A study in the Journal of Nursing Administration noted recommendations from the American Association of Critical-Care Nurses that nurses "be relentless in pursuing and fostering true collaboration as part of the solution to reducing preventable medical errors". A frequently missing piece in this collaboration was effective communication. The study focused on the nurses' barriers to speaking up when a patient's safety is at risk. The authors concluded, “Culture change must include hospital leaders expressing and demonstrating support for registered nurses who speak up when patient safety may be in jeopardy”.