A grounded theory of creating space for open safety communication between hospitalized patients and nurses

•Nurses were concerned about creating a space for open safety communication.•A trustworthy reaction was key to creating the space for open safety communication.•Open communication is needed for safety co-production between nurses and patients.•Nursing education should include trustworthy responses to patient safety concerns. There is evidence that fear of negative nurse response may prevent hospitalized patients from sharing safety concerns, adversely affecting patient safety. The purpose of the present study was to describe the process by which bedside nurses recognize and respond to safety concerns expressed by patients or their families. Twenty-five bedside nurses from 30 maternal-child, intensive, medical-surgical, and psychiatric inpatient units within an academic medical center participated in semi-structured interviews. Data were analyzed using grounded theory. Nurses reported creating space for open safety communication to foster trust and maintain patient safety and sense of security. Nurses anticipated safety concerns, invited safety discussion, were accessible, recognized insecurity, reacted in a trustworthy way, shared a plan, and followed up with patient and family. This process involves multiple interacting components, yet was remarkably consistent across acute care settings, despite differences in nurses, patient populations, and unit cultures.