How to be a Perfect Nurse

I am truly interested in having a positive discussion that attempts to answer the questions I posed here. But I am also reacting to the long discussions among at least three threads regarding the nurse charged with homicide. I don't believe a perfect human exists.

How to be a Perfect Nurse

Let's define "perfect nurse" so we can know how to be one. A perfect nurse is one who never makes a mistake. One who never makes a medication administration error and therefore adheres to all patient rights of medication administration every single time without fail. One who adheres to all professional standards of practice throughout every second of every work day. One who distinguishes between being a "good worker" and a "good nurse" and so knows when to stand up to her boss and refuse work assignments. One who knows her limitations, so can anticipate coming across something she might not have learned yet and will avoid being put into situations that might cause her to exceed her limitations. One who will always without fail ask for help when needed and ask or look something up before doing something new.

The nature of nurses' work and their role as "last line of defense" in patient safety demands that a nurse be able to think critically. So the nurse's brain is the utmost important tool in her work belt and must remain sharp. Brains are complex and often fail unexpectedly in people of all intelligence levels...e.g. looking for glasses when they're on your head. Brains can have moments of lapses when people are: fatigued; sick; distracted; overloaded with information; under intense stress; etc. Yet a perfect nurse does not have brain failure...EVER. A perfect nurse can work 12 hour shifts and still not have one single second of brain failure...EVER.

Questions for Consideration:

1. Is it possible to be a perfect nurse in an understaffed hospital? Is it possible to be a perfect nurse in any imperfect work environment? (Yes? -Tips to do so?)

2. Tragically, being a "good worker" is too often in conflict with being a "good nurse". If a working nurse is striving hard to please the boss due to her high work ethic, she quite possibly is failing to ensure patients' safety by taking on more than she can handle. So how do we reconcile nursing school knowledge and professional standards of practice with current unsafe conditions of many nursing jobs? Do employers have any obligation to make being a "good worker" the same thing as being a "good nurse" -- or does it all fall on the nurse to be perfect when faced with imperfect demands in an imperfect environment?

3. How can work environments, administration of health facilities, nursing schools, health care laws, or other entities which affect nursing jobs make it possible for the perfect nurse to remain perfect at all times in her job?

4. If any of you nurses have never experienced a second of brain failure (especially not a full 30 min. or more of brain failure), and if any of you are incapable of skipping one or more med. admin. safety steps despite any environmental circumstances, and if any of you declare yourself to be a perfect nurse as defined here...do you have tips to help the rest of us become more like you? This is a serious question and I for one am grateful you are a nurse, grateful for your service, and would be grateful to learn from you. Because truly, what nurse wouldn't want to be perfect? Sign me up!

Disclaimer: I don't believe there exists a perfect nurse who is incapable, regardless of any imaginable circumstances and environments, of skipping multiple safety checks in medication administration. Yet some claim to not ever be capable of such grave errors. To ignore the potential of our brains to fail and to so willingly condemn the charged nurse as a criminal without even knowing what was going through her mind and what circumstances and environment led up to her giving the wrong medicine is scary to me and lacks something the perfect nurse would surely have: compassion; the desire to understand; the desire to remedy rather than penalize; the desire to heal.

Some will say she should no longer be a nurse because she failed too badly in the professional standards of practice. I believe she was being mindless so never made the choice to skip any safety measures; I believe she had every intention of helping patients and that she took it for granted that she had no chance of harming them because she believed in those moments that there was no chance. I believe it was an accident that would not have happened in ideal work conditions, and I can imagine many things leading to a nurse becoming mindless through no fault of the nurse. Maybe she should never be a nurse again or maybe she would be the best nurse in the world after this experience. I'm not forming an opinion on non-criminal consequences right now. I try in the "Nurse Charged with Homicide" thread to convince you why, from what we know so far, the case does not warrant criminal charges. What should have been in her mind and what was ;in her mind are two different things, and that difference is why she is not a criminal for being in a mindless rush to give a medicine she believed would not harm the patient and then to not monitor the patient because she believed the patient was unharmed by the medicine. That's just my interpretation of the law. Don't forget, law is subjective so you get to have your interpretation too; I just hope judge and jury have more in common with my way of thinking. I hope this nurse doesn't spend a day behind bars when she likely was just trying to be a "good worker" and not experienced enough to focus solely instead on just being a "good nurse"

Anyhow, though writing this was inspired by my strong feelings in the other threads, we could keep our continual conversation about this case in the other threads (if you want) and save this particular thread for positive, creative ideas that might answer some of the questions above.

Also, there is a well-written and worth-reading article in this forum Is It Possible to Never Make an Error? The Perfect Nurse Fallacy by @SafetyNurse1968 (I wrote this and forgot that article was already broaching these topics!), but the discussion following it didn't seem to have a lot of tips from any perfect nurses for how to be perfect in understaffed hospitals or otherwise unsafe work conditions, so I'm trying here too.

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mtnNurse.

