1. Section Editor(s): Raso, Rosanne DNP, RN, NEA-BC, FAAN, FAONL

Article Content

With all the talk of safety cultures over the past 20+ years, you would think we would have achieved work environments with psychological safety. Maybe you have in your organization, and kudos if that's true. I've heard many stories of staff, and leaders, who still don't feel safe speaking up, even if it would prevent an error. Remaining silent just isn't okay. This is Nursing Management's annual safety issue, and the concept of psychological safety for all team members at every level shouldn't be an elusive lived value.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

What does it mean? Basically, that you can speak up, admit mistakes, ask a question, disagree, voice a concern, or make a suggestion without fear of punishment or humiliation-a culture where open and honest communication is welcome. Psychological safety isn't limited to patient safety and can be applied to any aspect of your work, even delicate conversations about an employee's attendance or performance. In the context of patient safety, it could result in a near miss not becoming a "hit" or proactive process improvement for broken or inadequate systems.


The opposite of psychological safety is bullying and/or being shut down. How many of us have heard these words: "Don't question my orders, just do it, now"? The humiliation and embarrassment from abuse of hierarchical power or bullying by a peer can shut you down for a long time. Even a perceived lack of inclusion implies a lack of psychological safety, connecting the concept with our diversity, equity, and inclusion efforts. We must support staff members who've been victims of a psychologically unsafe culture. After being silenced, it's unlikely a person will speak up again. Breaking that cycle is up to us. It takes effort and practice to create this type of culture. Be curious, draw people out, and recognize it publicly when it happens.


Of course, you have to speak up clearly and respectfully at all times. Communicating effectively is a learned skill all nurses need to acquire, preferably as early as their undergraduate curriculum. Communication skills are as important to nursing practice as clinical skills. An example of a structured communication methodology is the TeamSTEPPS system ( Designed for healthcare, this system has helped many teams improve the environment for safety. One of my favorite TeamSTEPPS techniques is the stop-the-line "CUS" approach: Saying "I'm Concerned, I'm Uncomfortable, this is a Safety issue."


As leaders, we must set the tone and role model the behaviors. We don't want "yes" to be the answer to everything. If this is the case, we won't learn, grow, or innovate. When psychological safety is present, team effectiveness and high performance are improved, maybe even predicted. Beware, it does slow things down. Another factor is the team itself-knowing and working with each other regularly creates a foundation of trust, which makes a huge difference. If nursing or multidisciplinary team members are new to the team, psychological safety can suffer. Creating an environment of inclusion for everyone from the chief to the clinical nurse, pharmacist, nursing assistant, respiratory therapist, housekeeper, and clerk is mission critical.


When all voices are heard and valued, not diminished, the environment for safety improves. Your leadership matters in making psychological safety alive and well for your team, and for yourself.



Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.