Meet a Champion of Nursing Diversity: Kimberly Williams

Meet a Champion of Nursing Diversity: Kimberly Williams

Kimberly M. Williams, DNP, MSN, RN, NE-BC, has dedicated her career to serving patients at every level. She started in health care as a front desk clerk and worked up to her current position as the Director of Nursing Operations at the Bass Center for Childhood Cancer and Blood Diseases at Stanford Medicine Children’s

Williams is an important nursing leader, and we are honored to feature her in the Champions of Nursing Diversity Series 2024. This series highlights healthcare leaders who are prominent figures in their organizations and are making significant changes in the nursing field.

Meet Kimberly Williams, DNP, MSN, RN, NE-BC, Director of Nursing Operations at The Bass Center for Childhood Cancer and Diseases at Stanford Medicine Children’s Health.

Talk about your role in nursing.

I am the director of nursing operations at The Bass Center for Childhood Cancer and Diseases at Stanford Medicine Children’s Health. As the director of nursing operations at a world-class pediatric hospital, I hold a multifaceted role encompassing numerous responsibilities. My role extends beyond the provision of patient care and involves strategic decision-making and ensuring the overall efficiency and effectiveness of the Center’s nursing operations. To do so effectively, I partner with over 180 nurses throughout the Bass Childhood Cancer Center’s various departments, including hematology, oncology, stem cell transplant, and the Center for Definitive and Curative Medicine. We deliver compassionate, high-quality care to our young patients and their families.

As the chair of the Patients and Families Committee on the house-wide Diversity, Equity, and Inclusion Council, I actively address health disparities, advocate for culturally sensitive care, and promote diversity, equity, and inclusivity within the healthcare system. I also mentor aspiring nurses, guiding and empowering them to pursue their dreams and overcome obstacles.

Tell us about your career path and how you ascended to this role.

My path progressed with a series of fits and starts. As a parent, I had to juggle motherhood, a full-time job, and my academics, so it took me roughly six years to obtain my BSN. Upon graduating from Texas Christian University in 2001, I settled into my first nursing role at Cook Children’s Healthcare System on the medical/surgical floor. Still, I always had my eyes on becoming a PICU nurse. After a year there, I transferred to the PACU to get some experience in intubation and sedation. I then transferred to the PICU, where I worked as a nurse and a charge nurse. There, I got the desire to return to school and obtain my master’s. I completed my MSN in 2010 from the University of Phoenix. Afterward, I accepted a job as a nurse manager, where I spent eight years before taking a leap of faith and accepting a position at Stanford Medicine Children’s Health as a patient care manager for The Bass Center for Childhood Cancer and Diseases. I worked in that role for about two years before taking the interim role of director of nursing operations. I have now been in that role for a little over three years.

It’s been a long journey, beginning as a Black, economically disadvantaged girl from a small town outside Pittsburgh, Pennsylvania. Growing up, I faced numerous challenges that could have hindered my progress. However, I was fueled by a burning desire to make a difference, overcome limitations, and pursue my dream of becoming a nurse. I rose above my circumstances to succeed in nursing, and my experience culminated in a leadership position at Stanford Medicine Children’s Health, serving as a testament to determination, resilience, and the power of education.

How long have you worked in the nursing field? Why did you become a nurse?

Sometimes, others can see something within us that we may not recognize.

I have been in nursing for almost 25 years and came into this field by happenstance. I was a single mother of three rambunctious boys at the time, working as a clerk in a children’s hospital. One of the physicians I worked with recognized that I had the qualities and potential to excel as a nurse. She would often tell me I should consider going to nursing school. For over a year, she kept encouraging me and was determined to get me to take one class. I finally agreed. I will never forget the first class I took, Psychology 101. I received an ‘A’ in that course. All I needed to confirm that I could do anything I put my mind to. I owe a lot of gratitude to that doctor. Her encouragement motivated me to pursue a new path and passion, creating a better future for myself and my family. Looking back, I feel that my journey is a true testament to the transformative power of mentorship.

What are the most important attributes of today’s nursing leaders?

I want to be intentional in answering this question from the lens of a Black nurse and DE&I advocate. I feel the most essential attributes of today’s nursing leaders include cultural competency, advocacy, mentorship, and community engagement.