About mtnNurse., BSN

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Forget perfect. Conscientious is worth striving for. Always put your patients first and put yourself in their shoes. That will carry you far. Maintain a strong set of standards and values that you will not surrender. I have heard many nurses say "They can fire me, but I will not..." Be willing to be fired before compromising your nursing principles. Never be afraid to say: "That's out of my league." "I won't be able to do that safely." DO NOT put being a good worker ahead of being a good nurse.

This isn't going to foolproof you from making the rare error. But hopefully you won't ever make such a series of really bad decisions that rise to the level of criminal charges.

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Maintaining a strong set of standards and values is not always as easy as it seems. Because while you're taking the proper amount of time to do everything correctly, the next patient is waiting.
I've seen more than a few tragic outcomes occur from people being kept waiting just a little bit too long. Sometimes you're damned if you do and you're damned if you don't.

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Specializes in ER.

Too long to read

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Specializes in Psych (25 years), Medical (15 years).

I could be a perfect nurse if it wasn't for that darn Y chromosome!

Just kidding.

I've made so many mistakes in my life and nursing career, I've gotten really good at it!

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Specializes in ED, ICU, Prehospital.
3 hours ago, Emergent said:

Too long to read

I like MtnRN. She's quite passionate in something she believes to be true. However, there just doesn't seem to be a middle ground with her. It's one extreme or the other...case in point. If you follow the rules and are trying to hold someone accountable for their rule breaking, you believe you are "perfect" and the implication is, that some of us feel that since we've gone >10 years with no med errors...we believe we're better in some way.

It wasn't the point, MtnRN, and this diatribe really does speak to how the extremes never help a situation. I was middle of the road. I fell on the side of unemotional, factual and lawful critique of Ms. Vaught's individual situation...as all crimes should be considered on a case by case basis.

I did read your manifesto. I think that having a clean as a whistle record (mine) for as many moons as I've been in the profession...as well as those others who have done the same...by following the rules...YES...every. single. time. (are you advocating for following rules only sometimes...because it makes you an orificehole because you're just so uptight about those rule thingies?)....is something to do a little chest thump about---because it's stressful, time consuming, and takes aaaaaaaaaaaaall the damn fun out of using work as a social tool.

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Specializes in Nephrology, Cardiology, ER, ICU.

There are no "perfect" nurses. The ones that "THINK" they are perfect are the ones that don't realize they made a mistake...or admit that they did.

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Specializes in Critical Care; Cardiac; Professional Development.

I confess I could not read this very verbose, lengthy document. It quickly became unclear if it was actually a complaint, sarcasm, a bone to pick, a diatribe or what.

I am sorry you are unhappy. I don't think about being perfect and I don't feel pressured to be so. I do think about being the best nurse I can be and I work hard to do that.

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Nobody expects nurses to be perfect, but what you are expected to do is follow policies.

They are written for a reason.

In every unit there is always this small group of nurses with the "I'm not going to be bothered" attitude that cause problems for everyone else that is following policy. So when one of their sloppy moves causes a problem with a patient, there is a huge investigation, everyone has to come in on their days off for inservice, new policies so it doesn't happen again, blah, blah, blah. So everyone on the floor gets punished because ONE PERSON didn't follow the rules.

I fully support professional Darwinism: Get rid of the problem nurses.

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That is the wrong question because it is not even speaking of reality - obviously 100% of the responses should be "you can't".

The first paragraph caused me too much stress to continue...

The right question: How imperfect must a nurse be before he/she is deemed too unsafe to practice nursing?"

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Specializes in Pediatrics, Pediatric Float, PICU, NICU.

Seems like everyone on this post “gets it” except for the OP; nobody is claiming to be a perfect nurse.

I read every single response of the other thread. Nobody said they were perfect and just about everyone admitted to errors.

In regards to your post, I’m not saying I personally have never had a “brain error” as you mention. I’m just saying that if I had as many “brain errors” as RV had, regardless of the reason(s) why, that resulted in a death then I would not be shocked if/when criminal charges were brought against me.

I would be devastated, heart broken, remorseful, scared, shattered...but not shocked.

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Specializes in LTC, assisted living, med-surg, psych.

Being a good nurse and a good employee are not necessarily one and the same. I used to take pride in the fact that I was a good nurse, but I sometimes clashed with bosses who called me "slow" and demanded I take more patients than I was comfortable with, or wanted me to work OT when I was exhausted from my three 12s. I was also one who protested having non-nursing tasks dumped in our laps (like housekeeping and laundry). And of course, I was alone in much of this because other nurses were too terrified of management to stand with me. So I often found myself quitting, or in several cases being terminated.

I wasn't perfect as a nurse, and I made a few minor med errors, but I was good at what I did and always did my best, even if that meant going slower than some of the other nurses and finding the time to fluff pillows and let patients talk if they needed to. I would never make it in a hospital today. But then, I seriously doubt I would have omitted not one, but several safety checks before giving a drug I wasn't familiar with, no matter how rushed I was. That nurse was negligent and should lose her license IMHO, although I don't agree that she should've been charged with a crime. She has to live with this for the rest of her life no matter what happens...that and losing her license should be sufficient punishment.

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