NURS 6051 To Err Is Human discussion: planning guide
Two prompts are hiding in one discussion: a claim about awareness you are expected to argue with, and a Simple Rule you have to find still running in a real organisation — and the second one needs a workplace example before you can write a word.
Editorial process
Last reviewed · August 10, 2026
What is the "To Err Is Human" discussion actually asking?
This looks like one discussion prompt and is really two tasks with different evidence requirements, and most posts answer only the first. The first task is evaluative: you are handed Wakefield's claim that the most significant barrier to improving patient safety is a lack of awareness of the extent to which errors occur daily, and asked to consider it. "Consider" here is not "agree" — it is an invitation to test a 1999-era diagnosis against the two decades of implementation that followed. Awareness was genuinely the binding constraint when To Err Is Human landed, because the scale of preventable death was not common knowledge inside the professions, let alone outside them. The interesting question is whether it still is, or whether awareness is now abundant and the constraint has moved to reporting culture, alert fatigue, measurement, or the long gap between knowing an intervention works and getting it adopted at the bedside.
The second task is empirical and it is the one that decides the grade. You must go to Table 3 of Wakefield's chapter, the Ten Simple Rules drawn from Crossing the Quality Chasm, and do two specific things with a real organisation: name one rule where the current rule is still in operation, and name another where the organisation has effectively transitioned to the new rule. That is a pairing, not a general reflection, and a post that produces only one half of it has answered half the question. Each rule in the table is a two-column contrast — care based on visits against care as a continuous healing relationship, professional autonomy driving variability against care customised to patient need — so your answer has to place your organisation in one column for two different rules and say what observable practice puts it there.
The trap in the second task is answering it abstractly, and it is the difference between a pass and a strong post. "My organisation still operates under the old rule of professional autonomy" is an assertion that could be made about any hospital in the country; "handoff practice varies by which attending is on, so the same post-operative instructions reach the family three different ways on one unit in one week" is evidence, and it is evidence only you have. Work backwards from the examples you can actually describe rather than forwards from the rules that sound most important. If you cannot name the unit, the process, or the moment where you saw the old rule operating, choose a different rule — the strength of the post is the specificity of the two cases, not the significance of the rules you picked.
Health information technology is the thread that ties both halves together, and it is the easiest thing to drop. The week's framing is how IT has helped address the concerns the report raised, so a transitioned rule reads strongest when the transition was actually carried by a system: shared access to a single record making information flow the default rather than a favour, decision support making the evidence-based choice the path of least resistance rather than the diligent one. Where the current rule persists, ask a harder question than whether technology is present. A unit with a full electronic record whose nurses keep a paper brain sheet because the system cannot show them what they need at handover is not an organisation without technology; it is an organisation whose technology lost an argument with the work.
That distinction is worth making explicitly, because it is what separates an informatics post from a general quality post. The IOM's argument was never that clinicians should try harder — it was that error is a predictable output of system design, and that safer systems make the right action the easy action. Technology is one way of redesigning the system, and it fails in a recognisable way when it is layered onto an unchanged workflow and then routed around. If your persistent old-rule example involves a workaround, say what the workaround protects: nurses do not build shadow systems out of stubbornness, they build them because the sanctioned system costs them time they do not have, and the shadow system is the shape of what the sanctioned one failed to do. Naming that gap is a more useful contribution to a Week 1 discussion than restating that adoption is hard.
One structural note on the post itself. The brief gives you a preparation list rather than a word count, which means the marker is looking for evidence you did the preparation and not for length. Cite the Plawecki and Amrhein summary when you characterise what the report said, and cite Wakefield when you use the table, because those two are named in the brief as the things you were told to read. Everything beyond them is yours to choose, and one well-used current source on where patient safety effort now concentrates will do more for the awareness argument than three more citations about 1999. Peers will overwhelmingly agree with the awareness statement and then describe an EHR rollout, so a post that disagrees with the statement, or that describes a rule the organisation has visibly failed to transition, gives the thread something to reply to. That is what the participation criteria mean by adding something new.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Analyse how health information technology addresses the specific failures named in the IOM report, rather than technology in general.
- 02Read the Ten Simple Rules as a two-column contrast and place a real organisation on one side or the other.
- 03Test a stated barrier claim against later evidence instead of restating it.
- 04Distinguish a system that is absent from one that is present and being worked around.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
Important information for writing discussion questions and participation Hi Class, Please read through the following information on writing a Discussion question response and participation posts. Contact me if you have any questions. Important information on Writing a Discussion Question Your response needs to be a minimum of 150 words (not including your list of references) There needs to be at least TWO references with ONE being a peer reviewed professional journal article. Include in-text citations in your response Do not include quotes—instead summarize and paraphrase the information Follow APA-7th edition Points will be deducted if the above is not followed Participation –replies to your classmates or instructor A minimum of 6 responses per week, on at least 3 days of the week. 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What the Week 1 post has to contain
- 01A position on the statement that lack of awareness of daily error is the most significant barrier identified in "To Err Is Human".
