Residents of long-term care facilities are particularly vulnerable to patient safety problems such as medication errors and falls. Improving safety in nursing homes depends on developing a culture of safety, but this survey of managers and frontline nurses found considerable variation in baseline perceptions of safety culture. Mirroring an issue previously identified in hospitals, nurse managers had a considerably more optimistic view of safety culture than did staff nurses. The authors recommend several interventions, including safety walk rounds, that could address this gap and thereby improve safety culture. The study measured safety climate using a slightly modified version of the AHRQ Hospital Survey on Patient Safety Culture.