Nurses Drive Change in Patient Safety Improvements

How nurses are finding new ways to effect change across institution and nation

By Megan Headley

Nurses serve on the front line of patient care, and so it makes sense that these talented, dedicated individuals are also at the forefront of a vigorous movement to improve patient safety. 

“Across all areas of nursing, I see nurses not only working on safety but defining plans to accelerate safety both for patients and the workforce,” says Patricia McGaffigan, RN, MS, CPPS, chief operating officer and senior vice president of program strategy and management at the National Patient Safety Foundation. 

This desire to effect change is being realized in a variety of forms—as varied as the circumstances facing individual nurses themselves, the largest segment of the healthcare profession. Because of their integration into every aspect of care, nurses are more than ever driving ambitious patient safety reform efforts.

Leading the way as patient advocates

Maureen Swick, CEO of the American Organization of Nursing Executives, notes that in their position as point person, nurses have the greatest opportunity to keep patients safe. It’s here, through patient engagement, that nurses are leading change. “By involving the patients and their families in the patient’s plan of care, especially as it relates to medications and understanding potential side effects, nurses help patients safely and seamlessly transition across the care continuum,” Swick says.

Given the extraordinary amount of time that nurses spend with patients, Swick says it is critical for nurses to be involved in safety initiatives. “Transforming change at the organizational level requires openness and shared responsibility by everyone in the organization,” she says. Chief in achieving this aim is creating an environment where nurses feel safe reporting errors and near-misses to leadership. “And,” Swick adds, “leadership needs to work with staff to implement new processes.”

In many instances, nurses are driving institutional improvements by moving from a reactive to a proactive stance in investigating adverse safety events.

“Many times nurses are involved in a retrospective view of patient safety events—and they may be involved in the sharp end, where the proximal error may have occurred, or they may be involved as part of the team over time where something unfortunate has occurred,” McGaffigan points out. Today, more nurses are learning to conduct effective cause analyses of events that have gone wrong. It’s a role they’re perfectly suited for.

“They’re a critical member not only of the care delivery team, but they have ample opportunity to understand why things have gone wrong—and why things go right—and be able to translate that [into action] through their ability to move the needle in terms of safety,” McGaffigan says. To do so effectively, nurses need support from leadership. 

“Nurses [can] lead change by reporting all potential safety issues to leadership,” Swick says. But this only works in a culture where error reports are encouraged. Swick notes that some organizations use safety hotlines and electronic safety reporting systems, “so senior leadership can review any real or potential safety issues reported by nurses and other members of the healthcare team.”