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June 2011, Volume 41 Number 6 , p 25 - 27



A major study involving 6,500 nurses and nurse managers finds that a "culture of silence" among healthcare professionals undermines the effectiveness of protocols, checklists, and other error prevention initiatives. Conducted jointly by the American Association of PeriOperative Registered Nurses and the American Association of Critical-Care Nurses (AACN), "The Silent Treatment: Why Safety Tools and Checklists Aren't Enough to Save Lives" builds on the AACN's 2005 study, "Silence Kills: The Seven Crucial Conversations for Healthcare."The new study focused on three "undiscussables," defined as risky, emotional topics that often go undiscussed. * Concerns about dangerous shortcuts: 84% of nonsupervisory nurses said they work with people who take dangerous shortcuts, such as not changing gloves when appropriate and not checking patient armbands. * Concerns about incompetence: 82% of these nurses said they work with people who "aren't as skilled as they should be"-for example, lacking basic skills or not being current on procedures. * Concerns about disrespect: 85% reported working with people who "demonstrate disrespect." Examples of disrespectful behavior include condescending comments, rudeness, yelling, and name-calling.Eighty-five percent of respondents said a safety tool warned them of a problem that might have been missed and harmed a patient. But 58% of nurses warned by a safety tool said that they didn't speak up to solve the problem because they felt it was unsafe to speak up or they couldn't get anyone to listen.Only 9% of nonsupervisory nurses spoke up about concerns relating to all three key undiscussables: shortcuts, incompetence, and disrespect. The study includes a section on seven skills, actions, and attitudes that these "exceptional nurses" cited as the reasons for their success. For example, they assumed the best, explained their positive intent, and defused defensiveness by raising issues in a tactful way. The study authors noted that "none of the exceptional

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