Nurse managers also described a failure of patients to adhere to estab-lished unit safety practices as a risky behavior. Such failures to adhere to policy and practices that were described by participants include ambulating without needed assis- tance, eating during the HD treat- ment, failure of patients to clean their access sites prior to HD initiation, and covering their faces and access devices with blankets during the HD treatment, thus impairing patient monitoring by staff. One HD unit nurse manager clearly summarized: “Some patients are a little head strong, maybe should be using an assistive device or maybe even should be in a wheelchair as far as ambulating, but they don’t want to let go of that independence.”