Nurses, Medical Errors, and the Culture of Blame

By Ramsey, Gloria | The Hastings Center Report, March-April 2005 | Go to article overview

Nurses, Medical Errors, and the Culture of Blame


Ramsey, Gloria, The Hastings Center Report


In June 2004, an article in the American Journal of Nursing reported the findings of a three-year study of the organizational culture, attitudes, and assignment of responsibility for patient safety in small, rural hospitals in nine Western states. The study found that most errors fall within the realm of nursing practice and that physicians, administrators, and nurses themselves tend to see patient safety as largely a nursing responsibility. Asked to identify which profession has primary responsibility for ensuring patient safety, 96 percent of the nurses and more than 90 percent of the physicians, administrators, and pharmacists assigned primary responsibility to nurses. Only 22 percent of the respondents believed that physicians, nurses, pharmacists, and administrators share responsibility for patient safety equally.

Unfortunately, however, nurses and physicians differed on the role of nurses in effecting change. Most of the nurses indicated that they had several responsibilities in reducing medical errors, including reporting them, educating themselves and colleagues, serving as role models, making recommendations for changes in procedure and policy, reviewing reported adverse patient-safety events, and participating in investigations. Only 8 percent of the physicians who responded to the survey identified nurses as members of the decisionmaking team.

Nurses have a genuine impact on patient safety. Studies have found a link between patient safety and RN staffing and an increased rate of error when the hospital nursing staff has a smaller proportion of RNs. These are worrisome findings in light of the severe national shortage of nurses. Part of the medical malpractice crisis, then, is the confusion in the health care system and how it affects the role of the nurse.

There is no confusion in the American Nurses Association's code of ethics. This document, first adopted in 1950 and revised in 2001 to reflect and embrace the role of today's nurse, consists of a set of planks that set out nurses' fundamental values and commitments. They also offer a starting point for understanding how nurses should be involved in thinking about medical error, and why nurses blame themselves for medical errors.

The first few planks are the most important. These planks state that the nurse's primary commitment is to the patient (plank 2), and that the nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient (plank 3). "Interpretive Statements" that accompany the code add that nurses are committed to the patient's health, well-being, and safety throughout the patient's life span, and in all settings in which health care needs are addressed. Further, the code directs that, as an advocate for the patient, "the nurse must take appropriate actions regarding any instances of incompetent, unethical, and illegal practice by any member of the health care team or health care system or any action on the part of others that places the rights or best interest of the patient in jeopardy." For nurses to function effectively in this role, they must be knowledgeable about the code of ethics, the standards of practice, relevant laws, and their own organization's policies and procedures.

Moreover, when the nurse is aware of inappropriate or questionable practice in the provision or denial of health care, concerns should be expressed to the person engaging in the questionable practice. Attention should be called to the possible detrimental effect upon the patient's well-being or best interests, as well as to the integrity of nursing practice. When factors in the health care delivery system or health care organization threaten the welfare of the patient, concerns should be directed to the responsible administrator. If indicated, the problem should be reported to an appropriate higher authority within the institution or agency, or to an appropriate external authority.

The interpretive statements for the third plank also remind nurses that they have a responsibility to implement and maintain the standards of professional nursing practice. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Nurses, Medical Errors, and the Culture of Blame
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.