I want to write a little more about mistakes and how the system sucks. Many nursing mistakes are also systemic problems, but the individual nurse is often punished. I recently made another mistake, and this one contributed to a fall. Four other people also had a role, but I have a bad feeling my head will be the one to roll. I am waffling about how much culpability I have. I was working as an aide, and my RN insisted that I do something about which my whole being was screaming "this is bad idea!" I objected, but not enough. Now I wish I'd said, "I'm sorry, but I am not going to do that. It's not safe. YOU can do it if you want it done." But since I didn't do that I wish I'd had extra knowledge and experience that I didn't have. No injury resulted except to my own sense of security at work. Here's the thing. I usually have six or seven mid- to high-acuity patients. And everyone works under similar or worse conditions. In short I have realized deeply and sharply that I have chosen to enter a profession in which even if I do the best I possibly can, the decks are stacked against me: circumstances combined with exhaustion cannot help but lead to error and possible patient harm. Most errors don't seem to lead to patient harm, but that seems like luck of the draw more than anything else. Chances are almost 100% that an RN will commit an error during a shift. After that it's a crapshot as to, first, whether it happens to lead to actual harm, and second, whether anyone notices it or not. Either way everyone is making mistakes all the time. I see them all day long. Most of the time things turn out OK. Sometimes they don't.
Could I have done a better job with the patient who fell? I'm not even sure. I wasn't rushing the situation and it was more a matter of inexperience. But the point is that I did the best I could for all my patients, and to show for it someone fell, my RN told me that I asked "stupid fucking questions for being a nursing student" (he shows a strange inability to distinguish updates on patients' conditions with questions about what should be done about said conditions), and I'll probably get written up (at best). In what way does this inspire me to go to work again? In NO way (but I will because I love the patients, and right now for no other reason). When I left work that day I felt as if I'd been energetically beaten from head to toe. My feet hurt every time I set them down. All of my patients who were conscious made a point of thanking me for the excellent care they'd received. Will any of that be taken into account? I don't know. I never really saw before how nurses could just say, "I've had it" and quit. I see it now. It is heart-breaking to work so hard and care so much and then be eaten alive by the system despite your best efforts.
Where is the spirit of learning from our mistakes instead of going on a witch hunt? The witch hunts induce an overlying miasma of fear and unwillingness to try very hard anyway (learned helplessness). I'd wager that for every serious medical error (of which mine was probably not, to anyone but me) there is a serious systemic problem behind it and/or two or three other folks to share in the culpability. Why can we not work together in the spirit of better patient care and safety so that these mistakes don't happen again? I have never seen a team sat down and asked, "OK, what all contributed to this fall/medication error/failure to note pressure sores over the patient's entire backside?" Instead everyone gossips and bickers about it and in the shadowy background someone gets written up and/or fired. Which is also gossiped about and contributes to the atmosphere of fear and dog-eat-dog.
There has to be a better way.