How a Pilot Applies Aviation Safety Principles to Nursing

Rebecca Hendren, for HealthLeaders Media , March 22, 2011

"I want nurses to understand that if a patient's condition is worsening and they need to communicate with physicians to obtain medical orders or treatment, the way they go about relaying that information can be the difference maker for the patient," says Sculli.

Sculli explains that nurses often engage in "hint and hope" communication, where rather than speaking directly and assertively, nurses send out hints to decision makers hoping they will catch on. This rarely works and just creates delays for patients. Sculli outlines specific tools and strategies nurses can use in communicating. He also discusses the importance of assertive communication techniques that can be used to respectfully escalate an interaction when physicians push back or fail to engage.

"Implementing respectful graded assertiveness in a structured manner gives nurses tools that ensures the patient gets what they need, right now," says Sculli. 

CRM allowed the airline industry to address the human factor and cultural problems that led to adverse events. Sculli believes CRM can do the same on the nursing unit where the majority of patient care is delivered, but it's a paradigm shift that requires nurse leaders, nurse managers, directors, and nurse executives openly support frontline caregivers as they incorporate new tools into existing models of practice.

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at
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