1. Mason, Diana J. PhD, RN, FAAN


Let's use the national attention on health care errors.


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Late last year, when the Institute of Medicine (IOM) released To Err Is Human: Building a Safer Health System (National Academy Press;, its report on errors in health care, Americans were horrified to learn that health care errors are the seventh leading cause of death in the U.S. But the extensive media attention on this report has placed patient safety on the public's agenda, giving nurses a rare opportunity to promote better working conditions. FIGURE

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The following highlights are particularly relevant to nurses:


Patient safety must be a corporate priority. Nurses may think that corporate priorities aren't within their control, but recent media attention should prompt both health care providers and the public to demand a commitment to patient safety from their local institutions. It's important for people to understand the connection between nurse staffing levels and patient safety. We should tell the media that improving nurses' working conditions could alleviate some of the problems outlined in this report.


Patient safety must be everyone's responsibility. The report discusses the "two-challenge rule," the policy in military and civilian aviation that authorizes a subordinate to take control of an aircraft if the pilot fails to respond satisfactorily on two occasions to the subordinate's report of danger. Why isn't there a two-challenge rule in health care?


Nurses can't ignore hazards, even if the leaders in our institutions choose to do so. All nurses who care about improving practice conditions should read this report, discuss it with colleagues, and demand that their institution adopt a patient safety program. Collective bargaining priorities ought to include creating and supporting an institutional commitment to safety. And nurses should continue to fight for legislation supporting whistleblower protections, health care's two-challenge rule.


Jobs must be designed for safety. Nursing's concerns are featured throughout the document, thanks to Mary Wakefield of George Mason University, the only nurse on the 19-member IOM committee. For example, the report notes that designing jobs for safety includes "addressing staff training needs and anticipating harm that may accompany downsizing, staff turnover, and the use of part-time workers and 'floats.'" Nurses have raised these issues with health care administrators for years, but this report, and its subsequent publicity, gives us new ammunition.


Health care organizations and teaching institutions need to create learning environments where reporting errors and hazardous conditions can be encouraged. This lays the foundation for shifting the blame for errors from individuals to systems. Such a shift would require institutions to consider the contexts of errors rather than the mistakes themselves, nursing schools to understand that mistakes are part of learning, and state boards of nursing to reexamine how they assess misconduct charges.


The IOM report isn't without controversy. Some fear that mandatory reporting of errors will lead to more lawsuits, or that hospitals and nursing homes will use back-up systems, such as video cameras in patients' rooms, rather than champion provider-patient relationships through adequate staffing.


In this issue, David Keepnews launches our new Policy Perspectives column by discussing in greater detail the IOM report and its implications for nursing. Also in this issue, Sharon LaDuke presents a provocative survey of nurses who have been convicted of professional misconduct. While a low response rate limits generalizations from this study, we hope it will raise awareness about how state boards of nursing, and nurses themselves, respond to those who have erred. Finally, if you attend the ANA convention this month, come to the AJN-sponsored plenary session on practice errors with presenters David Keepnews and Lucian Leape, a physician and leading authority on the topic. If you are unable to attend, log on to anytime between June 1 and June 25 to preregister for our live, interactive Webcast of a discussion with these experts, to air on June 25, at 12:00 PM EST.