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"Do No Harm": When Nurses Make Mistakes

Submitted by Admin on February 16, 2010, 8:02 am
A disturbed patient who commits suicide while nurses are within range of hearing. A healthy toddler who dies during a minor operation because of a medication overdose. An elderly man whose right hip was replaced instead of his left.

Horror stories like these make headlines. And sadly, while such stories may be sensationalized by the press, there's no smoke without fire. In 2008, nearly 90 serious medical errors occurred in Utah hospitals and surgical centers alone. This shows an increase of over 50% from the previous year, according to a Utah Department of Health report requested by The Salt Lake Tribune.

Why do mistakes happen? In no particular order, here are three of the main contributing factors to mistakes in nursing workplaces:

1. Lack of Sleep

According to studies cited by Reader's Digest, over 40% of medical workers say they’ve made fatigue-related errors. In one survey alone, just under 20% of medical workers report “worsening” a patient’s condition because of sleep-related fatigue.

2. Rushing or Over-Busy

In 2007, the ANA and Inviro Medical Devices developed and co-sponsored a study that explored the challenges related to labeling on syringes. The project, called the Study of Injectable Medication Errors, revealed that 78% of nurses believe the key factor related to injectable medication errors is "too rushed/busy environment."

3. Overworked and Understaffed

"The greatest common risk to patients is the understaffing of nurses," says Dr. Gary P. Brandeland, MD, Minnesota emergency room physician and author of "The Day Joy Died," an article published in a 2006 issue of Medical Economics. "A nurse may make a critical mistake, and a patient might die. She has to live with the error, but the real culprit, the root cause often is that she or he was understaffed and overworked and a mistake was made."

When considering the above reasons for nursing mistakes, keep two things in mind. Firstly, all the reasons are interconnected. Nine times out of ten if you're rushing you're also struggling with too much work and you're also fatigued.

Secondly, none of these common reasons for making a mistake are directly under your control. As a nurse who's part of a team, you can't always control the length of your shifts or the busyness of your environment. You can't call your workplace and say, "Sorry, but I've only gotten four hours of sleep in the past 24 hours, so I'd like to get some sleep even though there are critically ill patients who need me right now."

Until a gigantic transformation takes place in the nursing world, mistakes will continue to happen. It's inevitable.

Happily, most of the mistakes made by nurses are not as life-shattering as the one chronicled in Dr. Brandeland's article, in which a pregnant woman died as a result of a series of errors on the part of the nurse anesthetist. "Little mistakes happen all the time," writes a nurse blogger at Mediblogopathy. "Big mistakes, thank god, are much rarer and....tend to be the sort of thing you hear about but don't see."

Want to avoid the likelihood that you'll make a big mistake? Get a handle on the little mistakes first. Here are three ways not to react to a mistake, be it ever so small.

1. Play the Blame Game

"One younger nurse on my shift is known for making inconsequential mistakes," writes a nurse manager from Nevada. "I knew she was becoming a good nurse when I noticed she'd stopped blaming others for her mistakes or coming up with an excuse--how was I supposed to know the correct procedure, I thought Sam had documented that--and so on. She still makes mistakes occasionally but she is putting her energy into learning from her mistakes now instead of pointing the finger of blame."

2. Stage a Cover-up

Oops! The family wants to know why grandpa needs to stay in the hospital an extra day. You may be tempted to lie about the incorrect medication he was given. Don't. Not only is it unethical, but the stress you cause yourself and your co-workers by attempting to cover up a mistake will make you tense and brittle--and likely to commit a more serious faux pas.

3. Shoot the Messenger

"As the most experienced nurse in my unit I feel a lot of pressure to be a strong role model to the newer nurses," reports a critical care nurse with over 22 years of experience. "However I am not infallible and I certainly make my share of mistakes. If an LPN comes to me and says, you made a mistake in transcribing this dose, and I tear her head off, what is going to happen? Nurses are going to be less likely to report mistakes and bottom line is that patients will suffer. Always thank someone who points out a mistake, after all that person just helped you and helped the patient."

What Mistake You Made Taught You The Most?

"Do no harm" is a good intention to hold. But the reality is that as an overworked nurse, you will do harm somewhere along the way. All you can do is rely on your fellow nurses for checks and balances, learn from your mistakes, and share your stories.

What mistake during the course of your nursing career sticks out in your mind and taught you the most? Why not share it with other nurses and pass along the lesson you learned so you can help others benefit from your experience? Tell us your story.

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