1. Baker, Kathy A. PhD, RN, ACNS-BC, FAAN

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I have just returned home from moving my youngest daughter to her new "home base" as she starts her career as a flight attendant for American Airlines. The last six weeks have been a whirlwind for her as she trained at the American Airlines training center, which happens to be in my hometown. Her training was extensive, with long days in training and nights spent studying for exams. The pressure was immense as trainees are given only three opportunities to retest across the six-week training period before dismissal from the program. Landing a trainee opportunity is not to be taken lightly (330,000 applicants for 25,000 positions) so she was very committed to being successful. While my daughter has successfully obtained two higher education degrees, she commented that she felt the pressure and responsibility associated with this training was more stressful than any she had previously experienced.

Kathy A. Baker, PhD,... - Click to enlarge in new windowKathy A. Baker, PhD, RN, ACNS-BC, FAAN

While my daughter was home visiting and relaxing after three weeks into her training, she proposed that we see Tom Hanks' latest film, Sully: The Untold Story Behind the Miracle on the Hudson (Warner Bros. Entertainment Inc., 2016), produced and directed by Clint Eastwood. My daughter had just finished the most intense week of her training and was interested in seeing how the flight crew was portrayed in the movie, which depicts the incredible January 15, 2009 water landing of a U.S. Airways disabled jetliner with 155 passengers and crew aboard.


As we watched the movie and I listened to my daughter's commentary, I was struck at how intensely she was focused on the movie crew's adherence to safety protocols and passenger follow-through. As we debriefed afterwards, my daughter talked about how closely the crew did (or did not) follow the training she had just received in her training experience. She commented that while the public generally associates flight attendants with customer service responsibilities such as food and beverage service, her main focus and priority is passenger safety. I pointed out the value of her simulation training for embedding critical thinking skills and repetition for supporting safe performance and decision-making during emergencies. The similarity to nursing was striking, though I think in some ways, we have missed the emphasis on "safety" as our first priority in nursing. For me, there was a great deal of reflection after watching the movie and talking with my daughter.


I remember as a nursing student how excited I was to learn "nursing" skills such as intravenous line insertion, vital sign monitoring, or physical assessment. In my naive approach to nursing, I had not yet grasped that mastering those skills was not what made me an exceptional nurse. Fortunately, my first years practicing in an intensive care setting helped me to master many hands on skills that satisfied that initial need. Additionally, working with exceptional role models who demonstrated the truly broader aspect of nursing as well as pursuing my master's degree in nursing all commenced to provide me with a deeper appreciation of what it means to be a nurse.


One of the biggest reasons I failed to initially grasp my role as a nurse is that there was no real emphasis on safety in nursing during my early years. Safety was of course expected but not really a focus of practice in healthcare in general. But as we moved into the 21st century, a general appreciation for the need to focus on safety and quality in healthcare began to emerge with the airline industry in particular providing creative steps for safety and quality improvement. Noland (2007) provides an interesting article in which he highlights lessons learned from 10 plane crashes that fostered needed change to promote safety in the airline industry. This "lesson learned" systematic approach to process change is congruent with other quality approaches such as Lean (Womack, Roos, & Jones, 1990), Six Sigma (, Plan-Do-Study-Act (PDSA) (Deming, 1950; Langley, Nolan & Nolan, 1984), and Focus-Analyze-Develop-Execute (FADE) (Organizational Dynamics Institute, Wakefield, MA,, among others.


Since the Institute of Medicine's (2000) report To Err is Human was released at the beginning of the 21st century, the health care industry has focused great efforts on improving safety and quality, following the lead of what Tamuz and Harrison (2006) refer to as the "high hazard" airline industry. Our professional organization, Society of Gastroenterology Nurses and Associates (SGNA), has taken the lead in establishing safety and quality related to infection control by establishing an Infection Control Summit that brought together leaders in gastroenterology endoscopy practice and industry to develop strategies for addressing infection prevention in our specialty. Outcomes of these efforts to promote safety have resulted in the Infection Prevention Champions program, as well as national standards and statements addressing quality and safety issues surrounding endoscopic scope reprocessing and high-level disinfection. Establishment and support for our SGNA Fellowship and Scholars programs enables our members to develop skills in critiquing and synthesizing best evidence to promote quality and safety in our practice settings. I'm pleased our organizational leaders have made safety in our specialty a priority.


Like my daughter's belief that her primary role as a flight attendant is promoting safety first, then quality, I believe in nursing practice our first priority and responsibility should always be promoting safety, then quality. We need to do a better job communicating to patients (and employers) the multiple things we are doing to promote patient safety and wellbeing while in our care. We need to take responsibility to consistently and persistently improve our knowledge and implementation of best evidence into the practice setting. We must take seriously our annual competency renewal and participate in simulation opportunities to improve our critical thinking and process repetition to improve outcomes during crisis situations. We should continue to lead and participate in interprofessional activities that foster communication and understand of the healthcare teams' contributions and roles in safety and quality.


So the next time a friend, family member, or even a patient asks you "What do you do?," tell them you keep them safe. When you visit with students or new employees, emphasize to them that the most important role they have is to keep their patients safe. In organizational meetings about quality goals, seek to gain clarity that safety is the first priority, which in theory should then lead to organizational quality. As a leader in providing health care, make safety your priority. While you give care or perform your administrative roles this week, think about how you are promoting safety throughout your daily routines. Focus on safety, your first priority as a healthcare provider.




Deming W. E. (1950).Elementary principles of the statistical control of quality. Paper presented at the Japanese Union of Scientists and Engineers (JUSE). [Context Link]


Institute of Medicine (IOM). (2000). To err is human: Building a Safer health system. (2000). Washinton D.C.: National Academies of Science. [Context Link]


Langley G., Nolan K., Nolan T. (1994). The foundation of improvement. Quality Progress, 27(6), 81-86.


Noland D. (2007, August 28). 10 plane crashes that changed aviation. Popular Mechanics. Available online @[Context Link]


Tamuz M., Harrison M. I. (2006). Improving patient safety in hospitals: Contributions of high reliability theory and normal accident theory. Health Services Research, 41(4), 1654-1676. [Context Link]


Womack J. P., Roos D., Jones D. T. (1990). The machine that changed the world. New York: Free Press. [Context Link]