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On the Ball: Leadership for Patient Safety and Learning in Critical Care

Tregunno, Deborah PhD, RN; Jeffs, Lianne MSc, RN; Hall, Linda McGillis PhD, RN; Baker, Ross PhD; Doran, Diane PhD, RN; Bassett, Sue Bookey MEd, RN

Journal of Nursing Administration: July-August 2009 - Volume 39 - Issue 7/8 - p 334-339
doi: 10.1097/NNA.0b013e3181ae9653

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."

Authors' Affiliations: Associate Professor (Dr Tregunno), York University School of Nursing; Director of Nursing/ Clinical Research, Scientist, Li Ka Shing Knowledge Institute (Ms Jeffs),St Michaels' Hospital, Toronto, Ontario; Professor (Dr Doran), Associate Professor (Dr Hall), Doctoral Student (Ms Bassett), Faculty of Nursing, and Professor (Dr Baker), Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

This research was supported by a grant from the Canadian Health Services Research Foundation.

Corresponding author: Dr Tregunno, York University School of Nursing, 4700 Keele St, Toronto, Ontario M3J 1P3 (

© 2009 Lippincott Williams & Wilkins, Inc.