October 30, 2008, 8:33 am

So I Go Insane, Like I Always Do…

No, this is not a rehearsal for a Busby Berkeley musical.

These are student nurses!

Apparently calisthenics were part of the curriculum back in the day.

Nursing school was a lot more than studying and clinicals, you know.

One had to learn the niceties of society and proper etiquette, too!

I have an entire photo shoot on the life of a student nurse in the 1940s. When I post them, I’ll warn you ahead of time. You won’t want to be eating or drinking while you read, as aspiration is to be avoided at all costs!


Our Change of Shift host for the week, Amanda at Crazy Miracle Called Life, has just posted the new edition!


If you have not yet voted in our poll for topics to cover at next year’s medblogger conference, please do so! The poll stays up until the end of November.

I am amazed at the number of opportunities that are open for us next year! One minute it seems impossible and the next minute opportunities are there that we didn’t even know existed.

I’ll keep you posted on what is happening as details are finalized.

And now for our feature presentation:


Is it just me or has the nursing profession gone insane?

Let me give you a, shall we say, hypothetical situation.

Let’s say you work in a medium-sized community hospital.

The nurses in this medium-sized community hospital have busted their butts over the last year or two implementing Joint Commission standards surrounding medication administration.

For example:

  • The chart containing the medication order is taken to the bedside so that the medication can be checked against the order before administering.
  • All medications are either drawn up at the bedside or labeled in the med room when they are drawn up.
  • All patients are identified with two identifiers – full name and birth date (and they must say both!).
  • Full and complete (as much as possible) medication lists are obtained on arrival to facilitate medication reconciliation.

Let’s say these procedures have led to a dramatic drop in medication errors, which is what they were designed to do.

Time for celebration? Time for kudos? Time for acknowledging that our work has been effective, that the patients are safe, that this is a wonderful statistic and good for us, let’s keep up the good work?


What the nurses in this hypothetical department get (and this has happened twice, hypothetically, of course) is a note from the pharmacy stating that their percentage of medication errors is not up to what is expected, ergo they are not reporting their med errors.


Pardon my language.

Maybe I’m crazy, but there is a certain percentage of med errors expected of us the nurses in this ER?

That isn’t even the most astounding part of this Catch-22.

What the pharmacy is saying is, if I can paraphrase, “We know you are making these errors but you are not reporting them, meaning you are not acting ethically or professionally.”

This is bull****.

Pardon my language.

And who was sticking up for the nurses in this hypothetical ER? Who went to pharmacy and said, “Hey, buddy, we’re a damn good group of professional nurses and did it ever occur to you that our errors are down because we have worked our asses off to GET them down.”

Pardon my language.

No one did. Nada. No chance for feedback, as this pharmacy feedback was first put on a post-it note on the Pyxis and then repeated in a note that functions as a staff meeting.

In this hypothetical ER.

So all of the work, the extra vigilance, the extra time in filling out extra paperwork, the time actually doing what we those nurses were supposed to do (and then some) led to an improvement in patient care.

So obviously they are doing something wrong in not having their medication errors up to par level.


Am I nuts? Have I gone insane? Does anyone else see the ludicrousness of this scenario?

All I know is that there is a hypothetical nurse getting fed up with a hypothetical middle sized community emergency department.

Tell me.

Are there ANY hospitals out there who treat nurses with any modicum of respect?

A hospital where someone might stand UP for their nurses when something like this is comes up?

Please, let me know.

Because I am losing faith in the ability of this profession to stand up for itself.

I’m thinking a letter to the hypothetical Chief Nursing Officer with a cc to the manager of this hypothetical emergency department might be in order.

Lord knows it won’t change a thing, but there is a hypothetical nurse who might feel better.


  • Doctor Anonymous

    October 30, 2008 at 8:39 am

    Whoa! You’re right. This is the exact wrong way to present this: “We know you’re gonna screw up. Just screw up less.” C’mon, gimme a break!

  • PharmacistMike

    October 30, 2008 at 9:05 am

    It sounds like the pharmacy department or perhaps a single pharmacist needs to learn a little about effective communications. Obviously, the way that the situation has been addressed is inappropriate.

    There are no benchmarks for expected levels of med errors depending on what technology/procedures are in place to prevent them. However, if zero errors are reported then that number would be hard to believe. It is good to see that error rates are being reduced but to a level of zero is pretty unreal.

