Few people refute the contention that healthcare can be unsafe. There is a strong research base and wide recognition that some patients would be better off without care than with it. The clamor around a few bandwagon responses to the problem, with little more than carnival rhetoric for evidence, is almost overwhelming. There is, however, still a strong reluctance to apply some of the obvious solutions that have a foundation in systematically generated knowledge.

There seems to be no end to the money organized healthcare is willing to invest in technology solutions: (a) electronic health record, (b) bar-coded medication administration, (c) computerized provider order entry, (d) Web-based information in your palm, and (e) the wiring of American hospitals. And yet, collecting standardized data measuring outcomes sensitive to nursing care is said to be much too expensive to implement.

There seems to be no end to the parade through nursing units of hospital executives doing "walk-arounds" and rapid response team members backing up the care-team, although there is little evidence for the impact of either. And yet, increasing the registered nurse staff on those units, a solution with a strong foundation in research, seems impossible to achieve.

There seems to be no end to the pronouncements and communique[spacing acute]s about patient safety relayed through policy and practice circles. And yet, open communication among nurses, physicians, and the patients they care for is little closer than it ever was.

There seems to be no end to the high-tech diagnostic and therapeutic procedures provided to patients in our healthcare system. And yet, we still cannot find the time and place to fully listen to patients and provide the information they need to participate in decisions about their care and to keep themselves safe.

We must find ways to present what we know on the basis of evidence from nursing research, and have known for long enough that it has become mundane, in a way that blazes up and lights the way. Then we will reach the amazing possibility of safe healthcare.

Mary A. Blegen, PhD, RN, FAAN

Associate Editor

Director of the Center for Patient Safety

School of Nursing, University of California, San Francisco

[email protected]