Reflections On The Culture of Safety (1st Place Winner of AAMN 2016 National Nurses Week Essay Contest)

By Fidelindo Lim, DNP, CCRN

Clinical Assistant Professor

New York University Rory Meyers College of Nursing

The notion of "culture of safety" implies not merely the absence harm or injury or preventable death, but also the un-measurable feeling that one is in "good hands" even in bad times. The romantic idea (often revived during Nurses' Week) is that of Florence Nightingale doing her nightly rounds, reassuring the soldiers, while beneath the blankets, incurable infections and pain lurk. And yet, somehow, the soldier-patients felt re-assured and safe, though countess of them did not survive to thank Nightingale for the "culture of safety" that emanated from the nurses and her advocacy. A good part of the culture of safety is the feeling or vibes that comes with a peaceful and unhurried attention that nurses provide to patients without the doctor's order and has no expiration date.

How does the "culture of safety" relate to me as a male nurse? I do not think safety has gender, though different cultures assign specific values to what or who is considered safe. For example, the bias that male persons are more authoritative or that people of color (e.g., immigrants from certain countries) may have lower safety standards, undermines the culture of safety because it breeds mistrust between people and leaves long lasting stigma. To uphold gender equality - that male and female nurses are equally capable - and therefore must be given the same opportunity pays homage to a culture of safety based on equity. A deeper understanding of safety and quality in patient care demands that health care workers examine their own values. The kind of conversation that does not judge, but validates the common good that we try to achieve for our patients.

I became a nurse at nineteen. At 22 (the year was 1990), I was working in 500-bed hospital in New York City. One night, a patient expressed his reservations about my clinical competence (was I a safe nurse?) based on the idea that I "looked too young". I didn't ponder much about this, but sometimes I wonder if the patient's doubt, sublimated by saying I didn't look old enough to nurse him, is a symptom of general mistrust? Of nurses? Of the health care system? By extrapolation, is it possible that more senior nurses (administrators and supervisors) hold a certain bias that younger nurses (e.g., new grads) may be prone to lapses in safe practices, not because they are young and inexperienced, but rather because the senior nurses have instilled a feeling of mistrust among young nurses, of potentially committing the ultimate calamity of killing a patient? In return, new grads (and nursing students) internalize self-doubt. And self-doubt undermines a culture of safety because it throws conscientious people into silence and destabilize their confidence.

But times have changed.

Nurses are now the undisputed most trusted of all professions for the last decade and a half according to the Gallup Poll. If culture of safety is closely tied with trust, it probably makes sense to put as many bedside nurses in all kinds of safety councils, committees, teams, commissions, think-tanks, and organizations. This year's theme for nurse’s week, “Culture of Safety - It starts with YOU”, highlights the humble idea that nurses are the chosen guardians and defenders of patient safety by the public – for good.


Fidelindo A. Lim, DNP, CCRN

Fidel Lim has worked as a critical care nurse for 18 years and concurrently, since 1996, has been a faculty member at New York University Rory Meyers College of Nursing.  As the faculty advisor to various student groups (Undergraduate Nursing Student Organization, Asian Pacific-Islander Nursing Students Association, Men Entering Nursing, and the LGBT group) he has, among other things, fostered salience in nursing education.  His work as a Nurse Educator in a Magnet-designated hospital provides sustainable staff-focused educational support.  He is particularly interested in bridging gaps in nurse engagement and practice excellence.  Dr. Lim has published articles on an array of topics ranging from clinical practice, nursing education issues, LGBT health disparities, reflective practice, men in nursing, and Florence Nightingale among others.