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Quality and Safety

Quality and safety in the occupation of nursing concern primarily the effectiveness and suitability of services that nurses deliver to promote positive health outcomes for patients. In a discussion paper, the Canadian Nurses Association (2004) identifies nursing as a critical profession in the safety and quality of healthcare services for patients in the society. Nurses have a role in the provision of healthcare across all areas of the healthcare system each day. This universal need of nursing services and a sound knowledge base means that nurses have an important role in ensuring both safety and quality in healthcare services. The CNA (2004) observes that based on their skills, training, and vigilance, nurses serve to ensure the quality, safety, and effectiveness of patient care while identifying and addressing situations in the healthcare environment that require improvement and management.

The difference between quality and safety in healthcare, generally, is largely ambiguous. The common viewpoint among many members of the society and experts is that patient safety is an aspect of quality healthcare. In the operations of healthcare institutions, both concepts are indistinguishable from one another, with experts treating them as deeply related. In reality, Mitchell (2008) observes that quality is a standard that reflects the balance between realized possibilities and a framework of values or norms that form a structure of reference. This means that quality is the degree to which healthcare services for patients raise the likelihood of achievement of desired health outcomes and the consistency of such services with prevalent professional knowledge (Mitchell, 2008). Positive indicators of quality in this context include health-related quality of life, patients’ perceptions of receiving appropriate care, effective management of symptoms, and the demonstration of health-promoting behaviors. On the other hand, safety involves the absence or prevention of harm to patients in healthcare services (Mitchell, 2008).

To achieve safety, healthcare institutions emphasize on care delivery systems that prevent errors, promote effective learning from errors that may occur, and operate based on a culture of safety that engages organizations, professionals, and patients. In effect, safety in healthcare involves the enforcement and maintenance of practices that minimize the risk of adverse events associated with the exposure of patients to medical care across a variety of conditions or diagnoses (Mitchell, 2008). Mitchell (2008) identifies four classes of failures that represent the root causes of possible harm to patients. Latent failure relates to problems involving decisions that affect the allocation of resources, procedures, and policies at the organizational level. Organizational system failures relate to indirect problems resulting from organizational culture, managerial, knowledge management, or protocol challenges, while technical failures relate to problems with external resources and facilities. The last class of failures, active failures, involves problems or errors in the direct contact of medical staff with patients (Mitchell, 2008). This means that the safety and quality are products of multiple and interrelated processes and environments in healthcare.

Mitchell (2008) refers to the work of Florence Nightingale, whom health experts identify as the founder of modern nursing, to illustrate the connection between quality and safety in healthcare and the occupation of nursing. Based on hygienic and organizational practices, she achieved a minimum mortality rate among British soldiers in the 19th Century. The contribution of nursing to the safety of patients in any healthcare setting involves the capacity to coordinate and integrate multiple aspects of quality within the range of care offered in nursing and in conjunction with the care that other staff members deliver in the healthcare setting (Mitchell, 2008). This means that along with applying their best competences, nurses also need to cooperate and coordinate with other experts in the healthcare environment to ensure delivery of the highest quality of care to patients. Rather than a narrow range of responsibilities in direct patient contact, such as avoiding medication errors, nurses have a wide-ranging and integrated responsibility in the healthcare environment to ensure both quality and safety. This responsibility includes cooperating with other staff members and making appropriate decisions in the healthcare environment.

In its report, the Canadian Nurses Association (2004) notes that safety and quality are relevant issues in the healthcare environment because of the increasingly complex nature of healthcare services, increasing health conditions, and the significance of healthcare decisions and processes in promotion of positive patient outcomes. Healthcare systems in the modern society are prone to mistakes and adverse events that undermine the success of patient care. Most of these errors are preventable if staff members in healthcare institutions exercise caution and demonstrate commitment in their duties. The CNA (2004) observes that beyond skills and expertise, commitment is essential to ensure that nurses execute their responsibilities effectively and efficiently to prevent safety and quality breaches in the delivery of care to patients. Studies of healthcare systems in different countries have yielded observations that errors in the delivery of healthcare to patients are rarely the result of single factors or individual errors, such as negligence or incompetence. Instead, most of the harm in the delivery of care to patients is the outcome of structural or process problems in the healthcare system (CNA, 2004). These challenges include poor drug labelling, poor staffing, outdated equipment, loss, or mishandling, of information, or managerial problems.

The WHO’s evaluations of patient safety and quality at the international level strengthen further the case for a broad-based approach towards the safety and quality of patient care in the nursing profession. The organization notes that harms to patients (death, permanent injury, or increased length of stay) are significant risks in modern institutions because of the complexity of healthcare systems today, which influence a high likelihood of adverse events. Highly complex healthcare environments in the modern society, due to technology and many (and different) healthcare providers, imply that successful treatment and outcomes for patients are dependent on a broad range of factors, rather than the competence of an individual nurse or healthcare expert only (WHO, n.d.). This implies that patient safety and quality care services, which are important focuses of nursing, rely on a broad range of factors beyond the effectiveness of individual nurses’ contact with patients. Factors such as accurate and timely communication, effective decision-making, safety of medication, procedural and surgical skills, effective teamwork, effective technological functioning, and others are vital to ensure quality and safety in health care services. Competent understanding of the factors that influence errors or problems in the healthcare system is vital to prevent the commission of errors in the management of patients’ conditions (WHO, n.d.). This implies that the responsibilities of nurses in patient safety and quality of care ought to extend beyond the application of individual skills and direct contact with patients to include decisions and commitments towards ensuring the suitability of the entire healthcare environment to effective delivery of care.

Besides being important parts of the responsibilities of nurses, patient safety andquality of care are vital components of the code of ethics that governs the behavior and obligations of nurses (CNA, 2004). In all areas of nursing practice, including in the community, in acute care hospitals, or long-term care facilities, patient safety and quality in delivered care are essential aspects. The promotion of safety and excellence in nursing services is a principal element of the mandate of nurses in the interest of protecting and promoting public health.The CNA report identifies several challenges that undermine the capacities of nurses to provide safe and quality nursing care. Based on literature and subjective assessments among nursing leaders, the CNA (2004) classifies these issues into technology issues, a culture of blame, teamwork and communication issues, environmental and workforce issues in nursing practice, and both patient perspective and nursing perspective on patient safety. Important issues in these contexts include staffing, staff shortages, motivation, level of clinical support, leadership effectiveness, and data support.

Based on these assessments, the Canadian Nurses Association (2004) observes that effective nursing leadership is important to influence safety and quality in the performance of nursing responsibilities. Such leadership is essential considering that nurses have the deepest and best knowledge of the needs of patients and the functioning of the entire healthcare system.Mitchell (2008) observes that patient safety represents the foundation of high quality delivery of health services and nursing care. Nursing work involves surveillance and coordination of patient care processes, which are vital in minimizing negative outcomes such as morbidity and mortality. With effective nursing leadership, healthcare institutions can achieve and maintain safety and quality in the delivery of care to patients.



Canadian Nurses Association (CNA) (2004). Nurses and Patient Safety: a Discussion Paper. CAN Discussion Paper.

Mitchell, P. (2008). Defining Patient Safety and Quality Care. In Patient Safety and Quality: an Evidence-based Handbook for Nurses (Chapter 1). Rockville, MD: Agency for Healthcare Research and Quality.

World Health Organization (WHO) (n.d.). Topic 1: What is Patient Safety?WHO Safety Curriculum.