Six nurse executives across the United States discussed issues related to perinatal patient safety. Gaps in communication were identified as one of the biggest challenges facing nurse executives. Other issues included expectations of regulators and accreditors, the pressure for productivity with limited resources and staffing, and undercapitalized technology versus safety and staff competence. Each nurse executive discussed a perinatal patient safety initiative implemented recently in her organization. If costs were not an issue, construction of facilities, adoption of electronic documentation, and adding positions to help assure patient safety were at the top of their wish lists. Patient safety continues as the number one priority for nurse executives.