To truly provide equitable, compassionate care, we must recognize and respect the unique cultural dynamics and challenges faced by the diverse communities we serve. As leaders, we must be attuned to these nuances through cultural learning, which equips us to deliver holistic care, meeting each patient’s and their family’s psychological, emotional, spiritual, cultural, and individual needs.

Advocacy is a crucial attribute for leaders in the nursing profession today. We can promote patient rights, ensure patient safety, empower patients with the needed information to make informed decisions, and more through advocacy.

As I mentioned before, mentorship has the power to change lives. When I came into the field, few Black nurses were in any leadership roles. I was often the only Black leader in more rooms than I’d like to remember. And this was the catalyst for my commitment to promoting and supporting up-and-coming nurses and diversity within the profession.

The last attribute I’d like to touch on is the importance of community engagement. People don’t know what they don’t know. As the eyes and ears of some of our most vulnerable populations, we must embed ourselves within our communities to promote community health initiatives, provide educational resources, and collaborate with community leaders to address health disparities and promote health equity.

What is the most significant challenge facing nursing today?

One of the most significant challenges facing nurses today is the persistent disparities and inequities in healthcare access and outcomes among marginalized populations. One key challenge is the need for more diversity within the nursing profession. While progress has been made, nursing continues to struggle with achieving a workforce that reflects the racial, ethnic, and cultural diversity of our communities. A homogenous nursing workforce can limit patients’ ability to connect with and receive culturally sensitive care from healthcare providers who understand their unique needs and backgrounds.

Additionally, biases and discrimination persist within the healthcare system, impeding equitable care delivery. Implicit biases can influence decision-making, communication, and patient interaction, leading to disparities in treatment and outcomes. Moreover, the challenge of healthcare access persists for marginalized populations, including racial and ethnic minority groups, low-income individuals, LGBTQ+ communities, and those with limited English proficiency. These populations face significant barriers, including lack of health insurance, geographic disparities, and social determinants of health, contributing to healthcare inequity.

As a nurse leader, how are you working to overcome this challenge?

As a Black nurse leader, I strive to create inclusive and welcoming healthcare environments.

While often difficult to navigate, we can overcome many challenges by advocating for policies and practices that address these systematic barriers.

Nurses can foster culturally sensitive, competent care by actively listening to patients’ concerns, promoting patient autonomy, and respecting patients’ values and beliefs. As mentioned earlier, I am chair of the Patients and Families Committee on the house-wide Diversity, Equity, and Inclusion Council at Stanford Medicine Children’s Health. In this role, I advocate for inclusive policies and practices that value and support diversity, prevent discrimination, and cultivate an inclusive workplace that celebrates different perspectives and ensures equitable opportunities for professional growth. Through organizational partnerships, Stanford Children’s is addressing some of these challenges by developing nursing-focused education programs that emphasize DE&I as fundamental components of the curriculum. This ensures that our workforce, especially nurses, are clinically skilled and culturally educated. Ongoing diversity training, mentorships, and continued education opportunities can promote nurses’ understanding of diverse patient populations and foster inclusive practices.

Despite the numerous obstacles within our profession, I am confident that with continued education and systemic support, nurses can play a vital role in advancing health equity and reducing disparities in healthcare.

What nursing leader inspires you the most and why?

There are so many who inspire me. When I look at the history of Black nurse leaders, the first person that comes to mind is the remarkable contributions of Mary Eliza Mahoney. Mary Eliza Mahoney (1845-1926) was the first African American registered nurse in the United States. Mahoney’s resilience and dedication to overcoming significant adversity in pursuit of her nursing career during a time of racial discrimination and inequality had a lasting impact on nursing and continue to inspire nurses of all backgrounds to this day.

However, the nurse leader who inspires me the most is my sister-in-law, Dr. Shakyryn Napier, DHS, RN, CPN, NEA-BC, LSSYB, and the Director of the Heart Center at Cook Children’s Healthcare System. Dr. Napier is one of the few Black nurse leaders I’ve enjoyed working alongside for most of my career. She possesses exceptional humility, demonstrating intense sincerity in her interactions with others. What sets her apart is her unwavering commitment to professional and personal mentorship. She invested her time and energy into me and was one of a few Black nurse leaders who recognized my potential, even when I doubted it myself. She believed in me and played an integral role in my leadership development.

