Translating Leadership into Safe Nursing Practice

By Valerie Kiper, DNP, MSN, RN, NEA-BC; Assistant Professor TTUHSC School Nursing

Because nurses have the most interaction with patients, nurse leaders at all levels can influence organizational safety culture. Today’s concept of patient safety was addressed over 150 years ago in Notes on Nursing (Nightingale, 1860). Nightingale identified two key aspects that continue to resonate today. The first aspect is not the issue of being physically away from the bedside that is problematic, rather it is the failure to (a) ensure that there is a plan to provide safe patient care in those situations, and (b) empower others to think for themselves. The second aspect focuses on leadership. Nightingale said, “let whoever is in charge keep this simple question in her head (not, how can I always do this right thing myself, but how can I provide for this right thing to always be done?” (Nightingale, 1869, p. 40). From “colossal calamities, down to the most trifling accidents” Nightingale (1860) cites the issue of those in charge not appreciating the roles and responsibilities of being in charge. She believed a leader’s source of pride should be in establishing systems that ensure quality and safe care so no one individual is missed, or that all depended solely on one person. Nightingale in her Notes on Nursing (1860) spoke of “petty management” and recognized that the person in charge cannot be present at all times, stating it was not healthy for a person to even think they could. She stressed the importance of proactive critical thinking by encouraging nurses to determine how to prevent untoward events from occurring should the nurse need to be away from the bedside.

There exists a mistaken impression that any error in healthcare is the result of malfeasance and that individuals are at fault; this belief promotes a culture of blame and punishment with an accompanying hesitancy of employees to report concerns. A strong safety climate has also been linked to nurses’ adherence to safety work practices and promoting a culture of safety becoming a strong pillar of the patient safety movement.  As nurses advance from lower to higher levels in an organization, more conceptual skills are needed, including making a commitment to support the mission, vision, and goals of the organization; accepting the constant changes within a complex healthcare system while facing reimbursement and cost reduction challenges; and understanding the needs of external customers. Nurses benefit from seeking leadership education for their own professional growth and to develop confidence and competence in leadership skills. It’s beneficial to conduct a leadership style assessment to provide a baseline determination of the predominant leadership style across your particular service line. Mentoring, role-playing, developmental workshops, and performance evaluation play a critical role in leadership education.

Creating safe care environments requires nurse leaders to “listen and learn,” and involve employees in decision making. Nurse leaders must forge cooperative relationships, while anticipating and embracing change, to improve patient safety and care quality. As a former nurse executive, I often summarize the concepts of “just culture” and patient safety in the following way: Leaders need to support and build trusting relationships, implement best practices by employing objective outcome analysis and facilitating proactive problem solving, and encourage an atmosphere of interdisciplinary teamwork and professional growth. This requires learning the delicate balance between creativity and stability. It’s crucial in our current healthcare environment to have leaders who can balance patient safety, performance improvement, and quality with effective and efficient care delivery systems.

You can read the article in its entirety at www.NursingMadeIncrediblyEasy.com (Nursing Made Incredibly Easy; May/June 2018: https:// DOI-10.1097/01.NME.0000531874.33036.2a).