Professional errors

February 2004 -- Karen Cicero's lengthy and generally helpful article about health care errors in this month's Child magazine makes several valuable points about how nursing can affect patient outcomes. But because the story reflects the magazine's physician-centric approach, it fails to convey the central role nurses actually play in protecting patients, or that nurses are autonomous professionals with their own ideas about improving patient safety, not least of which is to end rampant nurse short staffing.

The piece does a fairly good job of explaining how health care errors can occur in modern clinical settings. It includes anecdotes involving serious errors by physicians, nurses and pharmacists, describes some shortcomings in the current regulatory system, and makes suggestions to help readers avoid errors. One of the suggestions is that readers "take the pulse" of the nursing at any hospital they are considering. The article advises us to check for adequate staffing ratios, appropriate shift lengths--noting that a fresh nurse makes fewer mistakes and "may" even catch physician errors--and the level of education of staff nurses, since research has associated better outcomes with nurses who hold bachelor's degrees. The fact that this mainstream article at least made these points about the role of nursing is praiseworthy.

Less admirable is the piece's failure to convey that nurses are not physician assistants who might occasionally catch their errors, but autonomous professionals with their own scope of practice who regularly protect their patients from a wide range of life-threatening hazards, including deteriorations in conditions due to disease, care environments, and of course, actions of other health care professionals. The impression the piece gives is that physicians direct health care and, aside from a passing reference to the inclusion of nurses in some hospital peer-review proceedings, that physicians are the ones responsible for reducing errors. The story quotes six different named physicians, sometimes more than once, but there is not a single quote from a nurse or pharmacist. This conveys disrespect, but it also deprives readers of ideas for reducing errors from the majority of health care professionals--i.e. those who are not physicians. Some of the information about nursing noted above may have come from a nurse, but nurses have a lot more important advice than that, as other recent articles have shown. The physician-centric problem also manifests itself in small ways, such as the quote from one physician about how her own daughter, in the hospital
after a soccer injury, stopped breathing after a nurse's medication error. The physician is quoted as saying that the "doctors and I revived her..."--as if no nurses were involved, which is possible but very unlikely.

Perhaps the most glaring omission in the article's discussion of health care errors is the failure to even mention the current nursing shortage or the related short-staffing. This crisis is responsible for countless life-threatening hospital errors, and surviving it calls for a range of measures by everyone from government officials to family members that the piece does not begin to address.

Karen Cicero's article "How Careful is your Doctor?" does not appear to be available online at this time. It appeared in the February 2004 print version of Child.

Karen Cicero maybe reached at Child's general emailbox at childmail@child.com