Nurse suicide follows infant tragedy - Page 3Register Today!
- Apr 23, '11 by woohQuote from orthorn1969Exactly.The hospital had every right to discipline her and so did the BON, but the harshness that was shown to her will cause other nurses to be afraid to report their mistakes and try to cover them up.
She practiced for TWENTY SEVEN years. If she was truly dangerous, I'd think it would have shown up before now.
There is NOBODY that is perfect. This was a tragic mistake. Throwing this nurse under the bus made it even more tragic.
- Apr 23, '11 by Old.Timeri think we, as nurses, have an opportunity to provide at least a small measure of value and meaning to this horribly tragic event.
we each should encourage formal discussion of this case within our organization’s performance improvement, patient safety or similar committees etc. in addition to discipline, that is within the context of the nurse’s previous history, provisions need to be in place to provide support and counseling to nurses experiencing traumatic errors.
as nurses are expected to take care of increasingly larger number of patients, the occurrence of medication errors will also increase. errors should serve as a red flag for systems and process review, not immediate staff termination.
ideally, this event will prompt review and establish protocols for the manner in which nursing medication errors are handled. just as the libby zion case and her death, was the catalyst for sweeping change within medical residency programs, perhaps the lives of kimberly hiatt and kaia can serve a similar noble purpose.
nursing is notorious for taking care of others.
we ignore our own.
that must change.
this is every nurse’s nightmare come true.
- Apr 23, '11 by j450nThis is heartbreaking and just an overall tragic ending to an unfortunate event. I will actually have my peds rotations at the same facility and I'm honestly a bit apprehensive. I definitely have a great respect for peds nurses...it's one thing to already work with the vulnerable, young patient demographic and overbearing parents, but the ramifications of a medication error are huge.
Here's some letters to the editors regarding the event:
Also found at: http://seattletimes.nwsource.com/htm...agicevent.html
Suicide of nurse after tragic event
Posted by Letters editor
We all make mistakes
I have followed your stories regarding the death of the infant at Seattle Children’s Hospital last year due to an overdose of calcium chloride. With the story Thursday and its additional facts, I find that my level of frustration is markedly increased [“Nurse’s suicide follows tragedy,” NWThursday, April 21].
One of the well-accepted principles of error management in medicine today is that mistakes are mostly commonly the result of system problems, not mere negligence on the part of the provider.
With the case at hand, my first concern is that I am hard-pressed to think of a reason that I would prescribe calcium chloride for an infant when the drug was to be administered by a solo nurse in a nonemergency situation. Second, calcium chloride is a dangerous drug and when used in infants, its dose should be double checked by the pharmacy staff.
The fact that the hospital changed its policies after the death implies that they realized that its policies were inadequate. Despite this, the hospital decided to fire the nurse for an arithmetic error.
In addition, I am at a loss to see how a fine, levied by the state disciplinary authorities, is even a help to the infant’s family, the public or the nursing profession.
If we fire every person in medicine who makes an error, we will soon have no providers. We all make errors. It is only by the grace of God that most of them do not result in great harm or death.
It is my belief that if the nurse had been dealt with appropriately — with compassion and insight — that she, today, would be a valuable and happy nurse. But she was fired.
I, in no way, want to minimize the tragedy of the death of this infant, however, the death of Kimberly Hiatt is no less tragic.
— F. Norman Hamilton (retired anesthesiologist), Seattle
Change the system
The Times’ story, “Nurse’s suicide follows tragedy,” illuminates an Achilles’ heel in America — the safety of our children.
In the face of a threat or in response to the tragic loss of a child, communities come together to punish the perpetrator. In this case, a veteran pediatric nurse was fired when a medication error resulted in the loss of a child. Heartbreaking as this is, the rush to punish Kimberly Hiatt feels reactionary at best.
As a student nurse currently in my pediatric rotation, I am bewildered by the 4-1 patient to nurse ratio in hospitals. The children I work with receive medications that can cause anaphylactic reactions at any point during their infusions.
With three other patients to juggle, the nurses I shadow cannot continuously monitor for signs of reaction. The nurses are forced to gamble, hoping the child does not have a reaction.
Are parents aware of the risk they take when walking through the doors of their hospital? I dream of the day when parents lead the way for upstream change in health care demanding universal and adequate coverage of our children versus punishing the nurses that do their best within a broken system.
When will we stop turning a blind eye and realize that until we change the system, we are the perpetrators responsible for failing our children and our society?
— Leesa Benenhaley, San Francisco, Calif.
- Apr 23, '11 by cjcsoon2brnIt's so sad to see a woman who dedicated more than half of her life to the care of critically ill children was essentially abandoned by the hospital she worked at during her most critical time of need.
Understandably, this mistake had to be thoroughly investigated and addressed because it resulted in the loss of a child's life but did they really need to fire her? Obviously this woman was wracked with guilt and extremely distraught after what had happened to this poor child but was firing her the right thing to do? Do you think a physician would have been fired if he/she had done the same thing? I doubt it...
She should have been received counseling, remediation and supervision and been allowed to keep her job at the facility she had loyally worked at for over 25 years. So now we are left to deal with two horrible tragedies, the accidental death of a child who left this world long before its time and the suicide of a woman whose life work was caring for ill children only to have it taken away by a single mistake that anyone of us could have made.
[RIP Kimberly and Kaia]
- Apr 23, '11 by tokmomI wonder if SCH has a computerized med scanning system? I'm assuming they do not. Had they, maybe this dosing error would have been caught.
It is all so tragic. I found out at my hospital during a staff meeting. None of us knew this nurse, it it hurt everyone of us sitting there. It's so sad and it makes me angry that Childrens tossed this nurse away like a piece of unwanted trash. I know Childrens has had 3 deaths last year. I wonder if they fired those nurses as well?
- Apr 24, '11 by Mrs. SnowStormRNI remember a story similar to this where the nurse hung the wrong med causing death of the patient and unborn child. She ended up with JAIL TIME and loss of her license. I dont know if this occurred because the family pressed charges or what. No matter what, in these situations - NO ONE WINS. now 2 lives are lost. Such a sad situation. Our jobs are more difficult than people know, being in charge of another humans life is so stressful. It would be hard to live with this error, I imagined she had many nightmares and so did the parents. This breaks my heart.
- Apr 24, '11 by DoGoodThenGoStill cannot wrap my head around this!
A seasoned nurse with nearly 30 years expereince makes a math error and is not only fired, brought up on BON charges but apparently blacklisted (or good as) as well.
Yes, one is *VERY* sorry for the loss of the child, but as the old saying goes "two wrongs don't make a right". As the writer to the Seattle Times pointed out, treating healthcare professionals whom make mistakes like this is counter productive. First of all it backs up the idea that you have to be nuts to report any error you make if you can get away with it.
This poor nurse begged and pleaded with the BON to be allowed to practice even with restrictions on her license, but it got her no where. So this is their idea of "protecting the public"?
One understands there is little to no room for error when dealing with meds for any acute or very acute patient, espeically a wee baby with many issues. But as the letter writer pointed out why was one nurse (no matter how good or seasoned) left to prepare and administer calcium chloride in that instance. The hospital changed it's proceedures after the incident so obviously what came before left room for mistakes.
Nurses out there you has my sympathies. If something like this can happen to a well seasoned nurse then the rest of you are one math error away from being out of a job. Talk about pressure!