1. Walsh, Colleen DNP, RN, ONC, ONP-C, CNS, ACNP-BC
  2. NAON President 2016-2017

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The summer went by so quickly, didn't it? It was a beautiful summer for most parts of the country and now we see school buses around every corner and pumpkins dot the landscape. The leaves are beginning to change, and the smell of a wood fire occasionally wafts through my slightly open windows.

Colleen Walsh, DNP, ... - Click to enlarge in new window NAON President 2016-2017

When I think of the past summer, a few things come to mind immediately. Forty-nine lives lost in Florida, a 6-year-old girl shot as she was playing in front of her house, the grandfather shot by a stray bullet as he was saying grace for his family at dinner, and in Chicago, where I live, countless lives forever changed by violence as people were just going around doing their daily activities and living their lives.


What did all these people have in common? The assumption of safety. People expect to be safe having a drink in a bar with friends, and certainly moms, sitting on the steps and porches of their homes watching, expect their children to be safe playing in the street. Most people do not live their lives expecting calamity and tragedy around every corner. How awful life would be if that was the norm and not the exception.


There is another group of people who expect to be safe and that group is our orthopaedic patients. When patients enter the healthcare system, they expect, for the most part, to leave the system in better condition than when they entered it. The expectation that the healthcare system will heal is implicit whenever a patient turns his or her care over to the system. Imagine the breach of faith that occurs if that expectation is not realized because of errors.


In 1999, the Institute of Medicine (IOM) released its seminal work, To Err Is Human: Building a Safer Health System. In that book, the IOM estimated that in the United States, about 98,000 people a year die from hospital-related errors. Recently, a study by Johns Hopkins found that up to one third of deaths in the United States can be attributed to errors, just behind cardiovascular disease and cancer (Makary & Daniel, 2016; McMains, 2016). That should, and does, scare the daylights out of patients. It should frighten you too.


In 2010, the IOM and the Robert Wood Johnson Foundation (RWJF) released a consensus report The Future of Nursing: Leading Change, Advancing Health. The report emphasizes the importance of nurses in the healthcare system. Through its deliberations, the committee developed four key messages:


* Nurses should practice to the full extent of their education and training.


* Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.


* Nurses should be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States.


* Effective workforce planning and policy making require better data collection and information infrastructure.


The RWJF's series, Charting Nursing's Future, examines the multiple issues related to current nursing practice including staffing levels, nursing education, collaboration to ease the nursing shortage, recruitment and retention, transformation of the work environment, nursing workforce data collection, quality patient care, the nursing faculty shortage, and the role of nurse leaders in transforming public health. Emphasis has been placed on the work environment and patient safety. The Patient Safety Through Workplace Transformation publication highlighted the Transforming Care at the Bedside (TCAB) initiative that significantly decreased errors and hospital readmissions (RWJF, 2014). Is your hospital using TCAB? What other specific safety initiatives are you implementing? Are they working?


On January 1, 2016, The Joint Commission released its new National Patient Safety Goals and I know that you and your institutions are busy implementing those new metrics. Although I personally believe that we orthopaedic nurses have been performing those measures for a long time, the added emphasis on safety is all around us.


Accountability is an essential component of professional nursing practice; accountability also is an essential component of patient safety. The American Nurses Association Code of Ethics states that the definition of accountability is "to be answerable to oneself and others for one's own actions" (American Nurses Association, 2015). That accountability includes patient advocacy, continuity of care, and lifelong learning. As orthopaedic nurses, we are accountable to our patients and their family members, our colleagues, our workplace, and our profession (Battie & Steelman, 2014).


So, what does all this mean to NAON and our members? Is hospital nursing leadership promoting a culture of safety? What are you contributing to the culture of safety? Are you cleaning up any toxic workplace environments that increase errors? Are you accountable in your individual practices, and is accountability visible throughout your organizations? Have you continued your education by perhaps obtaining your BSN or MSN? What tools do you utilize to assist you in providing a safe environment for your patients' care?


NAON's Safe Patient Handling and Mobility Course is in its final revisions and will be available to members soon. As someone who personally suffered a ruptured L4-L5 disc that required laminectomy trying to prevent a postoperative patient from falling, I have a keen interest in this course. Our Safe Handling Algorithms are available on our website. As our orthopaedic patients are probably the most mobility-challenged patients, it is so important that we use all the tools available to provide safety for both patients and nurses.


Providing an environment of safety for both patients and nurses can decrease the incidence of health-related errors. Isn't that the least we, as orthopaedic nurses, can do for our patients and ourselves? We as nurses need to take control and be accountable. Think what we as orthopaedic nurses can do to provide that safety environment.




American Nurses Association. (2015). American Nurses Association Code of Ethics with Interpretive Statements. Retrieved from[Context Link]


Battie R., Steelman V. M. (2014). Accountability in nursing practice: Why it is important for patient safety. Association of Operating Room Nurses Journal, 100(5), 537-541. doi:[Context Link]


Institute of Medicine. (1999). To err is human: Building a safer health system. Washington, DC; National Academies Press.


Institute of Medicine & Robert Wood Johnson Foundation. (2010). The future of nursing: Leading change, advancing health. Retrieved from


Makary M. A., Daniel M. (2016). Medical error-The third leading cause of death in the US. BMJ, 353, i2139. [Context Link]


McMains V. (2016, May 3). Johns Hopkins study suggests medical errors are third-leading cause of death in U.S. Johns Hopkins Magazine HUB. Retrieved from[Context Link]


Robert Wood Johnson Foundation. (2014, March). Patient safety through workplace transformation. Charting Nursing's Future. Retrieved from[Context Link]


The Joint Commission. (2016). National Patient Safety Goals. Retrieved from