1. Scott, Chantell BSN, RN, CCRN
  2. L., Toth BSN, RN

Article Content

Safety culture a must

Thank you for publishing "Transform Into a Culture of Safety" by Lynn Marie Bullock, DNP, RN, in the July issue. As the director of a cardiovascular ICU and a cardiovascular progressive care unit, I've been challenged with transforming our culture into a culture of safety. Preventing errors related to medication administration is one of our overarching goals for 2011. Despite the heightened awareness of patient safety revolving around medication errors, we, as nursing leaders, continue to set ourselves up for failure because our healthcare environments are so punitive.


In 1999, the Institute of Medicine reported medical errors as the eighth leading cause of death in the United States, contributing to nearly 100,000 deaths per year. The growing number of medical errors in hospitals and resulting preventable deaths present an ethical dilemma that must be addressed by healthcare leaders and managers. In other words, it's the responsibility of leaders and managers to direct attention to safety, which begins with perceptions of the safety environment.


According to the author, for healthcare organizations to improve patient outcomes, we must transform from a punitive environment into a culture that has high expectations. A culture of safety driven by ethics is required. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. A safety culture is enabled when leaders create a context in which employees are empowered to speak up and act to resolve threats to patient safety. I agree that the challenge for healthcare leadership and management is to answer the ethical call for a culture based on patient- and family-centered care.


In my opinion, patient safety should be a fundamental ethical requirement of all healthcare personnel. This can be achieved if healthcare administrators promote and support a culture of safety by allowing staff to report errors without the fear of punitive repercussions.


Chantell Scott, BSN, RN, CCRN


The University of Texas at Arlington


Doing away with 12-hour shifts

Nurse leaders are responsible for creating and maintaining healthy, safe work environments for their staff and patients. It's time for nurse leaders to take a hard look at eliminating 12-hour shifts on behalf of patient and staff safety. The article by Jacqueline A. Miller, BSN, RN, NE-BC, "When Time Isn't on Your Side: 12-hour Shifts" from the June issue prompted me to seriously look at the 12-hour shift staffing model for my department. I'm concerned about the negative effects that extended shifts can have on patients and staff.


Research supports that long shifts of 12 hours or greater can have a negative effect on nurse performance and, therefore, a negative effect on patient care outcomes. In addition to fatigue, 12-hour shifts have also been shown to have adverse effects on the health of the nurse and may contribute to conditions such as diabetes, depression, unhealthy behaviors, and hypertension. If we know this to be true, as nursing professionals, why do we continue to support the 12-hour staffing model in our healthcare facilities when it places our patients and nursing staff at risk for harm? The older nursing population experiences increased fatigue, requires longer recuperation time, and is less tolerant of sleep deprivation. If patient safety is truly the priority, maintaining the 12-hour shift staffing model on behalf of staff preference or economic benefit is neither in our patients' nor our nurses' best interest.


Nurse leaders frequently have to make hard decisions. The elimination of 12-hour shifts won't be an easy one. Nursing staff satisfaction may be negatively affected and increased cost in schedule coverage may ensue. Staff members must be educated about the negative effects that long work hours can have on themselves and their patients. The business case for eliminating extended shifts can be built around nursing productivity, personal injury rates, patient error rates, and absenteeism. The evidence is clear: The 12-hour shift staffing model isn't in the best interest of our patients or staff. Evidence-based management decisions must be made even though they may be deemed unpopular. It's imperative for healthcare leaders to implement changes and create workplace cultures that ensure healthy, safe work environments. It's critical on behalf of our patients' safety.


L. Toth, BSN, RN


The University of Texas at Arlington