"The Criminalization of Mistakes in Nursing" - NC Philipsen

[talaxandra]

I just read this brief, interesting paper from the Journal of Nurse Practitioners (via Medscape) that compares the increasing realisation in health care that most errors are system based and are best reduced by safety-conscious non-punitive interventions, with the growing counter-trend of criminalising health care errors.

Mistakes vs crimes. Although a mistake is generally understood to be an inadvertent error, a careless mistake that occurs due to failure to act in a reasonable way can be termed legal negligence. If a patient is harmed, then the nurse could be sued for malpractice. A crime, however, includes elements not found with a mistake; primarily intent (which may be the result of recklessness, negligence, or malice). The criminal intent and criminal act must be related, and actual harm must have resulted. A crime is considered to be an act against society rather than an error affecting a single individual, and thus the burden is on the state to prove wrongdoing. (source - note: free registration is required to read articles on this very useful site)

What I found particularly interesting was the author's conclusion that this discrepancy, which significantly affects the cost and function of the US health care system, is in no small part due to the minute number of nurses who belong to state and national professional organisations. Although cost of membership is given as the most common reason for not joining, Scudder (reporting on the original article by Philipsen) states that

Not to minimize that issue -- but belonging to a collective organization that protects one's profession is just the cost of doing business.

Thoughts on the article, conclusion, why you do/don't belong to a professional organisation...

[brandy1017, ASN, RN]

Like the ANA that is too busy *****-footing with the AHA too actually stand up for the rights of their bedside nursing members! Why waste your money on an organization that doesn't have your back! Not me!

[Esme12, ASN, BSN, RN]

I am not sure how belonging to a professional organization protects me from criminal negligence. The ANA (mentioned in the article) is $500.00 dollars a year!!! Add this to the costs of certification exams, CEUs, and other certifications like ACLS,PALS,TNCC,ENPC......and it becomes cost prohibitive at $30.00 dollars an hour......What Exactly do they do, or would they do for me in the event of an issue with practice? So I prefer to belong to my malpractice insurance or work at a union hospital that is governed by nurses like the Massachusetts Nurses Association http://www.massnurses.org/ that is also a part of the NNU. I am curious, however, as to the author's affiliations other than medscape considering all references were from the ANA.....I did however belong to the ENA as it gave discounts on testing and was useful to my specialty.

[AJPV]

I myself am not an automatic fan of all things ANA. I find them to be a bit presumptuous and offensive in their assumption that all nurses are (or at least should be) in favor of certain political persuasions or pieces of legislation. This was especially evident with the most recent healthcare law passage. They framed the issue in the language of morality and implied that the "nursing profession" was unanimous in their support of the legislation - as if the issues involved are that simple.

[talaxandra]

I found the swing to the conclusion a little abruptl re-reading it the key section to support the argument is

Actions. Advanced practice registered nurses and all healthcare professionals, should join together to highlight the negative consequences of a focus on blame. The health professions must educate the legal community, support evidence-based policies that enhance patient safety, and advocate for laws and regulations that reflect this policy. Joining a professional association allows for amplification of this message.

My question - the criminalisation/prosecution of health care practitioners affects doctors at least as much as nurses. In Australia, and I imagine it's the case in the US from what I've read, doctors belong to a very effective and coherent professional organisation. If the AMA hasn't managed to strengthen the no-blame systems strategy over litigation, how would united nurses do better?

[talaxandra]

Esme, I think the idea is that you wouldn't need indemnity insurance if health care was more like, say, engineering, where serious problems are approached from a blame-free exploration of systems failures over individual error.

[xtxrn, ASN, RN]

A true mistake is random. To me that is irrelevant to belonging to an organization that decides what the head cheeses want, and then say that's the overwhelming concensus. Not a chance I'd give them a dime.

What happened to personal accountability with a mistake? If it's a repeat offender, the offendee needs remedial help- not some club membership. JMHO. :)

[talaxandra]

To be clear, the situation is Australia is so different in almost every respect that I don't have any personal affiliation with the author's position, and I'm certainly not advocating we/you should al go out and join a professioanl organisation.

The biggest question I have for the author is, as I said a few posts up, if organisational unity has the power to change this, why hasn't the (far more powerful) AMA already done so, or at least made inroads?

In the interests of full disclosure, I'm a long time member of the ANF (the AUstralia-wide nursing union and professioanl body) and briefly belonged to the Royal College of Nursing (a professioanl organisation with an academic/career progression focus). I let my membership to the RCNA lapse after a year because it seemed largely irrelevent to my clinical practice, and it was OMG expensive, plus I was put off by my membership certificate, which was more ornate than some of my university degrees!