A chief nursing officer (CNO)has been hired to develop a healthy work environment and culture of safety in a hospital with a long record of safety problems and poor patient outcomes.The best initial action by the CNO would be to:

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This culture or environment would be considered immature, so the CNO needs to start with basic building blocks of a safe environment, including teamwork and skilled communication.Eventually, the CNO would want to implement policies similar to "Stop the Line," whereby all nurses have the authority to speak up and intervene before problems arise.However, in a facility where even basic safety is an issue (an immature environment), training needs to occur on more basic ideas of safety, such as skilled communication and teamwork.A culture of safety includes focusing on system problems leading to safety issues, not on individual nurses.Having all nurses reapply for their jobs indicates that because of past problems, only the "best" nurses (or nurses with better safety records)will be retained.It would be better to start fresh by implementing the "just culture" philosophy and move forward without penalizing the staff for past problems.Informing nurses that it is their job to report potential safety problems would be part of any drive to improve patient safety and outcomes, but this alone will not empower the staff to report problems, especially proactively.

A Chief Nursing Officer (CNO)has Been Hired to Develop a Healthy