Nurses' fear of blame following a medication event and confusion about the error-reporting requirements of multiple regulatory bodies that oversee nursing practice and nursing home operations can stifle the discussion and analysis of medication administration events to promote patient safety. The Massachusetts Board of Registration in Nursing and the University of Massachusetts Medical School Center for Health Policy and Research convened the Massachusetts Medication Safety Alliance, a 15-member collaborative of regulatory agencies and long-term care providers, to develop the Nurse-Employer Medication Safety Partnership Model to cultivate a safety culture in Massachusetts nursing homes that supports voluntary medication-event recognition and disclosure by nurses. A proactive approach to the Board's public protection mission, the model will promote public safety through early intervention and quality improvement. To guide the model's development, the Alliance assessed the perceptions of 1,286 nurses working in 109 Massachusetts nursing homes, finding more than half rated their practice environment as punitive and identified fears of blame, disciplinary action, and lawsuits as barriers to medication-event reporting.