By Diana Mahoney, Editorial Director
Patient safety is an essential component of quality nursing care. This year, as part of National Nurses Week, the American Nurses Association (ANA) is asking nurses to reflect on how they can make their workplaces safer to enhance patient care and nurses' well-being. The theme for the week, "Culture of Safety—It Starts with YOU," is designed to celebrate the unique and critical role that nurses play improving health care safety.
In this spirit, Press Ganey Chief Nursing Officer Christina Dempsey recently provided her thoughts on the vital role that front-line nurses and nurse leaders play in establishing and sustaining a culture of safety in their organizations.
Q: Nurses have been called the “gatekeepers” of patient safety. In what ways is this so, and are nurses aware of their essential role in this regard?
A: Nurses arguably spend more time with the patient than anyone else in health care. As such, they are not only the gatekeepers, they are the “thin white line” between patient safety and both the patient experience and suboptimal outcomes—much like police officers are the thin blue line between anarchy and order. I don’t think nurses realize the impact and importance of what they do every day to keep patients safe, but the patients and their families will forever remember the nurses and how they cared for them.
Q: One of the key elements of a culture of safety is speaking up about serious safety events. Do you believe nurses feel comfortable reporting adverse events and unsafe conditions? If not, what can hospital leadership do to make them feel less vulnerable?
A: I think nurses are beginning to feel more comfortable because there is a focus on safety through ANA, the American Nurse Credentialing Center (ANCC), the American Organization of Nurse Executives (AONE), and other key health care organizations. Safety is at the forefront today, however, we need to promote a common understanding of what “culture of safety” means. Safety is an essential component of quality, and it must be embedded into every fiber of the overall organizational culture, along with transparency, accessibility, visibility, and alignment. These provide the foundation for culture. In organizations that embrace all of these tenets, nurses are likely to be more engaged with the organization and with the profession, and they are more likely to bring issues to the fore.
Q: How does establishing safety as an organizational priority fit into the compassionate, connected model of care delivery?
A: There is really no separation between clinical quality, patient safety and the patient experience. The optimal patient experience is one that is safe and effective. We know that key drivers of loyalty and Likelihood to Recommend include teamwork, listening and respect, and cleanliness. What do all of these things have in common? If caregivers work well as a team, their patients feel safe. If they listen to their patients, involve them in their own care, and allow them to make decisions about that care, they feel safe. If their room is clean, their perception is that the whole organization is clean and they won’t get an infection, so they feel safe. It’s all about the totality of the patient experience, and safety is an integral part of that.
Q: Building a culture of safety requires sustained leadership and employee commitment over time. How can nurse leaders ensure they are consistently modeling or communicating the importance of safety in clinical care settings?
A: This is key. Nurse leaders must demonstrate the behaviors that they want nurses to exhibit. Frequent rounding, accessibility and visibility are essential. What is important to the nurse leadership will be important to the people at the bedside. If we want a culture of safety at the bedside with purposeful rounding, bedside shift report and meaningful connections with patients and caregivers, the nurse leaders must establish this culture. They, too, must sit and ask open-ended questions, and establish that connection with patients and caregivers. They must also foster teamwork and be transparent with communication and data. It takes practice and it’s important. Nurse leaders drive the culture.
Q: Improving the safety of health care includes both patient and caregiver safety. What are some of the things nurse leaders can do to make sure the safety of their direct reports and front-line nurses is part of the culture as well?
A: Nurse leaders must be observant. They must round frequently and observe interactions and behaviors. They must ask open-ended questions of patients and of nurses. They must know their people and create a culture of openness and transparency. The people doing the work have the answers, as leaders it is our job to ask the right questions. Nurse leaders are on stage every day and their actions speak volumes to the bedside caregivers. Listening, empowering, demonstrating and being transparent go a long way toward creating a culture of safety, engagement and the optimal patient and caregiver experience.