Background: Burnout impacts nurses' health as well as brain structures and functions including cognitive function, which could lead to work performance and patient safety issues. Yet, few organization-level factors related to patient safety have been identified. Purpose: This study examined nurse-reported patient safety grade and its relationship to both burnout and the nursing work environment. Methods: A cross-sectional electronic survey was conducted among nurses (N = 928) in acute care Alabama hospitals. Results: In multilevel ordinal mixed-effects models with nurses nested within hospitals, all burnout dimensions of the Copenhagen Burnout Inventory (OR for +1 SD ranging 0.63-0.78; P <.05) and work environment (OR for +1 SD ranging 4.35-4.89; P <.001) were related to the outcome of patient safety grade after controlling for nurse characteristics. Conclusions: Results indicate that health care organizations may reduce negative patient safety ratings by reducing nurse burnout and improving the work environment at the organization level.