Wrong site surgery waiting to happen

[Nurse Beth, MSN]

Dear Nurse Beth,

I was an OR circulator for a hospital with six ORs for nine years. I left town for a while and when I came back I had the opportunity to work at a small specialty surgery center. The similar pay, no nights/weekends/call made me say yes to the new job.

My problem is, six months later, that despite my speaking to the manager, speaking in staff meetings, and speaking to the staff, errors keep being made. The serious kind. Wrong site on consent forms. Wrong name on chart or on schedule. Wrong side said in time-out. Some of the staff and the docs seem very casual about this, and don't seem to see the need to do better.

I get the feeling I should shut up. I'm afraid this is an accident waiting to happen, and I don't really want to be a part of it. I have started looking for another job. Am I over reacting??

Dear Accident Waiting to Happen,

You are not over-reacting. You have been trained to expect a certain level of safety and it causes moral distress when you are pretty much told to accept the status quo and high level of mistakes as the norm.

Most likely there are multiple reasons for this culture. New employees "sink to the norm" as a coping mechanism when they watch others' behavior and come to understand the "real" rules. Poorly trained managers do not have skills and the support of administration to do the right thing. Managers are given responsibility but not authority. Doctors are allowed to practice outside of guidelines and best-practice.

By contrast, safe organizations (or High Reliability Organizations) focus on error prevention and defer to front-line staff as experts. There is a focus on errors, as in a sense of urgency around near-misses, rather than a sense of complacence.

You are wise to leave and not be a part of some unfortunate if not sentinel events that are bound to happen.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[Nurse SMS, MSN, RN]

You are definitely NOT overreacting and I like Nurse Beth's reference to HROs (High Reliability Organizations), which give lots of tools to help you deal with these kinds of situations. One such tool is called CUS, which is known in HROs to bring everything to a halt for review. "I am Concerned. This makes me Uncomfortable. This is a Safety issue".

There is no excuse for the kinds of mistakes you are observing and you are very right that you will soon be party to a wrong site mistake or worse. You have my respect for recognizing it. Everyone who has surgery does so under the assumption that precautions are taken to protect them while they are unconscious, vulnerable and dependent on all parties doing the right thing. I have seen where surgeons in particular can be very resistant to any steps that slow things down but don't result directly in increased compensation. That management bows to this kind of behavior makes this a less than ideal work environment, to put it mildly. I hope you find a different employer quickly and I applaud the ethical standards you continue to hold.

[djh123]

I would report this to the state too. Leaving the job helps you, but doesn't protect any future patients.

[rnpatrick]

Look at your nurse practice act. You have a duty to report. Hopefully, you created a paper trail with emails, etc. Like the other comment recommended, report to state since you did not get an appropriate response, internally. If Joint Commission, report. Or it could be other certifying agency. Your duty to protect patients does not end with reporting to management.You keep going until you get action. I am speaking from experience.