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Licensed Unlicensed Requires Authentication Published by De Gruyter July 19, 2017

Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action

Kelly T. Gleason, Patricia M. Davidson, Elizabeth K. Tanner, Diana Baptiste, Cynda Rushton, Jennifer Day, Melinda Sawyer, Deborah Baker, Lori Paine, Cheryl R. Dennison Himmelfarb and David E. Newman-Toker
From the journal Diagnosis


Nurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error. We offer a conceptual model to formalize and expand nurses’ engagement in the diagnostic process through education, maximize effectiveness of interprofessional teamwork and communication through culture change, and leverage the nursing mission to empower patients to become active members of the diagnostic team. We describe the primary barriers, including culture, education, operations, and regulations, to nurses participating as full, equal members of the diagnostic team, and illustrate our approach to addressing these barriers. Nurses already play a major role in diagnosis and increasingly take ownership of this role, removing barriers will strengthen nurses’ ability to be equal, integral diagnostic team members. This model should serve as a foundation for increasing the role of the nurse in the diagnostic process, and calling nurses to take action in leading efforts to reduce diagnostic error.

Corresponding author: Kelly T. Gleason, RN, PhD(c), School of Nursing, Johns Hopkins University, 525 N Wolfe Street, Baltimore, MD 21205, USA, Phone: +(708)334-4876
Drs. Cheryl R. Dennison Himmelfarb and David E. Newman-Toker are co-senior authors.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: Kelly T. Gleason received support from predoctoral fellowship in Interdisciplinary Training in Cardiovascular Health Research, T32 NR012704, and Predoctoral Clinical Research Training Program, TL1 TR001078. David Newman-Toker’s effort was supported by the Armstrong Institute Center for Diagnostic Excellence.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Received: 2017-4-6
Accepted: 2017-6-6
Published Online: 2017-7-19
Published in Print: 2017-11-27

©2017 Walter de Gruyter GmbH, Berlin/Boston

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