On the Ball

OBJECTIVE: To explore nursing leadership for patient safety in critical care and identify opportunities to improve leadership that promotes patient safety. BACKGROUND: There is limited systematic evidence about how nurses lead the microsystem of critical care and to the creation of a culture of patient safety. METHODS: Focus groups of multidisciplinary frontline providers and managers were used to gain insight into leadership that promotes patient safety and learning. RESULTS: 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. CONCLUSION: 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."