Is there anything else you would like to share with our readers?

I want to share a personal experience reaffirming that I am truly walking in my purpose.

Four months ago, my father was diagnosed with stage IV lung cancer that metastasized to his bones and spine. About a month after his diagnosis, my 35-year-old son underwent an above-the-knee leg amputation. The experience of sitting on the other side of healthcare as a daughter and a mother has profoundly touched me and deepened my understanding of humility, compassion, mercy, and grace. As I provide support to my father and son during these difficult times, I am witnessing firsthand the physical, emotional, and psychological toll that illness and disability can have on families. This experience has enabled me to approach my role as a nurse leader with an even greater depth of compassion and understanding. Humility is a crucial quality in healthcare, as it allows us to recognize our limitations and biases while respecting the diverse perspectives and needs of those we care for. My experience has humbled me, reminding me of life’s vulnerability and fragility. Through my experience, I hope to provide a comforting presence, lend support, and cultivate stronger connections with patients and families navigating their difficult journeys.

Lastly, I’d like to emphasize the importance of self-care. Please seek support when needed, as our careers and personal lives can also affect our well-being. When prioritizing well-being, we can provide better compassionate care and leadership to those who need it.

Meet a Champion of Nursing Diversity: Cara Lunsford

Meet a Champion of Nursing Diversity: Cara Lunsford

Cara Lunsford is the VP of Community at, fostering a community where nurses can find peer support, allies, professional opportunities, resources, and education. She’s also the host of’s NurseDot Podcast and a member of the LGBTQ+ community, highlighting a variety of voices within the nursing industry while also speaking to her personal experiences as an RN and founder of HOLLIBLU, a social networking app exclusively for nurses (acquired by in 2022).

Lunsford is an important nursing leader, and we’re pleased to profile her as part of the Champions of Nursing Diversity Series 2023.

The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.


Meet Cara Lunsford, RN, CPHON, VP of Community at

Talk about your role in nursing.

Beginning my career in pediatric oncology, I witnessed firsthand the effects such a stressful job can have on a nurse. I observed my peers experience burnout and abuse on a daily basis. I heard their stories of adversity, trauma, and hope and joy. With my fellow nurses at Children’s Hospital Los Angeles (CHLA), we started the first Supportive Care Committee to ensure nurses had an environment available to help cope with job stress. However, there remained a greater need for resources like this committee at every hospital and nurses throughout healthcare sectors to improve retention and recruiting.

Realizing there was a broader need for a safe and supportive community and the potential technology had to solve this issue, I had the idea to found HOLLIBLU, the first social media network for nurses. The app was designed to provide peer support, professional advice, and connections with other nurses. In 2022, HOLLIBLU was acquired by, where I was brought on as vice president  of community to oversee the app platform. 

To continue amplifying voices within the nursing community, we launched the NurseDot Podcast late last year. I sit down with my nursing peers to discuss their stories, industry trends, and professional growth advice.

How long have you worked in the nursing field?

I have been in nursing for over 15 years, working in the acute setting as a pediatric oncology, home health, and home infusion nurse. Throughout the past five years, I have used my clinical knowledge as a registered nurse (RN) to take on an entrepreneurial role delivering technology solutions to my fellow nurses to help with everyday challenges. Most recently, I have been using my voice and platform in the nursing space to elevate other nurses, fostering a supportive community for nurses of all specialties and settings. 

Why did you become a nurse?

I started my career as a nurse in pediatric oncology back in 2008 at CHLA. Before that, I worked as an American Sign Language interpreter at Cal State Northridge, where I discovered my interest in oncology. For two consecutive semesters, I interpreted the Biology of Cancer class, and as I was listening and interpreting, I became more interested in oncology and the nursing profession in general. Ultimately, I was so intrigued that I was motivated to embark on a career in nursing. From there, I went to Los Angeles County College of Nursing and Allied Health, where I received an Associate of Science degree and became an RN. 

What are the most important attributes of today’s nursing leaders?