    If zero errors really are the true facts then one needs to focus on near errors. Catastrophic errors really don’t do much to help improve a system as they are a rare occurrence. However, near misses can add real value. For example, seismologists learn more from small trembles over a period of years than they do from the rare major quakes.

    Another Catch-22, at my last center I had to take a class about how to use the new reporting system. From Thursday to Monday I reported 6 errors/adverse events and they were not little ones (hemorrhagic transformation of ischemic stroke with pt on heparin, 22 hour delay for initial antibiotics in septic patient, etc.) On Monday an administrator came to the department looking for me and I got talked to for reporting events and rocking the boat. Needless to say, I left that facility.

  • Healthcare Today

    October 30, 2008 at 9:10 am

    So I Go Insane, Like I Always Do… // Emergiblog…

    What do you do when your best is not what a hospital wants to see?…

  • enrico

    October 30, 2008 at 10:01 am

    I agree with PharmacistMike, not all errors are even close to being the same, and that’s a big part of this. You also didn’t mention how much the error rate dropped, “hypothetically.” A 500% (or whatever) decrease, “hypothetically,” will be viewed suspiciously with good reason from a statistical POV.

    That said, a memo assuming false reporting was solely to blame, an after the fact victim of judge and jury, was absolutely the wrong way to approach the situation. Investigate first, decide after getting the facts.

    Playing devil’s advocate, you shouldn’t be riled by another dept wanting to verify facts. In fact, take it as a compliment that the numbers went down so dramatically as to arouse suspicion, then you get even more of a spotlight when it’s proven that said department actually DID kick ass.

    “Hypothetically.” 😉

  • Nurse K

    October 30, 2008 at 11:12 am

    Uh, how many nurses “know” when they gave the wrong med. If you know you’re giving the wrong med then you’re like, what, intentionally doing it?

  • Black Cloud ER Tech

    October 30, 2008 at 12:08 pm

    … And god forbit we actually use the new laws of the land set forth by the ever so mighty Joint Commission (med rec, cross checking meds, pt identifyers). And for heavens sakes, professional staff members at Hypotheticville Community Medical Center utilize these tools.

    Recenlty, while talking to a night shift coworker, we got on the discussion of integrity. Our careers in health care, much like those of other public servants, require the utmost of integrity. A professional health care provider with inegrity, in my mind, would immediatly fess up to a error and report it.

    While yes, ZERO errors is a hard fact for even the perfectionist to beleive. However, if the errors are reported, but still far below the “expected average,” the unit in question must be doing thier jobs correctly.

    And the Joint Commission Laws of the Land don’t stop at medications… Even the most rudimentary tasks in the ER (12Lead EKG, Spinting, Crutches, Vitals) require patient identification and safety.

    Hypotheticville ER, as well as the whole hospital has busted thier backsides to train every single employee remotely related to patient care on the Laws of the Land so that patient safety and care can be top knotch.

    With this all said, it might be in order for the pharmacy to come and view the Emergency Department. See that the PROFESSIONAL STAFF with INTEGRITY, are following and utilizing the Joint Commission Laws of the Land, and, thusly, creating a much safer patient care environment and safer work enviroment for thier fellow employees.

    –Black Cloud ER Tech

  • annemiek

    October 30, 2008 at 12:59 pm

    Craziness! So why all these improvements if you’re expected to do it wrong anyway?

  • Trusted.MD Network

    October 30, 2008 at 4:39 pm

    So I Go Insane, Like I Always Do……

    No, this is not a rehearsal for a Busby Berkeley musical.
    These are student nurses!
    Apparently calisthenics were part of the curriculum back in the day.
    Nursing school was a lot more than studying and clinicals, you know.
    One had to learn the niceties …

  • Shellee

    November 1, 2008 at 12:26 pm

    I’m familiar with an instance where a hospital was dinged by a regulatory survey for not having enough ruptured appys; which was taken to mean that this error rate was the standard. Rather than looking at the fact that the physician clinicians were all experienced and competent practitioners who worked in a setting that was small enough that they actually knew their patients and were able to provide close followup, it was viewed as something wrong. A good perspective in this instance would have been to identify what is working in this setting and attempt to replicate it elsewhere. Perhaps this approach might have helped the hypothetical nurses feel better about the job that they had done in improving their medication errors. When you work hard being recognized as the good example, not only helps others, but puts value to what you do.

  • NPs Save Lives

    November 2, 2008 at 5:41 pm

    I can see why you were so upset. It’s bad enough that we get smacked when we do the wrong things but it’s even worse when we do the right ones and then not get believed that it’s really accurate.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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