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Every nurse, at every level of the organization, plays a role in an organization's journey toward high reliability. Each nurse and each member of the interprofessional health care team must be committed to high reliability. Direct Care nurses are essential in HROs. While many contributing factors lead to errors, an actual error occurs when the nurse or another clinician interacts with the patient, at the “sharp end” of care. The nurse is often the last line of defense against health care errors. As such, the nurse must be cognizant of personal behaviors to enhance safety and communication techniques that can be helpful in preventing errors and patient harm.

However, individual actions are not sufficient. Committed nurse leaders are needed to implement system changes that are essential for becoming an HRO. In collaboration with other organizational leaders, nurse leaders are accountable for the provision of effective and efficient care while protecting the safety of patients, employees, and visitors. Leadership's failure to create an effective safety culture is a contributing factor for many types of adverse events (The Joint Commission, 2018a, 2018b, 2018c). Shaping an organization into a culture of safety and reliability is essential for enhancing safety and improving the “blunt end” or care.

To prepare nursing students to function in the complex health care environment. The QSEN project was established. The QSEN Institute is a collaborative of healthcare professionals focused on education, practice, and scholarship to improve the quality and safety of health care systems. Their goal is to prepare future nurses at the baccalaureate and graduate levels with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the health care systems within which they work. Based on earlier work completed by the Institute of Medicine (2001), QSEN identified six core competencies for new graduates, as outlined in Table 4.4 (QSEN, 2018). Each core competency is described below. The competencies are used to frame this chapter's discussion of high reliability.

Table 4.4 QSEN Competencies

Patient‐Centered Care

Teamwork and Collaboration

Evidence‐based Practice (EBP)

Quality Improvement (QI)

Safety

Informatics

Source: QSEN.org.