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Patient Safety Starts with Nurse Managers

 |  By Alexandra Wilson Pecci  
   October 02, 2012

It's easier to fix a mistake—and ensure that the mistake doesn't happen again—if you fess up right away. Every school kid comes to learn this truth, even if it's hard and uncomfortable to admit.

Nowhere is following this simple rule of life more crucial than in the healthcare arena, where mistakes are often a matter of life and death. The importance of admitting mistakes doesn't necessarily make the task of admitting them any easier—one might argue that it makes it harder.

But according to a study, something does make it easier for nurses to admit their on-the-job errors: feeling safe doing it. And what makes nurses feel safe? Their managers.

Researchers surveyed 54 nursing teams in four hospitals in Belgium and found that nurses are more likely to report patient-care errors when they feel safe admitting them to their supervisors. That, in turn, leads to a lower overall error rate and a stronger commitment to safety protocols, according to the study in the Journal of Applied Psychology.

Nurses were first surveyed on their work environments and the perceived behavioral integrity of their managers. Researchers then examined the "psychological safety" of the work environment by gauging nurses' responses to the statement: "If you make a mistake in this team, it is often held against you."

Researchers tried to determine whether nurse leaders practiced what they preached about safety by asking nurses whether they agreed that "My head nurse always practices the safety protocols he/she preaches." Nurses were also asked to respond to this: "In order to get the work done, one must ignore some safety aspects."

Six months later, the research team examined the relationship between fostering safety and reporting patient errors and found that "head nurse behavioral integrity for safety positively relates to both team priority of safety and psychological safety.

In turn, team priority of safety and team psychological safety were, respectively, negatively and positively related with the number of treatment errors that were reported to head nurses."

In other words, if managers act like they prioritize safety instead of just talking about it, their nurses will, too.

Just last month I wrote that building nurse empowerment is pointless if efforts to do so fall on deaf ears. I argued that "it's up leaders to put their money where their mouth is and make sure that nurses feel safe enough to suggest changes and raise concerns."

Now there's evidence that patient safety actually improves when leaders live up to the standards that they espouse.

When patient safety mistakes happen, I can imagine how hard it must be for leaders to step back, take a deep breath, and not act in a retaliatory way against the nurse who committed the error.

But assuming that the mistake is just that—a mistake—and not some egregious act of negligence, it pays for cooler heads to prevail. If a nurse is punished for admitting the error, the message isn't "don't make mistakes." The message is "Keep your mouth shut."

That's because no matter how careful we are, mistakes happen. It's a fact of life.

If the culture on a unit is for nurses to keep their heads down and mouths shut as they move through their work day, mistakes will not only occasionally happen, there won't be any chance to improve or learn from them.

It's within nurse leaders' power to make sure that they walk the safety talk and encourage their staff to safely do the same.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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