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If only we could find a 10,000-word major metropolitan newspaper article on nursing malpractice, that would be so great!

December 20, 2005 -- Today the Baltimore Sun ran the last installment of Fred Schulte's massive three-part series "Masking malpractice cases." The gist of it is that Maryland's system for overseeing physician practice is failing to protect patients. According to the report, that is because regulators pay insufficient attention to malpractice claim trends, rules keep most physicians' claim histories confidential, and litigation practices by lawyers and elite hospitals often allow physicians to escape liability and scrutiny. The piece focuses on the small number of physicians who have had unusually high numbers of malpractice claims or payments; regulators in other states reportedly examine those physicians closely. So what's our problem with all this reporting about physician errors? The problem is that the subtext of the huge 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. Nursing is ignored because it is not deemed important.

The clear impression most readers will get from the Sun's report 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 three 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 this entire Sun report, whose text exceeds 9,500 words, neither the word "nurse" nor the word "nursing" appears 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. Complain about "problem nurses" whose errors may be killing people; with almost three million US nurses, 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.

See the article by Fred Schulte "Masking malpractice cases" in the December 20, 2005 edition of the Baltimore Sun.

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