#SuperSHIFTER Claire Betker, President of the Canadian Nurses Association (CNA), shares her insights on the Joint Position Statement for Patient Safety, developed in collaboration with the Canadian Federation of Nurses Unions (CFNU). Released in June 2019, the Position Statement supports the delivery of safe, compassionate, competent and ethical care while maximizing the health of clients and nurses.

What can you tell me about the four principles outlined in the Joint Position Statement for Patient Safety?

The first principle is centered around collaboration, competence and accountability. Optimal patient safety requires all three. Nurses and nurse leaders must be involved in decision-making. They have a unique knowledge and perspective to bring to the table and need to be in decision-making from the planning and overseeing to the coordinating, providing and evaluating of care.

Secondly, patient safety is about practice and providers, but it is also about the system. There are systemic factors that impact significantly on patient safety. Nurses can contribute to those decisions at a systems level in terms of the work environment and how it is structured. Nurses work in a fast-paced environment with very complex patient situations and they can lend that expertise and knowledge to the deliberations.

Thirdly, we need quality professional practice environments. That includes staffing and organizational models of care – not just the system pieces, but the actual models of care. Having a sufficient, competent workforce appropriately matched with acuity, the clinical situation, and staffing models. In terms of resources, we need to look at what we have now and how to use them best while following the evidence.

Finally, we need to build a culture of safety where it is safe to raise a flag, disclose hazards, or discuss adverse events. It is important to learn in terms of how to handle these situations the next time. This requires building a culture of safety versus a culture of blame, recrimination and fear.

The Position Statement provides nurses and nurse leaders with the tools and evidence to be involved. A toolkit was jointly developed with the CFNU so that nurses can advocate right at the point-of-care, as a team, at the unit level, with managers and leaders, and at the broader government systems level.

What is innovative about this Position Statement?

The collaboration involved in its development between the unions and the professional nursing association is what makes this work innovative. This Position Statement is an acknowledgement of shared responsibility. We must work together to improve patient safety – governments, organizations, members of the team, patients and families as well as the community.

What key learnings did you have in developing this Position Statement?

When we talk about patient safety or the safety of people, we need to think about the whole health system continuum. I have spent my career as a nurse in the community – but when you use the word patient, you tend to think about hospitals. We also need to consider residents of long term care as well as care provided to people in communities and in their homes. Thus, my learning was that patient safety goes beyond the patient-nurse interaction at the point of care in acute care institutions. People want to have access to nursing care in the community and in their homes, and we need adequate staffing and competence in those settings. This will require taking a broad view of patient safety.

Any advice for others in developing a Position Statement?

Do it in partnership. Involve people and not just in a token way; really involve them. Think broadly and upstream; patient harm is preventable. Involvement starts in every relationship, and in every interaction when you’re involving patients.

Any closing thoughts?

Canada falls below average on a number of patient safety indicators in comparison to other OECD countries. There is room for improvement and the opportunity to get things right. We need data that reflects the impact of nurses and nursing on patient safety. Canadians expect care to be safe and they trust nurses to ensure the systems and work environments are in place to support that care.

This isn’t just a Canadian issue or a Canadian health system issue. The International Council of Nurses, which has representation from more than 130 countries around the world, recognizes this as a global issue.

Where can I get a copy of the Position Statement and toolkit?

Click on the link to access a copy of the Position Statement and the online toolkit.

For more information, contact the Canadian Nurses Association at PracticePolicy@cna-aiic.ca.