Successful nurses and nursing leaders are empathetic, drawing from personal experiences and truly listening to others from different backgrounds. Having navigated the healthcare system as a queer family put me in the patient’s shoes rather than the clinician’s, with which I was very familiar. My wife and I had a child with two HIV+ gay men, and we all continue to co-parent together. To have our son, we had to meet with multiple IVF clinics and experienced professionals who were either unfamiliar with our family situation or had stigmas around HIV and LGBTQIA+ healthcare issues. I understand what it is like to be rejected from care because of the stigma around your sexuality and hurtful preconceived notions. As a queer nurse, it’s important for me to share my experiences with patients and fellow nurses to create a better care environment for everyone and foster the best possible results for all patients, regardless of background.

With this experience as a patient, I can relate to the struggles my patients are going through. Similarly, as a nursing leader, I understand the struggles of my peers. This knowledge allowed me to create an app to best support nurses and care for their needs. To care for patients you do not know, sometimes nurses must put their own mental health and personal life on the back burner, requiring nurses to be extremely caring and understanding. While this means caring for patients of all backgrounds, it also means putting yourself in their shoes.

What does being a nursing leader mean to you, and what are you most proud of?

It’s important to acknowledge that nurse leadership brings a tremendous amount of responsibility. Nurses have faced unprecedented challenges in the past few years, resulting in a staffing crisis. The solutions nurses seek will require that people across healthcare get aligned on the reasons behind this crisis. Nurse leaders are being called to use their voices and platforms to ensure these messages reach the decision-makers within this industry. I had spent most of my career being the squeaky wheel, speaking up even when it was unpopular. I have taken huge personal and professional risks to create a safe space for nurses and bring awareness to their challenges. But with risk came great reward. believed in my mission and vision. In March 2022, they acquired my company, brought our small but mighty team into the family, and are helping us to continue our mission of providing a vibrant community where nurses thrive.

Tell us about your career path and how you ascended to that role.

After years of nursing and founding HOLLIBLU, I was drawn to given its 30+ year legacy. The biggest thing that pushed me to collaborate with the company was its mission, which completely aligned with mine. aims to improve the lives of the most vulnerable members of society and those who care for them. As a nurse, this resonated with me deeply. It is a company I wanted to associate myself with and help build toward this mission by including the app I was so passionate about creating. 

What is the most significant challenge facing nursing today?

Following the COVID-19 pandemic, the broader public became abruptly aware of nurses’ important role in the healthcare system and their daily challenges. In this post-pandemic world, with severe nursing shortages putting increased pressure on healthcare staff, nurse burnout, and professional stress are incredibly high, not to mention the grief and trauma that comes from caring for patients.  

As a nursing leader, how are you working to overcome this challenge?

Nurses need resources and support to equip them with the skills to deliver better care. The last few years have proven that nursing is one of our society’s most demanding and crucial jobs, so we must do something about it. It is vital to provide nurses with adequate resources and a supportive community to deal with burnout and improve their mental health. Nurses need accessible and effective training to help them advance in their careers and targeted job postings to help them find the best roles that fit their interests and experience. At, we put nurses’ needs first, providing them with a community of peers, reading materials, continuing education courses, and the ability to take control of their career paths. 

What nursing leader inspires you the most and why?

A few nurse leaders come to mind, but I would start with Rebecca Love. Rebecca has been working to empower and elevate the nurse profession, whether it’s through grassroots initiatives, like founding the non-profit SONSIEL (Society of Nurse Scientists, Innovators, Educators, and Leaders) or giving TedTalks about how nurses can drive healthcare innovation. Most recently, Rebecca has set her sights on a significant issue, the insurance reimbursement of nursing services. The Commission for Nurse Reimbursement explores the history of how the rates of nursing services were once set by the nurses themselves and how changes made over 100 years ago has resulted in nurses now being a cost instead of a benefit to hospitals. I just interviewed her on the NurseDot Podcast, and you can listen to that episode here

What inspirational message would you like to share with the next generation of nurses?

Nursing is a marathon and not a sprint. If you want to work in this profession for decades, it is important to prioritize your personal needs, practice professional boundaries, and know when to say “no” or “not right now.” Remember that you are human first. Practicing awareness will help you identify when it’s time to make a change, so don’t be afraid to leave your comfort zone and try something new.

