President's Note: Make Waves: Find Courage to Confront Reality
By Denise Thornby, RN, MS
Sometimes the act of courage I find most painful to confront is the courage to see current reality, no matter how difficult and overwhelming that reality is.
One reality that recently was brought to the forefront of public attention through an Institute of Medicine (IOM) report, federal agency panels and a series of articles in the Chicago Tribune is the portrait that medical errors are more than a series of incidents; they are, in fact, common in the healthcare system in the United States. I was flooded with emotion when I read in the lead of one of the Chicago Tribune articles that “overwhelmed and inadequately trained nurses kill and injure thousands of patients every year as hospitals sacrifice safety for an improved bottom line.”
As many of you, I have mixed feelings when confronted with this public discussion of the reality that healthcare errors harm, injure and, perhaps, even kill the patients who we are trying to care for and who we are trying to protect and safely navigate through a complex healthcare system. As I read the four articles in the Chicago Tribune series and scanned the hundreds of articles that appeared in other newspapers across the country, I was concerned that nurses would be held accountable for errors that are well beyond their control, given the difficult, nearly impossible circumstances in which they find themselves. I also felt anger that nurses are being placed in risky situations, where errors are likely to happen, and a great deal of sadness that our system impedes the delivery of safe, humane and compassionate care.
At the same time, I was relieved that there is recognition of and public discussion about the fact that our hospital environments have reached a critical condition. Perhaps, the findings and ensuing discussion surrounding the IOM report and the federal panels examining healthcare error will lead to mandated changes that are designed to create a safe healthcare delivery system, one that is more conducive to optimal practice and the type of humane and healing care patients have the right to expect.
As healthcare leaders, we must realize that medical errors are the devastating symptom of a broken healthcare system, not the hallmark of a poorly educated or uncaring profession of nursing. Therefore, this public dialogue is an opportunity to be advocates for patients and their families, to discuss the realities, and to promote ways we feel this problem must be addressed. Patients and families are looking to you to reassure them that you are doing everything to safeguard them from harm. They need you to articulate how you ensure their safe passage and what you do to ensure that they are cared for safely. You must also reassure them that all healthcare providers are interested in ensuring their safety.
In this debate, there are opportunities for each of us to make a difference, to make waves. Following are some strategies to help you “catch the wave” and seize these opportunities:
1. Conduct a self-inventory, a self-assessment of how safely you practice and safe guard against error.
• Have you taken steps to ensure you employ the best of safe practices?
• Have you made certain that you have the skills, abilities, competencies and experiences needed to care for any patient presented to you?
• Have you made sure you have all the needed information to safely use medical devices, operate patient care equipment and administer drugs and infuse blood safely?
• Do you make sure you are well rested, focused on your work and not distracted when caring for your patients?
• Do you maintain effective relationships and communication with coworkers, physicians and other team members as you care for patients?
• Do you seek certification as a means of documenting your competence as a critical care nurse?
• Do you report errors or “near-misses” and examine the opportunities to prevent those errors in the future?
• Do you know how to report equipment failures, adverse reactions and other risk events?
• Do you understand the nature of the problem of healthcare errors, what the IOM report and agency panel reported, and what their recommendations are?
2. Help create a culture of safety rather than a culture of blame in your care setting.
Lucien Leape, an expert on medical errors, contends that one of the most important strategies for healthcare organizations and practitioners to embrace is the creation and maintenance of a culture of safety. A culture of safety includes not only an aggressive course employing every possible strategy to prevent error, but also an environment in which all of us accept accountability and responsibility for preventing errors and mistakes. Most importantly, we must create a culture where the stigma of making mistakes is removed and where there are incentives and recognition for every effort to identify, report, analyze and problem solve around points of error.
What will not work, and what I ask each of you to work hard to reverse, is the more prevalent culture of blame. This is a culture that says if we work hard enough, if we are “perfect” enough, there will be no errors and, if there is an error, it is because someone was careless, thoughtless, incompetent or worse. This type of culture that singles out, censors and punishes people only contributes to an environment that fosters error, cover-up and further disruption to our healthcare system. All the literature and analyses of errors points to the fact that the real root of the issue lies in systems, procedures and a lack of safeguards, not poor practice or careless practitioners.
I believe that one of nursing’s most significant contributions to healthcare is the never-ending vigilance to ensure safe passage of patients through the system. Twenty-four hours a day, seven days a week, nurses intervene to meet patient needs, from ensuring correct medical interventions are ordered to making sure the patients’ basic needs such as food, sleep and comfort are met.
However, as hospitals responded to financial pressures, their redesign strategies created additional gaps in the delivery of healthcare, which makes this protective role even more essential. This role, which nursing has always held in the care of patients, is now threatened by the nursing shortage; substituting nonlicensed, assistive personnel for registered nurses; dramatically shortening orientation; and the lack of ongoing education of staff.
Our patients and our communities will respect our efforts to address this issue, if we have the courage to talk about the current reality, the courage to confront our part in it and the courage to take action to create a culture of safety in each of our units. Although this will not be easy, it is at the heart of what we do for patients—a type of sacred trust we hold with patients. Because we must protect this proud legacy, I hope each of you will accept the challenge of the proposed strategies, and make a difference for our patients and our profession.
Where to Find Information and Resources
AACN offers a number of resources to optimize patient care in critical career settings, including a blueprint for proper staffing, practice protocols and standards of care. In addition, AACN’s statement in response to the Chicago Tribune series on nursing errors and talking points surrounding the issue are available on the AACN Web site at
Additional information related to medical errors is available in the “Public Policy” area of the AACN Web site at www.aacn.org. Click on “Public Policy Links” to access the Institute of Medicine report on medical errors, as well as information from sources such as the Quality Interagency Coordination Taskforce, National Patient Safety Foundation and Institute for Healthcare Improvement.
For more information about AACN’s public policy initiatives and resources, call (800) 394-5995, ext. 508.
Nursing Errors Issue Finally Surfaces
I am thrilled that the issue of nursing errors is finally being addressed! Similar problems are occurring in Florida, but are rarely covered by the news media.
Attorneys are even running ads soliciting business from family members whose loved ones have suffered from such things as bedsores and bruises from needle sticks. I am also tired of hearing patients be advised to have a surrogate stay with them in the hospital because of short staffing.
As a result, families become irate. I am really tired of families writing everything down, from monitoring how quickly the call light is answered to dating bed sheets.
This isn’t happening at just one hospital. I am a traveling nurse, and have seen it in various degrees across the country.
The buzz is that, although nurses still love being nurses, they are rapidly getting out because they are tired of the politics, staffing shortage, underpay and, particularly, the lack of appreciation at all levels. Welcome to the world of nursing. No wonder there is a shortage.
I think the new focus of AACN should be: “Campaign Nurse Appreciation Year Round,” not only during National Nurses Week.
Cindy Vickery, RN