1. Doucette, Jeffrey N. DNP, RN, LNHA, CENP, NEA-BC, FACHE

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Q I've worked hard to create a culture of safety on my team to support my organization's journey to high reliability. What ideas do you have to help me keep my safety program fresh and always improving?

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Nurse leaders are under constant pressure to balance patient safety, outcomes, and performance measures to deliver a high quality and reliable experience for key stakeholders. When considering the environment of safety, it's important that all stakeholders be considered, not just the patient. All caregivers, including nurses, physicians, and ancillary providers, as well as the patient's family and/or significant others play a substantial role in creating a culture of safety. One of the most important responsibilities of the nurse leader is to ensure a safe environment for everyone involved in the care process.


One evidence-based framework by which to evaluate your organization's safety program is the American Nurses Credentialing Center's Pathway to Excellence(R) safety standard.1 This standard addresses protection for nurses, staff, and patients through organizational policies, procedures, and processes. Further, it requires organizations to monitor patient and staff safety-related events, as well as how nurses are involved in addressing unfavorable trends. In addition to monitoring and resolution, the framework requires that processes are in place to resolve safety issues in a timely manner.


The most comprehensive safety program should assess and address safety opportunities in product selection, injury prevention, and issue resolution. There should be processes in place that involve clinical nurses in the evaluation and selection of new products considered for your organization. Clinical nurses should have input into the pilot, criteria for success, and ultimate decision on what products and equipment are purchased for use. The organization should have an inclusive injury prevention program that addresses potential patient injuries, such as hospital-acquired conditions and falls, as well as staff safety issues, such as sharps-related events and back injuries. Comprehensive safety programs contain clear and concise policies and processes for the identification and resolution of safety issues and must include clinical nurses in how issues are addressed.


When thinking about safety, we often forget to include nurse staffing, equipment training, and care transitions. Each of these areas presents unique challenges within the safety culture. Highly reliable organizations understand that the staff members doing the work each shift are in the best position to provide input on staffing decisions. Safe staffing levels require a level of critical thinking that includes current patient needs and acuity, the preparation and competency level of available staff, and the availability of resources to deliver safe and effective care. These decisions shouldn't be made in isolation and should always include the input of clinical nurses.


Nurses are so used to having in-service training on new equipment that this process is mundane and mechanical for many of us. We need to reshape our approach and consider proper equipment training as one of the early steps in a comprehensive safety program. If we get training right on the front end, the likelihood of related safety events is significantly reduced on the back end.


Care transitions represent one of the highest safety risk areas in the healthcare delivery process. Any time the patient is moving from one care setting to the other or when care is being handed off from one provider to another, the patient is at high risk for harm. Your safety program should have well defined processes for care transitions and monitoring programs in place to evaluate both compliance and efficacy. It should go without saying that all comprehensive safety programs should have a strong interprofessional focus using a collaborative approach.


As a nurse leader, you must also be actively involved in the removal of barriers to safe, cost-effective practice. Major attributes of nursing units in acute care hospitals that contribute to problems with patient safety and quality include unclear unit values, fear of punishment for errors, lack of systematic analysis of mistakes, complexity of teamwork, and inadequate teamwork.2


The patient care environment continues to grow more complex. The nurse leader is in a unique position to be the voice of patients and caregivers in organizational safety decision-making. It's critically important that you use this voice to advocate for resources, obtain support, and constantly work to improve the reliability of organizational processes.




1. American Nurses Credentialing Center. Pathway to Excellence(R) Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2016. [Context Link]


2. Kalisch BA. Overcoming barriers to patient safety. Nurs Econ. 2006;24(3):143-155. [Context Link]