Meet a Champion of Nursing Diversity: Shada’ Medley

Meet a Champion of Nursing Diversity: Shada’ Medley

Shada’ Medley joined the University of Maryland Medical Systems to be a change agent for innovative nursing care with a more diverse population.

Medley says her career path is part of God’s plan and cites Denzel Washington and Oprah Winfrey as a source of inspiration.

Shada’ Medley is an important nursing leader, and we’re pleased to profile her as part of the Champions of Nursing Diversity Series 2023.

The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.


Meet Shada’ Medley, MSN RN, nurse manager in the Ambulatory Service Department. She manages the THRIVE program clinic, known as infectious disease, at the University of Maryland Medical Center Midtown Campus.

How long have you worked in the nursing field? 

I have been an RN for 20 years and a medical assistant for five years prior.

Please talk about your career path and how you ascended to that role.

I feel that it was in God’s plan. I started as a MA and had a 5-year plan to be a nurse (5 years is how long the MA/phlebotomy certification lasted). I met my goal. However, just as I was ready to enroll in nursing school, I realized that I could not afford my livelihood and attempted to withdraw. As I withdrew from the day program, CCBC initiated its first evening/ weekend program (God’s blessing). I enrolled in that program and completed it on time as scheduled within five years. My next goal was BSN, so I enrolled in the first nursing partnership cohort with Notre Dame. With the same partnership, CCBC recruited faculty from within the hospital where I was employed. I then duplicated the same situation for MSN.

At the MSN level, l concentrated on nursing education. I started healthcare in ambulatory care as MA. I entered a nursing role in critical care for 14 years. Then, I transitioned to outpatient ambulatory care as an interventional radiology nurse. While working towards my MSN, my current leader transitioned to a more corporate role and inquired how I felt about management. I never thought about management, just education. I am a product of teenage parents. I remember holding flash cards for my mom. I remember organizing my mom’s books. I remember when my mom told me about tutoring adults that couldn’t read and how important it was not to be judgmental. My manager had been teaching and guiding me to function in her absence, and I also attempted to do that with my team. I remember thinking, why would I allow someone new to take over a role I already know I can progress? So I applied for that position and was hired. I branched off to skilled nursing and went from manager to ADON within a year and DON within two years. After skilled nursing, I felt I needed to help patients never reach long-term care or intensive care units. I then returned to ambulatory care with a focus on the PCMH model. I came to UMMS to be a part of a larger organization that would allow me to flourish and be a change agent for innovative nursing care with a more diverse population.

Why did you become a nurse? 

I have always been able to put the needs of others before my own. I have always enjoyed the satisfaction of taking care of others. I became a nurse to help, care for others, and give back to society.

What are the most important attributes of today’s nursing leaders? 

The essential attributes are empathy, diversity, equity, and inclusion. Even if it is not your belief, seeing someone’s point of view opens doors for communication, which is always good. Proper communication leads to innovation within the healthcare system.

What does being a nursing leader mean to you, and how are you making a difference?

Being a nursing leader means someone who inspires passion and motivation in others to believe in advancement and forward movement. A leader ensures their team has the support and tools to achieve their goals professionally and personally and to advocate for professional advancement.

What is the most significant challenge facing nursing today?

Access to diverse, equitable healthcare and the lack of available nursing educators.

As a nursing leader, how are you working to overcome this challenge?

Making short- and long-term goals include maximizing my education to obtain DNP and assuring work-life balance. Also, to actively and continually participate in the academia of licensed and unlicensed healthcare professionals. Also, by encouraging others to set goals for advancement in healthcare.

What nursing leader inspires you the most and why?

I am inspired by all nursing leaders who can lead the profession with their hearts first by balancing equitable patient care and cost-effective care. The nursing leader who truly empathizes with the population’s needs. The nursing leader who supports diversity, equity, and inclusion as a framework in their leadership style. Most of all, I am inspired by the leader who understands they are only as good as their team.

What inspirational message would you like to share with the next generation of nurses?

Denzel Washington said, “Ease is a greater threat to progress than hardship.” Everything worth having is worth working for… sometimes our circumstances should be our motivation.

Is there anything else you’d like to share with our readers? 

