A national spotlight was focused on the issue of patient safety when the Institute of Medicine issued its landmark report “To Err Is Human.”

Among other things, the report found that nearly 100,000 people died every year because of errors caused by professionals in hospitals (the majority due to poorly designed processes and systems). Medication errors, surgical mishaps, and other preventable problems are an ongoing threat to patients and professionals alike.

Nurses play a key role in improving safety in the environments in which they practice. But safety begins with education.

The more nurses know, the more likely they are to see problems that exist in the workplace. Armed with knowledge and skills, nurses are able to detect flaws and gaps in processes and systems that lead to errors. What’s more, education instills confidence and garners respect—which are vital when it comes to speaking out and being heard when such flaws and gaps are identified.

Nurses Are Critical to Improving Safety

There are very few processes in hospitals that nurses aren’t a part of. Nurses are often the first to notice when something isn’t working or safety is an issue.

For example, nurses who work alongside surgeons in operating rooms help ensure that safety protocols are followed, and their familiarity with procedures or knowledge of particular patients can mitigate risks associated with mistakes made during surgery.

Also, nurses are well positioned to identify multiple challenges that could lead to errors in the complex, interprofessional, and multi-step processes, from drug order entry to administration.

How Safety Affects Nurses

Nurses themselves are sometimes put in harm’s way, too. As a group, nurses experience career-ending musculoskeletal injuries and infections from blood-borne pathogens at an alarmingly high rate.

These problems mean it’s vital that hospitals have nurse- and patient-centered policies in place for moving patients and interacting with potentially infectious materials. Appropriate training and easy access to the right equipment is equally as vital.

In some cases, nurses’ safety may be threatened by patients or family members related to patients. Stress, pain, medications, and mental illness are all factors found in hospital settings that may ultimately result in harm against nurses.

Evidence-based protocols that ensure all health care workers are protected from violence should be a standard in all patient care environments.

What Can Be Done to Improve Safety

There’s no single solution when it comes to improving safety in health care. But everyone working in health care has a moral imperative to contribute to a culture of safety.

What needs to be done? Here are four steps leaders in health care—including nurses—can take to promote a culture of safety:

1. Recognize the issue. A culture of safety begins with an acknowledgment that we work in flawed systems that should always be in the process of continuous improvement. Hypervigilance for improvement opportunities is critical.

2. Encourage shared accountability. A true culture of safety requires that each team member (including those that are not patient-interacting) is fully accountable for safety. Furthermore, everyone must be empowered (actually obligated) to step forward when something of concern has been identified.

3. Budget for safety. Safety is not cheap, but it pales in comparison to the cost of errors. Nursing and other health care leaders should prioritize safety and be prepared to demonstrate the return on investment.

4. Build a just culture that encourages problem-solving. A just culture is related to a culture of safety. A just culture is one that focuses on the reporting of errors in order to engage in problem solving without the risk of punishment or retribution. The culture is identified as just because lack of personal consequences does not extend to willful at-risk or reckless behavior.

The American Nurses Association Code of Ethics for Nurses clearly establishes nurses’ professional responsibility and ethical obligation to promote a culture of safety.

In an environment where safety is a top concern, education may be the best tool for boosting everyone’s health.

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