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Is It Possible to Never Make an Error? The Perfect Nurse Fallacy

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and works as a Assistant Professor.

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Is it possible to get through an entire nursing career without making a mistake? If nurses are well-trained and careful, can we prevent patient harm? What does it take to get through a hectic nursing shift without making an error? This article attempts to answer these questions and more. I’ve included a personal safety checklist as well. You are reading page 2 of Is It Possible to Never Make an Error? The Perfect Nurse Fallacy. If you want to start from the beginning Go to First Page.

OldDude works as a School Nurse.

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1 hour ago, Susie2310 said:

I just posted the reply below to OldDude's comment, and for some reason it is not showing up unless I am logged in, hence my posting my comment again:

This approach protects the nurses at the expense of the public who are entrusting their care to qualified, competent nursing professionals.  You have described a "no employment consequences or civil consequences approach" for errors in care that may harm or actually do harm or kill patients, which many health care professionals would naturally like.  The general public places a huge amount of trust in the medical and nursing profession.

I am very aware that nurses often don't report their errors in medication administration (or other mistakes), just as some nurses sign the medical record with their first names only, which is why as a nurse I stay by my family members' bedside 24/7 when they are hospitalized - I don't have fundamental confidence in the nurses' honesty, competence, and professionalism (which has been borne out in my experience), and if I am proved wrong I am happily surprised.  A basic competency assessment when a nurse is first hired is no predictor of how they will continue to perform their job.  The general public, who are the recipient of nursing care, deserve accountability for medical/nursing errors.  The public has the right to receive competent, safe care by the nursing/medical professionals they are placing their trust in, and they are entitled to a full investigation in situations where they fail to receive this.

 

There is a little more reason to my post than you describe but I certainly agree with your concerns.

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Ruby Vee has 40 years experience as a BSN.

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The very first thing is to admit to yourself that you are human and will make mistakes.  I am very suspicious of the nurse who claims she has never made a mistake or the one who blames other nurses for mistakes, saying "IF they had just followed the five (or 12) rights, that wouldn't have happened."  We are all human and humans make mistakes.  If you cannot even admit the possibility that you might make a mistake, you won't recognize it when you make one.  And then you cannot do anything to mitigate the possible harm to the patient.

 

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KatieMI has 6 years experience as a BSN, MSN and works as a Internal Medicine.

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I actually know one guy from upper nursing management who boasts wide and loud that he never made a mistake and therefore nobody else ever should. 

The truth was, he was removed from 3 units after just a few shifts in each before he used his chance to kill someone. How he made it from there to upper chairs, I do not know but there he still is, living his wonderful career in rosy and rainbowy world of policies and schmolicies. 

He is a true incarnation of manager from hell, BTW. 

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Ruby Vee has 40 years experience as a BSN.

922 Likes; 11 Followers; 64 Articles; 168,822 Visitors; 13,721 Posts

3 hours ago, KatieMI said:

I actually know one guy from upper nursing management who boasts wide and loud that he never made a mistake and therefore nobody else ever should. 

The truth was, he was removed from 3 units after just a few shifts in each before he used his chance to kill someone. How he made it from there to upper chairs, I do not know but there he still is, living his wonderful career in rosy and rainbowy world of policies and schmolicies. 

He is a true incarnation of manager from hell, BTW. 

Blame the glass escalator.

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Daisy4RN has 20 years experience.

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I also find it hard to believe that 54% of nurses have never made a mistake. The last hospital I worked at also got dinged for not enough incident reports (one year there were zero). Who in their right mind would fill one out knowing there would be severe consequences. That is not to say that the errors did not get fixed, most were just simply overlooked if no harm, or if need be, MD called for notification and further intervention. Nurses will not self report until admin stops with the punitive responses. 

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Ruby Vee has 40 years experience as a BSN.

922 Likes; 11 Followers; 64 Articles; 168,822 Visitors; 13,721 Posts

31 minutes ago, Daisy4RN said:

I also find it hard to believe that 54% of nurses have never made a mistake. The last hospital I worked at also got dinged for not enough incident reports (one year there were zero). Who in their right mind would fill one out knowing there would be severe consequences. That is not to say that the errors did not get fixed, most were just simply overlooked if no harm, or if need be, MD called for notification and further intervention. Nurses will not self report until admin stops with the punitive responses. 

I'd venture that 100% of nurses have made a mistake, leaving 0% of nurses who have never made a mistake.  100% of nurses are human, and humans make mistakes.

