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Aim: To examine first‐line nurse managers’ perceptions of safety culture and explore relationships between their safety attitudes and safety factors in Henan Province, China. Background: Health providers’ perceptions of patient safety culture have been studied widely, but little is known about first‐line nurse managers’ safety attitudes. Methods: A cross‐sectional survey was conducted with a convenience sample of 823 first‐line nurse managers in 216 hospitals across Henan Province, China. The Safety Attitudes Questionnaire (Chinese version) was distributed to first‐line nurse managers during training meetings; responses were returned in a sealed envelope in person or by mail. ANOVAs were used to analyse the differences in Safety Attitudes Questionnaire (Chinese version) scores between first‐line nurse managers’ attitudes and safety factors. Results: The mean scores across the six domains of Safety Attitudes Questionnaire (Chinese version) ranged from 56.6 to 79.4 on a 100‐point scale. First‐line nurse managers: ≥45 years of age perceived better safety climate (p < .05); those with higher professional ranks and medical centre positions reported higher mean scores for teamwork climate (p < .01) and stress recognition (p < .01); and those with baccalaureate degrees or higher had significantly higher mean scores for stress recognition (p < .01). Conclusion: First‐line nurse managers’ safety attitudes were not satisfactory and there is great potential to improve patient safety culture. Age, hospital level, educational background and professional rank are positively related to first‐line nurse managers’ attitudes. Implications for Nursing Management: Hospital administrators and nurse directors should focus on the safety factors identified in this study and enact a variety of strategies to create a strong patient safety culture in China. [ABSTRACT FROM AUTHOR]