Nurses Often Maintain Silence About Physician Mistakes

Researchers affiliated with the American Association of Critical Care Nurses (AACCN; Aliso Viejo, CA, USA), the Association of periOperative Registered Nurses (AORN; Denver, CO, USA), and VitalSmarts (Provo, UT, USA), a best-practices training company, authored the study, called "Silent Treatment," which collected data from more than 6,500 nurses and nurse managers from health systems around the United States during 2010. The study included a story collector that generated rich, qualitative data, and a traditional survey that produced purely quantitative data.

The study found that 85% percent of respondents have been in a situation where a safety tool warned them of a problem; 32% said this happened at least a few times a month, confirming that safety tools such as checklists, protocols, and warning systems work, and are an essential guard against unintentional slips and errors. However, the study showed that the effectiveness of safety tools is undercut by "undiscussables"--risks that are widely known, but not discussed. Of the nurses who had been in situations where safety tools worked, 58% had also been in situations they felt unsafe to speak up about the problems or where they were unable to get others to listen.

The "undiscussable" include three areas of concern when it came to patient care. The first undiscussable is dangerous shortcuts; 84% percent of respondents say that 10% or more of their colleagues take dangerous shortcuts, such as not donning a full sterile barrier during arterial line placement or not washing their hands. Of those respondents, 26% said these shortcuts have actually harmed patients. Despite these risks, only 17% shared their concerns with the colleague in question. The second undiscussable is incompetence; 82% say that 10% or more of their colleagues are missing basic skills and, as a result, 19% say they have seen harm come to patients. Shockingly, only 11% have spoken to the incompetent colleague. The third undiscussable is disrespect; 85% of respondents say that 10% or more of the people they work with are disrespectful and therefore undermine their ability to share concerns or speak up about problems; and yet, only 16% have confronted their disrespectful colleague. The study is available online at the AACN website (please see Related Links below).

"When it comes to creating healthy work environments that ensure optimal quality of care, individual skills and personal motivation won't be enough to reduce harm and save lives unless speaking up is also supported by the social and structural elements within the organization," concluded coauthor David Maxfield, vice president of research at VitalSmarts, and colleagues of the AACCN and AORN. "Changing entrenched behavior in healthcare organizations will require a multifaceted approach and, to this end, [we] provide a series of recommendations leaders can follow to improve people's ability to hold crucial conversations."

Related Links:
American Association of Critical Care Nurses
Association of periOperative Registered Nurses
VitalSmarts
VitalSmarts, AORN, and AACN Study