As Oprah powerfully stated, “No matter where you are on your journey, that’s exactly where you need to be. The next road is always ahead.” So be kind to yourself and know that you can do it!

Career Moves: From Shift Nurse to Leadership

Career Moves: From Shift Nurse to Leadership

You’ve been working as a shift nurse for a few years. You love it, and you love caring for patients. But there’s always been something else calling to you: leadership.

How do you start? What steps should you take? Do you need more education?

Don’t worry; we’ve got you covered.

Making the Shift to Leadership

“Think about how you want to influence the health care system at large,” says Rachel Neill, MSN, RN, CPPS, Founder of InnovatRN Consulting, Chief Clinical Advisor for HealthEdGlobal, and a Clinician Advocate at Vivian Health. “Leadership roles often provide opportunities to affect change at higher levels and support health care teams across disciplines.”

If you’re not certain that leadership is for you, Ophelia M. Byers, DNP, APRN, WHNP-BC, NEA-BC, CPXP, CDE, Chief Nursing Office, Overlook Medical Center, and Associate Chief Nurse Executive, Atlantic Health System says “it’s important to gain knowledge that will inform decision-making.” Read nurse leadership textbooks, journal articles, and books by or including nurse leaders. She suggests Fast Facts for Making the Most of Your Career in Nursing, edited by Dr. Rhoda Redulla.

Once you’ve decided to move to leadership, Byers says you need to determine your track. “There are two formal leadership roles: supervisory/managerial and non-supervisory/functional. In supervisory or managerial leadership, the leader has direct and indirect reports that comprise a team and is responsible for the care of those people and the operation, e.g., staff on a clinical unit. In non-supervisory or functional leadership, the leader does not have any reporting team members but rather is responsible for overseeing a specific function (e.g., Nurse Educator) or program (e.g., Magnet Program Director),” she explains.

Find a mentor, says Desiree Hodges, MBA, RN, CCRN, NE-BC, The Vice President of Care Services at the ALS Association North Carolina. “Having someone in your corner is truly key. I recommend having a trusted source give you a 360 evaluation, taking personality surveys, etc. We all have blind spots when it comes to communication, which allows you to recognize your bias,” she explains.

Know about the tasks you may be doing that you aren’t doing now. “You may oversee budgets, organize staff training, and otherwise ensure that nurses follow the right procedures and protocols,” advises Kelly Conklin, MSN, CENP, SVP, Chief Clinical Officer for PerfectServe.

If you don’t have that experience, you may need to earn a higher degree than the one you hold and/or obtain certifications. “Know your organization’s requirements, reach out to your current leader and discuss your plans to obtain the necessary degrees or certifications,” says Hodges. “The American Association of Critical-Care Nurses has an online course designed just for nurses new to leadership roles that cover the basics of finance, human resources, safety, and quality, as well as the leadership skills to be successful in the role of nurse manager.”

Trust your instincts as well, Neill says. And don’t forget your experiences as a nurse at patients’ bedsides. “When moving into a leadership role, it is important to have a direct leader and health care system that will support you as you navigate this transition. In addition, the nurse leader serves as the first-line advocate for the nurses doing the daily work. You cannot support the nurses adequately without a team/system to support you as a leader,” she says.

Conklin says that no matter what you choose to do, “Don’t cut yourself off from opportunities—whatever they may be—that challenge your thinking and bring you to a higher knowledge.”

Reducing Mistakes: What Every Nurse Can Do

Reducing Mistakes: What Every Nurse Can Do

RaDonda Vaught, RN, was not the first nurse to be prosecuted for making a mistake, but the circumstances and her trial were the most public.

Nurses from around the country watched and spoke out, supported her, and shared similar issues about the environment of care that she worked in, the failure of organizations to support nurses after self-disclosure, and the lack of trust in non-punitive response to error.

We learned that organizational system issues were present and acknowledged, yet RaDonda was held individually accountable, prosecuted, and convicted. (Department of Health and Human Services, 2018)  This punitive response to the error is the biggest reason for the lack of trust in just culture. It can cause nurses to suppress patient safety information as they attempt to protect themselves, their licenses, and their livelihood.

