Despite more than a decade of patient safety initiatives in our health care system, nurses (N = 172) identified a large number of safety issues in the ambulatory care setting, including issues in their own practice (50.7% of the encounters), feeling rushed or hurried (34.8% of encounters), and being interrupted (27.0% of encounters). Greater patient complexity was a significant predictor of identifying a diagnostic or management and treatment issue. The presence of an electronic health record was not related to reporting of a patient safety issue.