Changing how the world thinks about nursing

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Q: Why do you call for more discussion of nursing errors and nursing malpractice in the mainstream media?

A: Because if nurses want real respect for their professional practice, they must also accept full responsibility for it. That means helping the public understand that nursing errors--just like physician errors--can mean the difference between life and death. In the long term, it actually hurts nursing when nurses keep their heads down and let physicians take all the blame for adverse patient outcomes, because that goes hand in hand with physicians getting all credit for positive outcomes. And that feeds the lack of public understanding that is a key factor in the nursing crisis.

The subtext of the huge media focus on physician malpractice in recent years, whether from the angle of patient safety or the cost of malpractice insurance, is that only physician care has important effects on patient outcomes. For instance, in December 2005 the Baltimore Sun ran Fred Schulte's massive three-part series "Masking malpractice cases." The gist of it was that Maryland's system for overseeing physician practice was failing to protect patients. According to the report, that was because regulators were paying insufficient attention to malpractice claim trends, rules kept most physicians' claim histories confidential, and litigation practices by lawyers and elite hospitals often allowed physicians to escape liability and scrutiny. It might seem good for nursing that nursing errors are being ignored. But nursing is being ignored because it is not deemed important.

The clear impression most readers get from reports like that in the Sun is that they are reading an account of the full universe of health care errors that may affect them. When an article like this discusses physicians and hospitals, it is difficult to imagine many readers asking: "Why aren't they also talking about nursing malpractice? There are four times as many US nurses as physicians. And if nurses actually save lives all the time, like that crazy Center for Nursing Advocacy is always saying, doesn't it also stand to reason that nurses' errors are also causing harm all the time? Especially today, when short-staffing is putting many nurses under great stress." Indeed, the Sun reports that there are 17,000 physicians in Maryland, and new data on the size of the nursing force shows that the state has 53,000 registered nurses. Yet in the entire Sun report, whose text exceeded 9,500 words, neither the word "nurse" nor the word "nursing" appeared even once, not even as part of the phrase "nurse practitioner." We would also be surprised if Mr. Schulte or the Sun--or any major newspaper on the planet--could direct us to a past or planned article on this scale about nursing malpractice. Even when nurses are mentioned in the context of health care errors or misconduct (such as participation in torture), the press commonly suggests that only the physicians are ultimately responsible; nurses are often not even named. Yet with hospital patients sicker than ever and many nurses stretched to the limit, it is not hard to imagine a failure to detect a subtle change in condition that would threaten a patient's life, or a failure to catch a deadly medication error. Recent research confirms that increasing nurses' patient loads can increase patient mortality dramatically.

Of course, we understand that nurses (like anyone) might be glad to escape scrutiny for errors. And we can just hear nurses fuming that we're actually calling for more discussion of it. But it seems to us that if nurses want the respect it will take to resolve the global nursing crisis, they will have to accept--and even seek--the responsibility that goes with that respect, as it does for all other serious professions.

I can't even say I made my own mistakes. Really--one has to ask oneself--what dignity is there in that?

-- Stevens the butler, The Remains of the Day (1989), Kazuo Ishiguro

Nursing malpractice exists, and there are reportedly an increasing number of nursing malpractice claims being made. Nurses' own roles in the legal system continue to expand, for instance in the area of forensic nursing, and this would presumably increase nurses' visibility with attorneys. Recent US court decisions have begun to define more clearly the rules relating to such claims, including the ability of non-nurses to provide competent testimony as to nursing standards of care. And it would appear that, because of cases like that of confessed serial killer Charles Cullen, even some in the mainstream press have reason to understand that nurses are in a position to cause harm in clinical settings, though there may be only a fuzzy understanding that a nurse could cause harm by mistake, in simply trying to do her job.

So why can't the mainstream press discuss nursing malpractice? Are there oversight problems, as the Cullen case clearly suggests? Who tracks "problem nurses?" What information is available about them? Are claims really increasing? If so, why? What does it take for a nurse to lose his license because of practice-related claims or allegations? Are nurses complaining about their insurance rates? Why or why not? If not, is that because nurses are not deemed major players, as physicians and hospitals are? Is that because of a lack of respect and understanding for what nurses really do for patients, and thus of the serious effects when they fail to do it? Or the sense that nurses lack significant resources to pay claims, even though their malpractice carriers presumably do not? Is it because nurses are regarded as the most "trusted" and "ethical" workers? You may know the answers to some of these questions, but it seems safe to say that the public does not, because it does not even know that the questions are worth asking.

So go on, nurses. Tell everyone, including the news media, what happens when nurses make mistakes. Talk about the effect on patients when nurses don't have time to do their jobs right. Complain about "problem nurses" whose errors may be killing people; with about three million nurses in the US alone, there might just be a few. And if you feel the urge, go ahead and complain about your malpractice rates. You have nothing to lose but your perceived insignificance.

last updated: December 21, 2005