Healthcare Environment Can be a Chaotic Place for a Nurse

The healthcare environment is an ever-changing, distraction-ridden, and often chaotic place nurses work. Nurses have learned to develop workarounds of procedures to care for patients within systems riddled with roadblocks and a lack of staff. They drift from ideal practice interventions and are forced to multi-task most of their day. These behaviors are often mistaken for autonomy rather than the root cause until that mistake is grave or deadly. This environment of care is ripe for error and unsafe patient care outcomes.

When direct care nurses and nurse leaders fully understand how the environment impacts patient safety, they can develop a better awareness of the behavioral choices nurses make when providing care and build ways to decrease the likelihood of error. The first and most crucial part of arming yourself with knowledge about why mistakes happen is understanding the difference in behaviors.

Human error is unintentional and not considered a behavior at all. It is an outcome of the fallibility of being human. Risky behaviors occur when we drift away from policy and procedure and develop habits that we think are safe because we don’t appreciate the risk of injury. Reckless behavior is a conscious disregard for a known risk, understood by the person, and the action is taken anyway. It is intentional. (Institute for Safe Medical Practices, 2022)

Healthcare is not perfect, and mistakes will be made no matter how careful a person’s actions and behaviors are. It is a mistake to expect no mistakes! Organizations should strive to be reliable, not perfect, and provide an atmosphere that includes and promotes systems that catch mistakes before they reach the patient. (Rodziewicz, Houseman, and Hipskind, 2022)

What Every Nurse Can Do 

Direct care nurses can improve the environment of care and decrease the possibility of making mistakes by:

  • Speaking out and sharing concerns about the culture of safety with your leaders. Nurses are the most vital source of error identification in all organizations and all circumstances.
  • Insist on duplication and validation processes for high-risk injury interventions. Embrace teamwork by helping each other to ensure that clinical practice is correct.
  • Become active members of shared governance committees and assist in developing policies driven by real practice, not ideal environments. The best policies have multiple decision trees to the desired outcome, for example, “if this occurs, then do that .”Policies can then incorporate the known workarounds so that leaders understand the multiple avenues nurses may need to take to provide efficient and effective care.
  • Learn about the incident management and investigation processes in your organization. Volunteer as “subject matter experts” so investigators understand how nursing care is provided, and the incident analysis is fair.

Nurse leaders ensure that the care environment is safe. Actions they take can include:

  • Create real fixes when systemic or other issues are raised and praise those nurses who are brave enough to raise their voices.
  • Avoid quick responses and decisions to occurrences and let the investigation take its course.
  • Stand by staff when human errors or risky behaviors happen. Console nurses who make mistakes and avoid causing them more harm from the punitive response.
  • Promote transparency of the investigative process and promote legal support for nurses who may be held individually accountable.
  • Promote teamwork and consider alternative nursing delivery methods that can be flexed as acuity increases and decreases
  • Develop on-site resources for self-care and staffing schedules that enable nurses to take advantage of them. Stress, lack of sleep, poor nutrition, and lack of exercise can create cognitive changes that cause a lack of appreciation of risky decisions that direct care nurses can make. (Okpala, 2020)

Finally, all nurses need to become politically active. By participating in local and state governments, nurses can educate elected officials who may need help understanding the healthcare environment and expect perfection in care. In addition, nurses must help to create or support legislation that protects healthcare workers from legal prosecution. A culture of safety in healthcare takes a village!


  1. Department of Health and Human Services, Centers for Medicare and Medicaid. Statement of Deficiencies and Plan of Correction: Vanderbilt University Medical Center. Published December 10, 2018. Accessed July 29, 2022
  2. Institute for Safe Medical Practices. Criminalization of human error and a guilty verdict: A travesty of justice that threatens patient safety. ISMP Medication Safety Alert 27(7). Published April 7, 2022. Accessed September 25, 2022
  3. Okpala P. Nurses’ perspectives on the impact of management approaches on the blame culture in health-care organizations. Int J Healthcare Manage. 2020; 13(S1): 199–205. doi: 10.1080/20479700.2018.1492771
  4. Rodziewicz TL, Houseman B, and Hipskind JE. Medical Error Reduction and Prevention. Updated May 1, 2022. StatPearls. Treasure Island, FL: StatPearls Publishing; 2022: 42-44. Accessed August 2, 2022