Thank you, Maureen Shawn Kennedy, for discussing the "uncomfortable truths" about missed nursing care and errors in your Editorial, "Straight Talk About Nursing" (December 2013). I've worked with about 175 health care organizations during the last 22 years as an educator and consultant, and I've heard frightening patient care stories, observed the results of omitted care, and witnessed the care processes and systems that contribute to putting patient safety and outcomes at risk.

Compounding my concern is my personal experience: immediate family members and elders have experienced multiple medical and nursing errors, contributing to disability, lengthened hospitalization, and loss of function.

Given reasonable staffing and systems, RN leadership at the point of care is essential to maintaining patient safety in all areas of practice. Assistive personnel can only complete tasks safely, effectively, and more economically if RNs know how to delegate and supervise expertly.

We can't fix issues that are kept secret or avoided. This very real disconnect between best practice and reality must be openly discussed and addressed without repercussions for those in management and at the point of care. Raising nursing practice standards has the potential to lead to better, less expensive clinical results, such as fewer hospital-acquired conditions, decreased readmissions to acute care, and healthier patients and communities.

Your editorial made me cheer!

Ruth Hansten, PhD, MBA, RN, FACHE

Port Ludlow, WA