Please read this story about a nurse who committed suicide after committing a medical error resulting in a patient death. The nurse admitted to making the mistake and subsequent events reportedly pushed her over the edge: being fired from the hospital and a State Nursing Board investigation.
Is is really just culture or it just culture the newest "PC" term for the powers that be, be not, and be gone in healthcare?
Healthcare providers who commit errors are being called "second victims." The patient is the first victim as the person injured or killed by a preventable error and the second victim is the person who has to live with the mistake: Kimberly Hiatt, R.N. Medical errors can be eliminated 100% in a perfect healthcare system , with a perfect work environment, with perfect staffing, staff and processes, and administration by the perfect nurse.
I am not sure what type of debate this will spark however the pendulum has swung toooo far to the left or right (whichever hand you use) in general. I get "public protection" and "patient safety" as a priority of course as a nurse license defense attorney but how do you balance this with the rights of nurses (as the largest group of HCPs) who:
1. are at a severe & extremely unfair and "unjust" disadvantage in the investigation of these cases by the State Nursing Board (compare the rights and more importantly the discovery process afforded to criminal defendants and civil litigants with the rights and "discovery" afforded to licensees in State Nursing Board disciplinary investigations in your state);
2. are usually terminated by the healthcare organization with little or no recourse but filing a "wrongful discharge lawsuit" (I said filing a lawsuit not prevailing...);
3. the now former employer then challenges the claim for unemployment benefits; and
4. there may or not be a medical mal case lurking (depending on the error); or
5. a criminal case (depending on the error) and more state and regulatory investigations forthcoming.
We are talking about nurses; most of us with two year or diploma degrees who are trained now to pass the NCLEX (there isn't much time left for anything else) and then pushed out into practice into the Where is Waldo World and regulatory maze of practicing "safely" in a healthcare system. What is just culture? I don't know because I don't see it from end of the table expect in a very limited cases; it is certainly not the norm and what is a just culture is subject to more interpretations than Purple Pain by Prince (I wanted to the say the Bible here but I can't; my grandmother reads my blog now). Also some of the blog posts ask why is a nurse treated so differently than a physician or a dentist in this type of siuation? What do you think?
The cards are stacked against nurses from Day One: before any error is committed or before anything happens, the facility has a plan to deal with the situation and you as an at-willed employed or nurse under a CBA. I see it every day and I cringe because it is just so "unjust." 20+ years with an employer means nothing anymore and you will be discharged the same as someone working at the facility for 2 weeks.
You are essentially at the whim of HR and management who while having visions of sugar plums, dates, raisins, figs, and Fig Newtons are mesmerized and magnetized by the brillance and effectiveness of the organization's strategic planning.
The nurse is thinking what will happen to my career, my license, my livelihood, how will I pay my bills now? and what about my family? The employer is thinking about JCAHO, leveraging the State Nursing Board complaint in the grievance process and arbitration as a long-term "plans within plans within plans" strategy for finally busting up the union, and appealing your award of unemployment benefits to the State Supreme Court and to infinity and beyond: which means filing formal Motions to "Engage You in Mortal Kombat" or in the alternative "Pimp Slap You" on Judge Judy. Just how many blows can one take to the head wearing a broken helmet when the opponent is wearing cheap gold plated brass knuckles?
It is the nurse (with limited resources) against the employer (with deep pockets, trade association backing, and enough insurance coverage and legal needs to make most attorneys (plaintiff or defense) want to sip its Kool-Aid. I make my own Kool-Aid thank you very much.
It becomes the nurse against the world (like Pac) because for most of us your career, your licensure, your employment and your title is who and what you are. It is not just a title, a role, or a job: it is your essence. Kimberly Hiatt, RN is a nurse. LaTonia Denise Wright, RN is a nurse. You are _______ and you are a nurse. For some if not most of us are you are your license.
When you pull and tug at the essence it is like pulling flesh from the bone for some. This is the rawness exposed when you term a nurse and report to the State Nursing Board for whatever reason for some nurses because the nurse and her license are one and the same. License defense rivals family law with the sheer emotion and criminal law with the potential loss of livelihood (instead of liberty).
Everything comes into question: finances, licensure, career, marriage, relationships, health, etc. all at once and it can be overwhelming and actually knock the wind out of you. It is a professional matter but it is personal because you are your license and it is your license being questioned. How can it not be personal some of us may say? The condemnation of the nursing practice is internalized because how do you separate the nurse from the license if you are your license? The same can be said for any licensed individual if your license affords you benefits you would not otherwise have without the license: teachers, doctors, lawyers, RTs, MTs, PTs, OTs.......
This is a tragedy for the family who lost a child. I am so sorry for your lost.
This is also a tragedy for the family of the nurse who took her own life at age 50. I am so sorry for your lost.
I am sure some of you are saying I am more than my license and I am more than a nurse; I am not defined by my license, education, or title. Of course you are but until your license, livelihood, and identify as a nurse is threatened, I don't think one can appreciate the throws of what it means for some of us as nurses if you are your license. How would you know that you are your license until this happens and then what do you do? Is this normal? Is it acceptable?
I would like to think if my law licenses and nursing license was in jeopardy and I was in the mix of a professional crisis affecting my small business and law practice, my career as a nurse license defense attorney, and which would certainly impact everything else in my life (to say the least) that I would be okay but you don't know until are there.
Nurses if you are terminated by your employer and subsequently reported to the Board reach out for help if you are having trouble coping with your circumstances. Don't be ashamed; you are a helper and there is nothing wrong with needing help when you are in a crisis. You worked hard to finish nursing school and get your license and you may have to work even harder to keep it. There is always hope and the road ahead is never as bad as it seems if you have faith in a higher power or if you believe this too shall pass.
1. Seek assistance immediately from colleagues, family members, neighbors, and friends to be there for you. This isn't the time to be super-woman or superman. You are being offered help so please take it and utilize your resources.
2. If you need medical care, get it before your health insurance lapses. Also you can seek medical services on a sliding scale basis.
3. If you need mental health assistance, get it. Counseling can be a positive and provide you with an outlet for your feelings of despair, hopelessness, and help you manage the pain and sort through your feelings and emotions. If you need counseling, there are facilities which offer it on a sliding scale basis if you don't have insurance. Consider attending a support group at a local church for unemployed workers; it may give you a totally different perspective on your situation and plight. If you are considering suicide, call someone, call 911, and reach out for help.
4. Talk to someone at your State Nurses Association for general information on your options. Let them know you are a nurse and you are in a crisis: someone whether it is the Executive Director or the Nurse Practice Consultant will listen and assist you. See http://nursingworld.org/FunctionalMenuCategories/AboutANA/WhoWeAre/CMA.aspx
5. If you are a member of a nursing union, contact your union rep and your local union president to further discuss your situation.
6. Seek legal advice and counseling and consider representation before the State Nursing Board. See www.taana.org.
7. Review your finances carefully as you may need to tap an emergency fund, retirement fund, etc. Tighten up your finances and start spending less. If you need a room mate to make ends meet, get a room mate.
8. Consider applying for unemployment benefits if you are having trouble securing employment.
9. Eat right and do some type of physical exercise. Crying isn't physical exercise.
10. Remember you are loved and you are wanted and needed by your family, your friends, your colleagues, and the profession. I don't know you but I love you because we are all nurses and just one nurse committing suicide because of what is perceived and objectively and subjectively mirrors professional, licensure, and career suicide to nurse is unacceptable and unjust.
God bless you, Kimberly Hiatt, RN and may your soul rest in peace.
Kudos to the Washington Nurses Association for doing what it does best.