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On 1/24/2019 at 5:14 PM, SafetyNurse1968 said:

I wrote an article a while back talking about how nurses, despite our best efforts, make mistakes that sometimes lead to patient harm (Why Do We Continue to Harm Patients?) At the end of the article I gave a survey asking how many of my readers had made errors. Of the 39 folks who voted, 54% of you said you had never made an error. Compare that to the 18% who weren’t sure.

 

46 minutes ago, Daisy4RN said:

I also find it hard to believe that 54% of nurses have never made a mistake.

It would help if it were clarified that, as I recall, the poll in question did not ask if one had ever made an error, it asked if one had ever made  error that harmed a patient. Implicit but not stated would be the idea that one would need to be aware of harm caused in order to answer the question in the affirmative. 

Sure, everyone could have answered "not sure" - but I am guessing people answered based on whether or not they are aware of having made an error that  caused harm to a patient. Since that's what the question asked.

Good data reported in a genuine manner is important.

 

 

Edited by JKL33

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morelostthanfound has 25 years experience as a BSN and works as a R.N..

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On 1/24/2019 at 4:15 PM, HiddencatBSN said:

Ooof, a nurse who claims to never have made an error or mistake makes me really worried because they're either not aware of their errors or they're hiding them. No way have 54% of nurses never made an error. 

Absolutely-this ⬆️.  54% of nurses having never made an error?  That is an absolute statistical impossibility-sorry!  Having worked in direct care for many years and administered thousands of medications (as most acute care nurses do)-regardless of one's cautiousness or attention to detail, a med error, unfortunately, is an eventuality.  Also don't get me started on the recommendation to join the ANA to promote patient safety.  The ANA's last position statement on nurse/patient ratios made it abundantly clear to me that they were in bed with large healthcare associations who are fighting tooth and nail this very important safety measure.  

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^ Yes. The information has been incorrectly reported.

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On 1/25/2019 at 2:30 PM, Susie2310 said:

This approach protects the nurses at the expense of the public who are entrusting their care to qualified, competent nursing professionals.  You have described a "no employment consequences or civil consequences approach" for errors in care that may harm or actually do harm or kill patients, which many health care professionals would naturally like.  The general public places a huge amount of trust in the medical and nursing profession.

I am very aware that nurses often don't report their errors in medication administration (or other mistakes), just as some nurses sign the medical record with their first names only, which is why as a nurse I stay by my family members' bedside 24/7 when they are hospitalized - I don't have fundamental confidence in the nurses' honesty, competence, and professionalism (which has been borne out in my experience), and if I am proved wrong I am happily surprised.  A basic competency assessment when a nurse is first hired is no predictor of how they will continue to perform their job.  The general public, who are the recipient of nursing care, deserve accountability for medical/nursing errors.  The public has the right to receive competent, safe care by the nursing/medical professionals they are placing their trust in, and they are entitled to a full investigation in situations where they fail to receive this.

Susie, I think you are missing the point of why some places give nurses a way to report mistakes with no threat of penalty. As you said yourself, if there's a possible penalty, mistakes will often go unreported. On the other hand, if there's no possible penalty, we can learn from the mistakes made and investigate the root causes. We are better able to find ways to prevent future mistakes if more mistakes are reported which will happen if there is no threat of penalty.

Penalizing nurses for errors will not reduce errors. Understaffing, a very common problem, will cause mistakes (this seems like such common sense to me that it baffles me when people wonder why mistakes are made) -- a nurse will have much less time to ensure safety when assigned too many patients. Also, as people have pointed out, nurses are humans and humans make mistakes. No matter whether nurses are held more accountable as you wish, mistakes will be made for these reasons at least. If every nurse who has ever made a mistake was removed from their job as you may wish, there would be even fewer staff causing even more hazardous conditions to care for your loved one.

I agree with you that the public has a right to competent, safe care. But if you want to hold someone accountable, do so with whoever is deciding to give the nurses (or doctors or others) more patients than they can safely take care of. What is your solution? If we fire everyone as soon as they make a mistake, will that cause hospitals to suddenly decide to hire enough staff so that mistakes are more easily avoided? 

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I agree that many errors come from being too task oriented. I remember my very first med error and I will never forget it. I remember feeling very stressed and overwhelmed with my pt load. I gave a med IV that was ordered IM. I never gave pain meds IM so I just assumed it would be IV. I was guilty of not performing my 5 rights. I think having a culture of learning from mistakes and not of punishment and humiliation is so important. I think every nurse that makes an error has that initial moment of panic and wonders if they should report. 

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and works as a Assistant Professor.

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On 1/24/2019 at 10:54 PM, JKL33 said:

"I still think the medication administration process your school is teaching is a crime."

I think I might have missed a previous post - would you be willing to explain more what you mean by this statement? Thank you!

 

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