Thinking about medication safety is one of those things nurse leaders don’t really get to turn off. Even on days when nothing obvious goes wrong, the “what ifs” still follow you as you’re driving home and catch yourself reflecting on your day. You wonder if the evening shift ended up shorter than planned, or if someone stayed late to finish a medication pass. You replay a conversation from earlier in the week about a near miss and think, “Did we actually fix that, or did we just move on because the unit was busy?”

After years at the bedside, in leadership, and now working with healthcare organizations on medication workflows, my view of medication safety has shifted. It’s not really about telling nurses to slow down or be more careful. Most of the time, they’re already doing that, and carrying more than anyone realizes. When medication safety breaks down, very rarely is it about carelessness. It’s usually a sign that the system couldn’t support the reality of the shift. And along the way, it’s impossible for nurses to forget that medication errors have real consequences. Read More >