I enjoyed reading the article "Weaving a Culture of Safety into the Fabric of Nursing" by Ilia M. Echevarria, PhD, MS, RN, CCRN-K, CENP, CHES, NEA-BC, and Michele Thoman, MBA, BSN, RN, NEA-BC, in your December 2017 issue. Many of the initiatives listed are what my healthcare organization has put into place, such as a professional practice model, shared governance, staff professional growth and development, a safety survey, and quality outcomes. Although nursing is making great strides to improve the safety culture, I think more collaboration and interdisciplinary work need to happen to truly do so. We strive to empower nurses, but there's still a fear of speaking up when physicians, surgeons, and some leaders are involved. Developing a fair and consistent culture of safety for everyone in the healthcare organization should be a priority.

For example, the World Health Organization surgical safety checklist is initiated for the improvement of safe patient passage throughout surgery. However, it can only be effective if there's a positive attitude change, an improved safety culture, sticking to each checklist item, and OR surgical team buy-in. Healthcare institutions need to instill a culture that promotes patient safety while holding each individual accountable. We'll continue to improve our safety culture, but collaboration with other professionals also needs to occur.

-Teresa Feathers, BSN, RN, CNOR

Arlington, Tex.