A common dilemma among nurses when talking with people outside of the healthcare system is whether to disclose that you are a nurse, such as when crammed onto a full flight where a little small talk eases psychological discomfort caused by shrinking personal space. Often, what starts out as a casual conversation, such as "What do you do?" "I'm a nurse," becomes listening to a stranger recall experiences with healthcare. The good news is that the public trusts nurses; why else share a story of a very personal nature. However, over the years, the stories are increasingly focused on what went wrong in the hospital.

Credible evidence that things have gone wrong in hospitals is available from the Institute of Medicine's (IOM)1 2000 report To Err is Human: Building a Safer Health System, which reported that an estimated 98,000 hospitalized Americans died each year as a result of errors in their care. In a follow-up national survey about errors in healthcare, 24% of the members of the public reported an error that had serious health consequences for themselves or a family member, including death, long-term disability, and severe pain.2 Recognizing the contributions of nurses and nursing practice to patient safety, the US Department of Health and Human Services Agency for Healthcare Research and Quality requested that IOM conduct a study to identify the aspects of nurses' work environment that likely impact patient safety and to suggest improvements in working conditions that would increase patient safety. The results of this IOM study are described in the Keeping Patients Safe: Transforming the Work Environment of Nurses, published in 2004.3

Keeping Patients Safe outlines actions for creating safer patient care. The commonalities between the outcomes of clinical nurse specialist (CNS) practice4 and the IOM recommendations bring into focus the unique contributions of CNSs to the national patient safety agenda. For example, CNS practice outcomes in the patient-client domain include delivering evidence-based care, deleting outdated and inappropriate interventions from care guidelines, transitioning patients across the continuum of care, and preventing unintended consequences and errors. There are 16 outcomes of CNS practice in the patient-client domain, each one demonstrating remarkable parallel with the recommendations in the IOM report. Likewise, the 13 CNS outcomes in the nursing/nursing practice domain and the 13 CNS outcomes in the organization/system domain parallel the recommendations of the IOM report, with expectations for practice-based leadership that empower nurses to solve problems at the point of service, improve job satisfaction, increase participation in decision making, integrate change throughout the system, and actively engage healthcare professionals in collaborative practice.

The expected outcomes of CNS practice clearly address patient safety. To assist CNSs in leading nursing in the call to transform the work environment for nurses and achieve high-quality, cost-effective, safe patient outcomes, the National Association of Clinical Nurse Specialists (NACNS) is crafting a national CNS patient safety agenda. This agenda will demonstrate the articulation between CNS practice and the recommendations in Keeping Patients Safe. The national CNS patient safety agenda will sharpen the focus of the unique contributions to safety of CNSs by setting priorities for CNS practice and establishing resources to assist CNSs with innovative interventions along with procedures for evaluation and instruments for measurement of patient outcomes. CNSs are invited to share outcomes of patient safety initiatives with the NACNS members by submitting manuscripts and letters to the editor. CNSs can assure the public that their trust is well founded by providing quality patient care and the leadership necessary to actualize the recommendations of the Keeping Patients Safe report and thereby changing those strangers' stories of problems to expressions of gratitude.

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