I’d like to share with you what I think is the number one reason why nurses make mistakes while providing patient care.
Over the years, I’ve handled literally thousands of personal injury accident cases, cases that involve negligence, or people who commit errors while driving a car, for example. In accident cases, the initial screening questions are who is at fault and why did it happen. It’s similar to the questions I ask myself when I sit down with a nurse who is being investigated for a possible violations. The questions are, “Why did this mistake happen?” and “How could the mistake have been prevented?”
What is the main reason why nurses make mistakes? Is it lack of training? Is it lack of caring? Is it reckless or intentional misconduct? In almost every case I see, the answer is none of the above. If it isn’t any of those, is it negligent misconduct? Again, I submit that in most cases, even then the answer is no.
What then is the main reason that can account for mistakes? I submit to you that nurses make mistakes primarily because of the unreasonable demands that are placed upon them by their employers–by the system. This is not an attempt on my part to try and shift the blame or point the finger away from real mistakes that are lapses in judgment, or intentional misconduct. But frankly, in the cases that I review, it has to do with demands placed on the nurses.
Do you know what the number one reason is for nurses quitting their jobs? The number one reason? It’s because they feel they cannot provide the quality of care that they have been trained in their profession to offer. This is shocking to me as someone who is not a nurse, as someone who also handles personal injury and medical malpractice cases. We have competent, able, well-trained nurses who leave important positions at hospitals, for example, who quit their jobs because the potential for making a mistake is exacerbated by the fact that their work conditions are such that it’s only a matter of time before something goes wrong and they are blamed.
The problem is a Catch-22 for the Nursing Board. They regulate nurses. They don’t regulate hospitals, administrators, doctors, and the like. They are very concerned, and rightly so, for making sure nurses do not do anything that threatens the safety of the public. They are sensitive to this, perhaps hypersensitive. I understand this, and I understand why. But this narrow, laser focus on nurse errors does not account for real reasons most mistakes occur.
Do you want some examples? I’ve got a file cabinet full of them. The biggest thing employers do to nurses that leads inevitably to errors is the ratio of patients to nurses. Nurses can perform quite well when the ratio is 1 to 5, one nurse for every 5 patients. In California, they passed laws to regulate the ratios, which range anywhere from 1 to 1 (operations) to 1 to 6 (eg. Initial medical/surgical, or psychiatric). See this summary of the law.
What do we have in Nevada? Do we have any protections, any laws the regulate this ratio? Nope. What are employers doing in this State?
I know for a fact, having talked to many, many nurses, that the ratio of nurse to patient care at hospitals is as high as 1 to 10! In an effort to boost profits and ignore critical patient care, the ratios in some facilities is completely out of control. These high ratios create a vicious cycle. Do you know why? Because the competent nurses who care about the treatment they render see the writing on the wall, and they can’t provide the kind of care they were trained to provide, they quit and find jobs elsewhere. And when they leave those important jobs, who fills their spot? Nurses who don’t care as much. Patient care goes down, and with it, concern and care for the patient, and safety.
This is wrong. I’ve seen nurses leave the profession because of the inability to balance the pressures placed on them by employers, combined with the scrutiny of oversight by the Board, and combined with the inability to find a job they feel they can perform to the standards by which they are supposed to perform them. I’ve seen nurses change jobs to avoid getting tagged on their record for a mistake that they may inevitably make.
You want examples? Here’s one. Nurses are supposed to chart notes. But some employers keep them so busy that they have no time to chart. At the end of their shift, they stay after to chart, not the best practice in the world, it’s better to do it as you go, right? Some employers even give nurses flak for staying on the clock when their shift is ended. The “unnecessary overtime” is duly flagged, and they get in trouble for it. So what happens? Nurses clock out and then stay over for an hour to finish charting. Employers get a free hour of work each shift from their nurses! How good of a job is a nurse going to do charting when she or he is forced to do it for free?
What about the nurses who are on shift, and they tell the charge nurse or the administrator that they can’t handle the workload, and they are short-staffed and have no one to help they? What are they supposed to do? According to one source, if you can’t handle the job, you should quit. Well, when do you quit? Do you quit right then, in the middle of a shift? If you do, will you get written up and sent to the Board by your employer on charges of patient abandonment? On the other hand, if you make a mistake if you stay, you get reported. It’s another Catch-22.
I don’t know whether the Board ever sends people out to just sit and observe what some of these employers are requiring of these nurses. If we could all stand in the shoes of the nurses and see what is happening, maybe we could reduce the number of mistakes and loss of great nurses who care about their patients to less critical functions if we observed, listened, and took action to stop the creeping problem of high nurse-to-patient ratios.
A potential malpractice case recently came into my office. A high-risk fall patient was allowed to walk freely about the floor, around the nurses station, while medicated and a with a heart-rate of less than 40 beats per minute. The nurse’s notes indicate he walked unassisted for several minutes. He fainted, fell, suffered a subdural hematoma, and died. Was this the nurse’s fault? My initial impression is yes, it is; but I’m pretty sure when I dig into the medical records more, and take some depositions, I’m going to find out the nurses working that shift were inundated with other patients, and simply unable to do their job effectively. We’ll see.
Until the problem is addressed, I’m afraid for me or my family to be treated in any Las Vegas hospital. Not because of the quality of the nurses, but because they are effectively prevented from providing quality care.
