When it comes to healthcare, I’m passionate about culture because the feel of the workplace is critical in allowing individuals to do their best work. When nurses and the entire healthcare team are doing their best work, that is when patients are safest.

Don’t most healthcare systems state their main goal and purpose as some variation on safe patient care? Organizations have committed to a plan to deliver the best care possible, which is presented under many names, such as;

·       continuous process improvements

·       HRO principles

·       using CUSS

·       encouraging see something, say something

·       best practice

·       Evidence based best practice

and the list goes on. I believe in each of these initiatives and have seen improvements and safer care when each is used. However, in the end, if the culture of the organization is not positive or does not feel safe for the individual member of the team, can any safety program succeed. Is it possible to overcome a culture that allows bad behavior with a program designed to improve safety?

You may question this line of thinking, but I would ask that you take a minute to ponder. If we encourage staff to stop-the-line, but the culture is that they will not be heard or they will be bullied if they do, are they going to stop-the-line? If we bring in the best, most current evidence and ask staff to follow the standard, but there are senior employees who are unwilling to change and imply that anyone who does is dumb, will the change happen?

I am not implying that nurses, the largest body of healthcare workers, are weak or mean. However, if one has worked in healthcare long enough, you will know that the pull of doing what seemed successful all these many years, is a strong pull.  Individuals with high seniority have seen many things, frequently have been involved in some amazing health battles and wins. People who stay in healthcare and nursing usually do it because they love the work and they are constantly amazed by what has been accomplished in their time. Accepting a new way, that may seem to imply what was done in the past was not as safe as it could have been, can feel threatening.

So, consider the other end of the spectrum, the new nurse walking in. Many nurses come out of school, like I did, believing that they were going to make a real and positive impact on each patient’s life. New nurses can have very strong ideals about what should be done and at the same time be very intimidated by the enormity of what they are tasked with doing. This can be a person who looks strong on the outside but is easily crushed on the inside.

Those two extremes, the experienced, assured, sometimes stubborn, senior nurse and the beginning, idealistic, intimidated new nurse need to work together in unity. If the culture is that one person is right and the other is wrong, frequently the newer nurse will cave first. That can show up as the newer nurse being quiet and going along. Sometimes deciding to find a new unit or organization to work for, or, sometimes, that team member will leave the profession or direct patient care, before they have a chance to really know what nursing looks like.

So, I come back to my passion in healthcare, culture. Without a positive culture, patients do get cared for, they are saved and they do go home, but are there mistakes that could have been avoided, are there things overlooked that could have been seen? If the answer to the previous sentence is yes, then, have we given the SAFEST patient care?

For the safety of the patients and the survival of the nurses, please pay attention to culture. Make culture your first priority every day.