http://www.beckersasc.com/lists/50-experts-leading-the-field-of-patient-safety.html

TOP 50!

only 7 out of 50 are nurses. There are 3 million RNs in the US. In 2008 that translated to 854 nurses per 100,000 people (RWJF.org). Nurses are at the front lines seeing patient safety issues everyday. Why aren’t we more involved in leading the patient safety movement? Since the IOM report “To Err is Human…” many have argued we have not made the progress that would be expected. Is this directly attributed to failure to take the lead by nursing?

Is patient safety yet another arena where decisions are made without nursing in the rooom? Nurses prevent errors and make errors, and sometimes take the fall for organizational failures: and are as close to the patient as one can get, at the bedside 24 hours a day. There are still reports of moral distress in that nurses feel they are not able to advocate for their patients. Many nurses have little control over their workload or schedules. How can nurses be at the bedside and at the table? Token nurses on committees may improve the voice a bit but it is not the same as full participation from all the stakeholders in the nursing workforce. According to Axelrod & Axelrod (2000), employee representatives on committees essentially create a parallel organization where these employees temporarily join the management team. Those who are not on these committees wonder why they were not chosen and assume their voices are not important. In essence committee structures common in hospitals today exemplify old change management paradigms and discourage participation. With today’s interactive technology, it should be easier to include all stakeholders in a process. But then again, many nurses are not used to participating.

The Future of Nursing (FON) Report mentions the need for nursing to be full partners in healthcare. Other opinion leaders feel nursing is imperative to the patient safety agenda (http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2010/01/groundbreaking-new-survey-finds-that-diverse-opinion-leaders-say.html). The question is how do we do this? How do we engage all nursing stakeholders? We need nursing leaders in the patient safety movement who can facilitate this.

My interpretation from the FON report is that they are banking on higher education of nurses to be the key. While I agree that safety and improvement science needs to part of every nursing curriculum, education and training is low on the safety intervention effectiveness hierarchy so I do not see this as the ultimate solution.

System changes and work environment changes will make the difference, and valuing everyone’s input does not require advanced education. If we believe what we say in that everyone in the traditional hospital hierarchy from the housekeeper to the MD has an impact on safety, education is not necessarily a factor. We need to find a way to ask the right questions of the frontline nurses and hold sacred their answers so they can remain at the bedside while their voices resonate loud and clear at the table.