On the ball: leadership for patient safety and learning in critical care

To explore nursing leadership for patient safety in critical care and identify opportunities to improve leadership that promotes patient safety.

There is limited systematic evidence about how nurses lead the microsystem of critical care and to the creation of a culture of patient safety.

Focus groups of multidisciplinary frontline providers and managers were used to gain insight into leadership that promotes patient safety and learning.

Gains in critical care patient safety require a skilled nursing leader who is mindful of bedside situations and has real-time decision-making authority. Patient safety is seen as management of the moment, rather than a function of organizational systems and processes.

Leadership for improved patient safety resides primarily with nurses who provide direct patient care. These nurse leaders play 3 critical roles: they are the "go-to," they are "on the ball," and they "keep the ball rolling."