Nurses feared punishment and legal action or losing their jobs. The qualitative findings revealed that fear was a key causal factor for underreporting of medication errors. Moreover, less than 10% of nurses report errors in two participant hospitals in the last two years. The findings from surveys showed that 50% of nurses in this study have not made an incident report in the last 12 months. Results: The literature review highlighted a lack of studies exploring the relationship between perceived safety culture and nursing leadership styles and medication errors reporting. The second, qualitative phase involved face-to-face semi-structured interviews with nurses (n=8) and nurse managers (n=8). The first phase began with the collection and examination of quantitative data from four hospitals in the Qassim region using the Hospital Survey on Patient Safety Culture (HSOPSC) (n=218) and the Multifactor Leadership Questionnaire (MLQ 5X) (n=186), along with a prospective audit of type and rates of reported medication errors on these wards. Methods: The methodological design adopted for this study was an explanatory sequential mixed methods design quantitative followed by qualitative in two phases. A review of literature highlighted that no study had previously investigated the effect of safety culture and nursing leadership styles on medication error reporting.Īim: The aim of this study was to explore the relationship between perceived safety culture, nursing leadership and medication errors reporting (by nurses) in adult medical-surgical wards in the Qassim region of Saudi Arabia. A positive safety culture and effective leadership likely plays an essential role in improving medication error reporting systems. Error discovery through an effective leadership and active reporting system uncovers medication errors and encourages safe practices. Background: Medication errors have significant implications for patient safety and can cause serious harm and even death.