Should Medical Errors Result in Jail Time?

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On March 25, Tennessee nurse RaDonda Vaught was convicted of criminally negligent homicide and negligent abuse of an impaired adult for a 2019 medication error that resulted in the death of a patient. We covered this story as it first unfolded three years ago. In fact, the most recent update on our blog, published in March 2019, reported that state health officials had considered the circumstances surrounding the error and declined to take any action.

Outrage from multiple nursing and health care organizations.

Subsequently, however, the Tennessee board of nursing revoked Vaught’s license and the decision was taken to charge her after all. In the past weeks, Vaught’s conviction has sent shock waves through the health care professional community, and many organizations have spoken against the verdict:

From the statement by the American Nurses Association:

“Health care delivery is highly complex. It is inevitable that mistakes will happen, and systems will fail. … The non-intentional acts of Individual nurses like RaDonda Vaught should not be criminalized to ensure patient safety.”

From the statement of the American Association of Critical-Care Nurses:

“Decades of safety research, including the Institute of Medicine’s pioneering report To Err Is Human, has demonstrated […]

Is Your Facility’s Computer System a Patient Safety Risk?

Discussed in this post: “How Often Do EHRs Result in Patient Harm?(AJN, News, March).

When we first had computers in the hospital—that is, while we still charted on paper but had quick online access to lab, radiology, and pathology results and could easily look up a patient’s prior admission history—it was wonderful. No more little lab slips floating all over the nurses’ station. No more unit-to-unit searches trying to figure out who last had custody of the patient’s X-ray films. (How could objects so large be so easily lost?)

A rocky transition to EHRs.

electronic health recordsThe transition to almost fully digital charting, on the other hand, has been pretty much a nightmare from the beginning. Nursing was rarely included in initial needs assessments. Many rollouts were chaotic, without additional staffing for the inevitable glitches that are bound to occur. Training of frontline clinical staff has been routinely minimal; we seem to be expected to pick up the many fine points of new software by some kind of digital osmosis.

That elusive clinician friendly EHR.

It’s very clear at this point that electronic health records (EHRs) were designed primarily for data collection and billing purposes. I have yet to see a system that could in any way be […]

2020-03-12T08:02:22-04:00March 12th, 2020|digital health, Nursing, Technology|2 Comments

One in 4 Million: The Nurse Who Mentored Me

Hostility among nurses is a well-documented topic of discussion, a phenomenon studied by both academics and hospital administrators wanting to create functional teams. Perhaps the remedy for healthy nurse–coworker relationships isn’t found by studying dysfunctional relationships but by observing the successful ones.

I was lucky to have one.

I excelled as a student, even with balancing the role of nursing student with the role of mother to a preschool-aged daughter.

However, academic success and my talent for multitasking did not prepare me for the reality shock of a new-grad nurse.

Thrown into the deep end.

There was a nursing shortage. I was hired to a pediatric unit before graduation, skipping the two years of adult medical-surgical nursing before entering a specialty that was customary for new grads at the time. I began my first job, pending successfully passing state boards, with an interim permit.

It was an era before nurse residencies or comprehensive orientations. My orientation consisted of accompanying a day shift nurse while she managed her patients.

After two weeks, I began night shift on a 30-bed pediatric unit during the height of the respiratory infection season.

Night shifts were staffed with up to three RNs, overseeing certified nursing assistants. Often the CNAs came from agencies, possessing varying amounts of skill. As a new grad overseeing […]

A Call to Address Fatigue to Protect Nurse Health and Patient Safety—from 1919

The evidence on nurse fatigue has been there all along.

During Women’s History Month, which is about to end, I’ve been posting (here and here) on nursing history (and in the process exploring its close confluence with women’s history). For this last post, I’m highlighting an article published in the March 1919 issue of AJN—exactly 100 years ago. The evidence on fatigue from long working hours has been there all along.

The Movement For Shorter Hours in Nurses’ Training Schools” (free until April 15; click on the pdf version in the upper right), was written by Isabel Stewart, who was professor and then director of the nursing program at Teachers College, Columbia University, and coauthor of the National League for Nursing Education (the forerunner of today’s National League for Nursing) Standard Curriculum for Schools of Nursing.

A call for 8-hour work days for nurses.

In this article, which is in some ways disturbingly relevant today, Isabel Stewart notes that major nursing organizations recently met and were seeking “to enlist the support of a great many influential organizations and the general public in establishing an eight-hour day and a fifty-two hour week for pupil nurses.” (As a reminder, hospital nursing staff at that time were mostly nursing […]

Too Tired to Nurse

By Shawn Kennedy, AJN editor-in-chief

by patchy patch, via flickr by patchy patch, via flickr

Just about every nurse I know has been “asked” (or “guilted” or “mandated”) to work an additional shift on top of a grueling one. The worst such experience I ever had was having to work from midnight to 8 am after working a straight week of 4 pm to midnight shifts. I was exhausted, but someone had called in sick, leaving only two RNs and one aide for the 11-bed ED trauma unit.

I was so tired that at one point I found myself falling asleep while I was standing by a patient’s bed charting vital signs. I couldn’t remember the blood pressure reading I had obtained just moments before. It was good luck that I didn’t make an error—and had the good sense to have a colleague double-check medications I was readying (these were the old days, before unit dosing). […]

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