Far from the Nashville courtroom where nurse RaDonda Vaught was convicted of homicide for giving a patient the wrong drug, medical experts and talking heads have mostly asked the right questions. Will the case have a chilling effect on the nursing profession? Did software system issues at Vaught’s hospital contribute to the tragedy? Aren’t chronically low staffing levels priming the pump for future mistakes?
All are important, all worthy of examination. But the rush to answer these questions obscures a development, nurses say, that may radically alter the delivery of medical care in our country. It is a sea change hiding in plain sight.
Over the past two decades, health systems in the U.S. have moved steadily toward the “just culture” model of care. In a just culture, caregivers are held accountable for their mistakes, but without scapegoating. The larger emphasis is on identifying and improving the processes, procedures, and training and design flaws that led to the failures in the first place. Many have argued that in a profit-driven health industry, just culture is one of the few effective means of constantly forcing reevaluation and upward evolution in care.
The just culture approach, though, relies heavily on a
free flow of information and transparency, with doctors and nurses encouraged to self-report their errors as part of the system-wide effort to improve. From the moment Vaught was criminally charged for the mistakes that killed 75-year-old Charlene Murphey, that model has been fraying at the edges.
In interview after interview, nurses told me they believe their colleagues will be much less likely to self-report errors, or even near misses. “People will die because of this,” says Janie Harvey Garner, founder of
Show Me Your Stethoscope, an online nurse advocacy group that helped raise money for Vaught’s legal fees. Nurses also say they’ll think twice about employing the sort of routine shortcuts and workarounds that can be necessary in hospital settings to expedite care to patients, particularly those in critical settings.
“We will not report errors for fear of going to jail,” Leslie Silket said bluntly. Silket, a registered nurse in Northern California with 22 years of experience in major hospitals and clinic settings, told me the case is almost certain to drive more of her peers out of the profession, adding, “This is going to drastically impact the future of nurses and add to the shortage.”
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Topic: Why a nurse’s recent homicide conviction could make hospitals even less safe (Read 694 times)