Nursing leadership and patient safety: Can you think of two concepts that go together better than they do? As nurse leaders, we must stand strong for the safety of those for whom we provide care, as well as those who provide that care; both are indelibly intertwined. Patient safety is our job-to forget this is tantamount to professional negligence.
This issue of Nursing Management is dedicated to patient safety. It takes so many forms in our practice environment, from the simplest procedure to the most complex decisions. Why are simple procedures so hard to achieve as "always" events? Hand washing and patient identification come to mind. Unfortunately, "simple" doesn't seem to exist, which is emblematic of the struggle we face every day to be true leaders for safety.
The why's of our struggle are numerous. We, our staff, and our colleagues are fallible human beings who work in environments where 100% perfection can't be hardwired. We may not have access to real-time data that illustrate our needed areas for improvement. Intraprofessional colleagues may not share the same values. Support for change can be elusive, but let's not focus on the negative.
There's so much you can do as a pillar of patient safety. For one, make it obvious that safety is an ever-present priority. Speak to it. Live by it. Make decisions by it. Your staff should be eminently clear that putting patients at risk isn't negotiable. That being said, the balance between nonnegotiable safety and a just culture is difficult for many. However, without a just culture, you won't have a safety culture; without a safety culture, behaviors won't be automatically focused on preventing harm and protecting patients from risk of harm. And without both, you won't have a highly reliable organization when it comes to patient safety.
So now you're wondering what it takes to balance a fair approach to errors and near misses that doesn't violate a nonnegotiable value. One tenet is to listen to David Marx and the just culture community, avoiding punishment of an individual unless there's evidence of persistent risk to patients despite coaching or there's intentional negligence. In every case, get to the deepest reasons why it occurred and fix the reasons. Taking a systems approach is the only way to make a real difference. Otherwise, the errors of one will be the errors of others. When history repeats itself, shame on us. If you see an opportunity to improve patient safety, don't be shy, be courageous.
Help your staff members be as passionate as you are. At the frontline they're our vigilantes, our eyes and ears to stop the line when violations of clearly established protocols occur, as well as those not so clear, including situations that just don't feel right. Allow them to speak out and be supported, correct or not. Let them acknowledge mistakes without fear of reprisal. Every experience must be viewed as a learning experience if we're to grow reliably safer.
Have those crucial conversations to promote accountability, look at practice in your area (what's really happening, not what you think is happening), understand the why's of errors, promote technology and practice improvements that reduce variation, celebrate successes, and, most of all, avoid the knee-jerk reaction to punish until you know the story-the whole story.
Every step forward is important to the critical links between nursing leadership, patient safety, and highly-reliable organizations. We can and must do this!
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