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Official Journal of the Society to Improve Diagnosis in Medicine (SIDM)

Editor-in-Chief: Graber, Mark L. / Plebani, Mario

Ed. by Argy, Nicolas / Epner, Paul L. / Lippi, Giuseppe / Singhal, Geeta / McDonald, Kathryn / Singh, Hardeep / Newman-Toker, David

Editorial Board: Basso , Daniela / Crock, Carmel / Croskerry, Pat / Dhaliwal, Gurpreet / Ely, John / Giannitsis, Evangelos / Katus, Hugo A. / Laposata, Michael / Lyratzopoulos, Yoryos / Maude, Jason / Sittig, Dean F. / Sonntag, Oswald / Zwaan, Laura

CiteScore 2018: 0.69

SCImago Journal Rank (SJR) 2018: 0.359
Source Normalized Impact per Paper (SNIP) 2018: 0.424

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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
  • School of Nursing, Johns Hopkins University, Baltimore, MD, USA
  • School of Medicine, Johns Hopkins University, Baltimore, MD, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Diana Baptiste / Cynda Rushton
  • School of Nursing, Johns Hopkins University, Baltimore, MD, USA
  • School of Medicine, Johns Hopkins University, Baltimore, MD, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jennifer Day / Melinda Sawyer / Deborah Baker / Lori Paine / Cheryl R. Dennison Himmelfarb
  • School of Nursing, Johns Hopkins University, Baltimore, MD, USA
  • School of Medicine, Johns Hopkins University, Baltimore, MD, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ David E. Newman-Toker
  • School of Medicine, Johns Hopkins University, Baltimore, MD, USA
  • School of Public Health, Johns Hopkins University, Baltimore, MD, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-07-19 | DOI: https://doi.org/10.1515/dx-2017-0015


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.

Keywords: diagnostic error; interprofessional collaboration; nursing


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About the article

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.

Received: 2017-04-06

Accepted: 2017-06-06

Published Online: 2017-07-19

Published in Print: 2017-11-27

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

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.

Employment or leadership: None declared.

Honorarium: None declared.

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.

Citation Information: Diagnosis, Volume 4, Issue 4, Pages 201–210, ISSN (Online) 2194-802X, ISSN (Print) 2194-8011, DOI: https://doi.org/10.1515/dx-2017-0015.

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