- 02One Simple Rule from Table 3 where the current (old) rule is still in operation in your organisation, with the practice that shows it.
- 03One Simple Rule where the organisation has effectively transitioned to the new rule, with the practice that shows it.
- 04An account of the role health information technology played, or failed to play, in each case.
- 05Citation of the Plawecki and Amrhein summary and the Wakefield chapter, which the brief names directly as the preparation.
How to structure a post around two Simple Rules
Position on the awareness claim
State whether lack of awareness of daily error is still the most significant barrier, and say what has changed since 1999 that supports your view.
The rule still in its old form
Name one Simple Rule where your organisation's practice still sits in the current-rule column, and give the practice that demonstrates it.
The rule that has transitioned
Name a second rule where the organisation has genuinely moved to the new-rule column, and identify what carried the change.
Where the technology sits in each case
Connect both rules back to health information technology — what it enabled, what it failed to enable, and where it is being circumvented.
Where to find Table 3 and the awareness evidence
Recommended databases
- NCBI Bookshelf (for the full text of both IOM reports and the AHRQ nurses' handbook)
- AHRQ PSNet
- PubMed Central
Search sequence
- 1.Open Wakefield's chapter on NCBI Bookshelf and find Table 3 before writing anything — the two rules you can evidence should drive the post, not the other way round.
- 2.Read the Ten Simple Rules in Chapter 3 of Crossing the Quality Chasm in their original form, since Table 3 is a condensed restatement and the original wording is more precise about what each column means.
- 3.Check a current AHRQ patient-safety primer for what is now named as the binding constraint, so your position on the awareness claim rests on something later than 1999.
- 4.If you argue technology carried a transition, find one systematic review of health IT effects rather than a single implementation study, because single-site results are exactly what the literature says do not generalise.
Which patient safety sources carry this argument
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
To Err Is Human: Building a Safer Health System
Institute of Medicine (US) Committee on Quality of Health Care in America / National Academies Press · 2000
The primary report the whole discussion is about, in full text. Go here for the recommendations themselves rather than relying on the article summary; the chapters on error reporting systems are where the awareness argument is actually made.
- 02
The Quality Chasm Series: Implications for Nursing
Agency for Healthcare Research and Quality, in Patient Safety and Quality: An Evidence-Based Handbook for Nurses · 2008
The chapter the brief sends you to, and the source of Table 3. This is where both halves of the assignment are anchored, so read the table's two columns carefully before choosing your rules.
- 03
Crossing the Quality Chasm: A New Health System for the 21st Century
Institute of Medicine (US) Committee on Quality of Health Care in America / National Academies Press · 2001
Chapter 3 gives the Ten Simple Rules in their original wording and the reasoning behind each contrast. Useful when Table 3's condensed phrasing leaves you unsure which column a practice belongs in.
- 04
Patient Safety 101
AHRQ Patient Safety Network (PSNet) · 2024
A current statement of where the field says the constraints now lie — reporting culture, ambulatory and diagnostic safety, alert fatigue. This is the evidence for arguing that the awareness barrier has or has not been superseded.
- 05
Effects of health information technology on patient outcomes: a systematic review
Journal of the American Medical Informatics Association · 2016
Evidence on what health IT does and does not demonstrably change in patient outcomes. Cite this when you claim technology carried a transition; it will also stop you overclaiming, since the review is careful about weak study designs.
Before you post
Common mistakes
- Summarising "To Err Is Human" — its 44,000–98,000 figure, its history — instead of arguing about the awareness claim the brief actually quotes.
- Naming only one Simple Rule, when the brief asks for one still in its old form and another that has transitioned.
- Choosing rules by which sound most important rather than which you can evidence with a concrete practice you have seen.
- Describing the organisation's aspiration — the policy, the mission statement — rather than what is observably done.
- Dropping health information technology entirely, which turns an informatics discussion into a generic quality post.
- Treating the presence of an EHR as proof of transition, when a system that staff route around is evidence of the old rule persisting.
Submission checklist
- The awareness statement is answered with a position, not paraphrased.
- Exactly two Simple Rules are named, and each is quoted or identified from Table 3.
- One rule is shown still in its old form; the other is shown transitioned.
- Each rule carries a specific observable practice, not a general characterisation.
- Health information technology appears in the account of at least one rule.
- Wakefield (2008) and Plawecki and Amrhein (2009) are both cited, since the brief names them as the preparation.
- The organisation is described without identifying patients or breaching confidentiality.
Use this guide to plan and review your own work. Follow your institution's rules and read our academic-integrity policy.
Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
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Argumentation and thesis development
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