attitudes (β = 0.530, p < 0.001). However, patient safety culture was not directly associated with adverse event reporting attitudes (β = -0.037, p = 0.500).

A stronger patient safety culture appears to translate into more favorable reporting attitudes mainly through its influence on job satisfication, rather than through a direct effect. This suggests that a supportive safety climate alone may not be sufficient to strengthen reporting behavior unless nurses also experience satisfaction with their day-to-day working conditions, highlighting job satisfication as a key mechanism linking safety culture to reporting attitudes among nurses in community health centers.

A stronger patient safety culture may indirectly improve attitudes toward adverse event reporting through enhanced job satisfaction. Strategies to improve reporting in community health centers should therefore combine efforts to strengthen safety culture with practical interventions that improve nurses’ job satisfaction, managerial support, and psychological safety.