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By Tejal Gandhi, MD, Chief Safety and Transformation Officer, Press Ganey. Coauthored by Milissa Eagle, MA, Director of Workforce Analytics, Press Ganey.

A key part of healthcare’s employee experience is creating an environment that’s safe for both the individuals providing care and the patients receiving that care. Sustaining a culture where individuals feel comfortable reporting and learning from safety events—and are equipped with the tools and resources to deliver high-quality, harm-free care—is essential to fostering engagement, trust, and a positive experience. Press Ganey data affirms a powerful truth: Engagement and safety culture are deeply interconnected. Yet our recent analysis of employee experience by shift uncovered another striking insight: Perceptions of safety aren’t consistent around the clock. And these inconsistencies are well worth exploring further.

A strong safety culture benefits staff and patients alike—and is foundational to delivering high-quality, compassionate care. Research consistently shows that night shifts pose greater risks for patients, with higher rates of medication errors, ICU admissions, and mortality. Fatigue, poor sleep quality, lower staffing levels, and less experienced teams during overnight hours contribute to these outcomes, and highlight the systemic vulnerabilities that must be addressed to ensure all patients are equally safe, regardless of when they receive care.

The challenge of the night shift

The data tells a clear story: Employees working the night shift report significantly lower experiences across most areas compared to their day, evening, and weekend shift counterparts. What stands out most are gaps in safety culture perceptions. The three largest differences emerged in:

Looking at item-level data, the disparities become even more human. Night shift employees are less likely to feel that their safety matters, and that leadership actively collaborates to ensure safe conditions. In fact, employees on night shift are 2x more likely to comment about safety and security than those working the day shift. Night shift employees are also less likely to feel that mistakes lead to learning and not blame.

This paints a picture of isolation where employees may feel unseen and unsupported during off-hours. If employees feel unsafe, or that the culture isn’t as safe overnight, those perceptions are trickling down, and patients are likely to feel the same—and can translate to less safe care.

It’s not a tenure problem

Even though approximately 50% of those working the night shift are made up of lower-tenure employees, our data did not reveal tenure as a large contributing factor to lower perceptions of safety culture. Regardless of tenure, these perceptions were consistently lowest across the night shift, compared to others.

Safety culture isn’t just a daytime priority

Safety risks don’t clock out at 5 p.m.—and neither should our commitment to safety. A strong safety culture is more than compliance; it’s a promise that every employee, regardless of shift, feels physically safe, feels they can provide safe care, and that every patient feels safe, all the time. It builds trust, encourages reporting without fear, and ultimately safeguards both employees and patients.

What can healthcare organizations do?

Safety is a lived experience, shaped by what people see and feel in real time. And that experience must hold true for every employee, on every shift, every day. A strong, around-the-clock safety culture is the foundation for trust, workforce well-being, and organizational success. It must be built intentionally—and upheld consistently—for every employee, on every shift, every day.

To learn more about Press Ganey’s safety solutions, reach out to an expert.