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