One of the issues facing nursing practice is that of accountability. Nurses are increasingly held accountable for errors in an effort to improve patient safety and quality-care delivery. Throughout this degree program, this issue has been presented. Reflect on what you have read about quality and safety and the many presentations on this important issue. Consider the ANA's Code of Ethics and its application to patient safety and quality-care delivery. You may also want to review some of the earlier media presentations including that of Dr. Don Berwick in NURS 3005, Dr. Lucille Joel in NURS 3000, and the media presentations for this week. With these thoughts in mind, read the following scenario and respond to the questions below.

Tower 4 West is a 36-bed medical unit. The nurse leader, Renee, is a new leader, and her performance is evaluated based on the number of medication errors reported on her unit. As a result, she has told everyone very clearly that she will tolerate no errors and that she wants the unit to have zero medication errors each month. When an error does occur, she meets individually with the nurse, writes up the nurse's error, and puts a report in the nurse's performance review files. She has put two nurses on performance probation. As a result, the nurses on the unit are afraid to report when an error occurs, and they have begun to cover for each other and not report errors. You are a staff nurse on the unit, and you want to serve as a leader in creating a blame-free environment.

1. What's wrong with Renee's approach to medication errors?

2. What first steps would you take to change the culture?

3. How do you think the ANA Code of Ethics applies, or does not apply, to this situation?