I am doing DNP research on culture of safety and implications of disruptive and inappropriate behaviors in the clinical setting.
We know that often, several errors lead up to a critical or sentinel event occurring. The key to prevention is for staff to feel empowered and safe enough to report "near-misses" or opportunities for improvement.
The question I have for you is: in your job, do you feel safe enough to report...or do you feel you will be somehow reprimanded? Is there a "blame culture" on your unit?
I have worked in many facilities over the years. I have HEARD that self reporting SHOULD be blameless and is designed to identify the root cause of the error.
Unless the error caused harm to the patient.. I will keep MY mouth shut. It would be all up to my immediate manager to use it against me or not. Most of them would.
Either I can't view the poll on the mobile app or I just don't know how to do it [emoji6]
I don't feel safe reporting. I work in a small clinic that is part of a large multi hospital organization, so it wouldn't take my direct management long to figure out who reported anything to risk management or HR (errors, employee issues, all the other supposedly anonymous thing we can report). I have no doubt if any of us reported anything our clinic manager would be gunning for us. The only things that get reported are falls and that's only because it's mandated to be reported.
Nope. I have NEVER worked at an employer who actually promoted a culture where honesty wouldn't bite you in the butt. One in fact encouraged you to rat on fellow coworkers, sure that's not how they said it, but it's the take away we were supposed to get.
My manager serves on many committees and really pushes for us to file incident reports so things can be improved. I was frustrated by the lack of communication between departments after an incident (I wasn't alerted by another department of an issue with a patient that could have delayed care) and I had to file a report so there was written record of it to help push for changes. I also made a med error and it was identified as an issue others have had, not just in my unit. Another recent med error that a coworker made pointed out another big flaw that was addressed and continues to be addressed. In all cases thankfully none of the patients were harmed.
Always felt safe but that's not why I report. My one self imposed anxiety is worse than anything an employer has doled out.
Our staff are safe to report to me but of course if there's a pattern of unresolvable issues with a particular employee then it becomes a performance issue that will have disciplinary action.
Disruptive and inappropriate behaviors--which in my experience are reported ad nauseum and rarely is there anything done about it, as a warm body is better than no body--and YES, there is a culture of "snitching" and "tattling" that make most nurses ignore it or get themselves all worked up about it on their off time. There SHOULD be consequences for the person who is behaving badly, but there is not.
Med errors--To report it seems to count as a flag on the nurse--and nurses can be let go for med errors, all the while it is "supposed" to be a non-punitive thing. And there seems to be a question on "what is an error, exactly". If the MD orders a med for QHS, that could be 8pm for some, 11pm for others, but the "rule" is 9pm. So, is it an error if you give the med at 8 or 11? It seems to go round and round. But at the end of the day, most nurses who report errors even if not causing harm to a patient, are somehow blamed. Because that is what management seems to do best. Especially those who have never worked at bedside, haven't in many years, or who are not even nurses...
I would only report something if it really does cause harm to the patient. Like the time I didn't have time to get a IV pump to run a thorazine infusion as a piggyback so I did it manually. Well, I infused it way too fast and it knocked the patient's respiratory drive, completely snowed her. She could have respiratory arrested and died. That is damn reportable. Anything else, I won't. Same goes for reporting errors made by others. I also take this same track with complaints by patients about other coworkers. Coworkers would have to say or do something utterly reprehensible for me to take the complaint to my manager.
I've known people to be written up for a fall, as if the RN was standing in the doorway laughing maniacally and watching while the patient was attempting to ambulate hooked up to monitors and drips. No way I'm handing management ammo to a gun pointed at my head.
Specializes in Float Pool - A Little Bit of Everything.
I feel safe enough in most instances to self report. I have once and I think my manager appreciated that I manned up to screwing up a med. We notified the NP and monitored the patient. Luckily no harm to anything but my ego.
I can envision circumstances under which I would be reluctant to report an "invisible" error given the often punitive and judgmental way that errors are often handled.
At the places I've worked, there's always a culture of blame around falls (no matter how much you did to prevent it, it is always the assigned nurse/aide's faults), but I've reported myself for two med errors that did not result in harm and there were no problems. I've also seen a few other nurse's med errors reported and it the response was usually "Hey, be careful not to do that again" and a quick look at the situation for any systemic/modifiable contributing factors.
Adele_Michal7, ASN, RN
893 Posts
Could not have said it better.