Having a problem with the atmosphere of fear

llg, PhD, RN · May 5, 2008

A lot of people enter the profession without being prepared to accept responsibility for the mistakes they might make ... or the anger (and/or greed) of patients who might sue. Many people enter the profession with the most altruistic of motives and may never had come to terms with the fact that the world is not as friendly, kind, and altuistic as they are. They may never have faced the possibility that someone might sue them, or prosecute them, or fire them, etc. They assume that if they do their best, the world will treat them well.

So ... sometimes in an attempt to get these new nurses to practice safely (and self defensively), older nurses emphasize the negatives in order to try to make an impression on the new nurses that things they might not see as important need to be given serious attention. It is an attempt to "wake the new nurse up" to the reality that self-defensive activities are necessary. Sometimes, that comes as a shock to new nurses who never prepared themselves for that aspect of practice.

It's like a pendulum swinging back and forth. Sometimes, it swings a little to far to the left and sometimes a little too far to the right. The true state of affairs is somewhere in the middle.

Take the threat of law suits seriously. Take appropriate precautions, CYA, and have good insurance. But there is no need to let it dominate your practice and "poison" everything you do. Put the threat in its proper place.

doublecheck · May 11, 2008

I would like to second your question of "what can nurses be written up for?" and also add, "what can nurses be sued for?"

During my BSN program, I don't ever recall hearing about RN malpractice insurance or the possibility of being sued. Of course it is entirely possibly that both were topics of discussion at one point or another and I just didn't give it much thought at that time.

However, having now only been working as a nurse for 10 months, these are two questions that are constantly weighing on me. I am concerned about what minor mistake or offense I might cause that can get me in trouble, either legally or internally within my job. Couple this with the innate fear of causing undue harm to a patient, and at times I feel like a nervous wreck.

So what can/are nurses be written up for, and what can nurses be sued for? Can Unusual Occurrence/Incident Reports be used for legal reasons?

SoundofMusic · May 11, 2008

We heard a lot about being sued in nursing school, and were advised to get malpractice insurance -- but never heard about being "written up," and especially didn't realize we could be written up by our peers.

It's a scary thing to learn about when you're new. It seems to create an atmosphere of distrust also among your fellow nurses. I also think it brings out the worst in those who seem to delight in being "perfect' and being the ones to write others up. I'm seeing this on my unit with some of the different personality types.

It's sad for me as I have always had great relationships with co-workers in my past career. Some of them I still keep up with after 15-20 years! Of course, we never worked in an atmosphere like this and no one but the boss took care of employee reprimands. So, it's very strange indeed to get used to.

llg, PhD, RN · May 11, 2008

What can we be sued for? ANYTHING A patient doesn't need a legitimate reason to file a lawsuit. They can make up a reason -- and hope that the hospital gives them a settlement rather than face an expensive court battle. So, you can't waste your energy worrying too much about that. Try to make a positive impression on the patients so that they don't target you for those types of complaints and/or an actual lawsuit.

The real question is:

Do you have the protection you need to prevent any great harm coming to you from a disgruntled (or unscrupulous) patient? In othe words ... Do you have malpractice insurance? Do you practice according to your employer's policies and in accordance with the regional standards of care? Do you keep you knowledge and skills up to date?

If you are adequately protecting yourself, then that's all you can do. Get your strength to live with the threat of a complaint or lawsuit by knowing that if one happened, you are prepared to deal with it and would survive.

We take risks all the time. We drive in cars, fly in planes, expose ourselves to diseases, live in tornado country, etc. A million things can go wrong and we can never guarantee that we will never be hurt by anything. But taking appropriate precautions help us get through the day. You have to take those same behaviors and attitudes that help us cope with other risks in life and use them at work, too.