Errors arise from the absolute panic nurses are in trying to get everything done. Often units have no secretary, and there are one to two techs for an entire tele or med-surg floor, and one of them may have to be a sitter....ICU is lucky to have techs, even when taking 2-3 patients, frequently with multiple admissions & transfers, answering phones, dealing with families & visitors, + passing meds, turning and suctioning patients + giving other basic nursing care, and God forbid if you have someone who is trying to circle the drain. Rapids, code blues, outrageous charting requirements, and if you've drawn the short straw, charge duties so you can deal with patient assignments and staffing issues. It's way too much everyday.
Change has to come from the top. All this is upper management squeezing the life out of the supervisors and unit managers to have bare bones staffing, regardless of staff feedback and the negative patient care effects. Somehow, CEO's are going to have to actually start believing that on the ground hands on care makes a difference in patient outcomes, and they are going to have to actually want good care for the patients, at least want it enough that they are willing to pay a little more to get it. As we can see, for now, they are not. We all hear about "patient care is our first priority" at the orientations or occasional pow wows, but we know it's just bs, because if they actually believed "Patients are #1" or whatever, they wouldn't leave one tech and 5 nurses for 30 patients. That's sh*t care and everybody knows it. If one patient goes bad it's a disaster. Pt outcomes and satisfaction suffer terribly because we just need "another set of hands" to help us. No one is lazy; we just want to be enabled to give proper nursing care to all our patients if we bust it for our entire 8 or 12 hour shift.
Anyhow, because of staffing, instead of practicing Nursing Excellence, we are more often than not practicing Seat of Your Pants Nursing, mainly putting out fires and barely keeping the head above the water. That means rush-rush-rush, & by necessity nearly ignoring some patients while dealing with the other needier ones, with very little time for double checking, reassessments, and thinking things through, and hence the perfect storm for errors. Then when someone makes an error that we get dinged for, everyone swoops in so this "never happens again." What happens then? Instead of looking at the root cause and giving the floor more HELP, they add more processes, checklists, and paperwork to an already overwhelmed nursing staff.
Now management is coming back in with that ridiculous and insulting "huddling" crap they had going years ago. Yeah, we are woefully and potentially dangerously understaffed, but we are supposed to just huddle, and if we work together as a team, then we can get through it.... Like it's just us not working as a team or putting our heads together that's the problem. Scripting, huddling...my head is going to explode. A long and meandering answer, but in a nutshell, in looking at error prevention, it's generally all about staffing.