I’m not perfect. I have made errors, multiple errors over my 45 years of nursing. I think though I am not alone. From day one of nursing, we are taught to seek perfection. Nothing less is acceptable. Yet the complexity of nursing work fosters just the opposite, a milieu conditioned for imperfection.
A recent study explored nurses’ decision-making regarding the reporting of medical errors.1 Unlike previous investigations that addressed how nurses make errors, this research focused on the nurses’ decision-making to disclose errors. Critical care nurses were chosen to participate in this study due to the high rates of errors noted in intensive care units. Interview results were characterized into five stages associated with the admission of errors.
The first stage, Being Off Kilter, described nurses sense of working conditions that were challenging, taxing, or that flustered them. They cited instances of floating to another unit or being new or in a learning curve that enhanced the possibility of making mistakes.
Living the Error described the consuming nature the error assumed in the nurses’ thinking. They blamed themselves, questioned their credibility as a nurse, and even cited psychosomatic reactions such as “feeling sick to my stomach.”
Reporting Or Telling About the Error focused on how the mistake became known to colleagues in the work setting. Nurses described their deliberations about whether, when and how they revealed the error to others. Results ranged from formal reporting, speaking to the patient’s physician, making a conscious decision to withhold reporting, and negating blame by rationalizing factors associated with the error.
Living the Aftermath described the ongoing memories of the event even if it was resolved or deemed not having a deleterious effect on the patient. Due to a lack of follow-up after the event in many instances, nurses were left to dissect on their own how the error happened and if it could have been avoided.
Lurking In Your Mind depicts the final stage of the disclosure process whereby the memories of the error prevail, often despite time. Because of this, many nurses became hypervigilant in similar situations to ensure that repeated errors not occur.
All five of these phases have significant emotive qualities that frequently lie below the surface of awareness. Yet they often prevail and may influence nurses’ future work. The complexity of environmental factors within nurses’ settings that promote care delivery failures has been well-documented.2-5 Interruptions, multitasking, competing demands, and time pressures, all contribute to a heightened likelihood of mistakes.
I have tried to think of other professions where this degree of work-generated bustle is the norm. The only one I can think of is elementary school teaching which similarly is characterized by the above qualities. However, mistakes in this setting do not have the potential negative health implications that nurse error-making have. Hence, our profession as direct care providers is uniquely positioned to cause harm when carrying out, or inadvertently interpreting, orders from others.
While we talk about errors, and report and evaluate them, I have not heard of any cutting-edge processes to avoid them. Until then, errors as a major element of patient safety, will remain on our radar front and center.
- Koehn AR, Ebright PR, Draucker CB. Nurses’ experiences with errors in nursing. Nurs Outlook. 2016 Nov-Dec;64(6):566-574.
- Ebright PR. The complex work of RNs: Implications for healthy work environments. Online Journal Issues Nurs. 2010 Jan;15(1): 11.
- Hall LW, Scott SD. The second victim of adverse health care events. Nurs Clin North Am. 2012 Sep;47(3):383-93.
- Hopkinson SG, Jennings BM. Interruptions during nurses’ work: A state-of-the-science review. Res Nurs Health. 2013 Feb;36(1):38-53.
- Sitterding MC, Ebright P, Broome M, et al. Situation Awareness and Interruption Handling During Medication Administration. West J Nurs Res. 2014 Aug;36(7):891-916.