mistakes in healthcare | JParadisi RN's Blog

Clouds-Nature Journal Page ink and watercolor 2020 by Julianna Paradisi

I mentioned in previous posts I’ve taken up nature journaling as a new hobby. I enjoy it for many reasons: It promotes spending time in nature, increases meditative observation, and improves my drawing skills.

An unexpected benefit of nature journaling is that close observation of nature has revealed gaps in my knowledge of natural science. For instance, as a child I learned there were different types of clouds. I remember and can identify by sight cumulus, stratus, and lenticular, but after that, they just become pretty things to look at.

In Oregon, we have LOTS of clouds. I decided I want the ability to identify them. There are 10 major types of clouds, not including subtypes. They are identified not only by shape and color; altitude is also a factor. Altitude is difficult to judge unless there’s a mountain or tall building of known height to use as a reference point.

Despite their ubiquity, the more I research, I discover identifying clouds by type is not as easy as I’d expected.

I became discouraged about achieving my goal, until I remembered my science classes, prerequisites for nursing school. Microbiology required I learn to identify and draw various bacteria viewed on slides under a microscope. And what nurse can forget learning to identify the psoas muscle by sight in anatomy? It’s not easy to differentiate the fine borders and connections distinguishing individual muscles from what initially looks like a solid slab of tissue! At the time, both tasks appeared overwhelming, but I learned to see, receiving A’s in these classes. This memory persuades me I have the capacity to learn the different types of clouds, too.

Which brings me to another benefit of nature journaling: learning that I am not too old to learn new things, including about myself.

Perhaps, as we age, it’s not the ability to learn that is lost, so much as it’s the fear of being wrong that is developed.

Generally speaking, nurses need to be competent, and competency is sometimes confused with being right. A nurse can be highly competent, but still make a mistake. In our worst fears, the mistake involves the safety of a patient. What saves us then is the level of accountability we bring to our practice. Nurses remain number one in the Gallup poll list of most trusted professions, not because we never make mistakes, but because of the overall accountability, characteristic of our profession. Society trusts nurses.

It appears counterintuitive, to be trusted because of how we handle our mistakes. I’m reminded of the saying,

Integrity is doing the right then even when no one is watching.*

I mull over these thoughts while drawing outdoors between rain showers, making ink and watercolor sketches of clouds in the rapidly changing Portland sky. Typical of Oregon weather, to the south is blue sky as the sun breaks through. Looking north, more rainclouds gather, ominously. Shortly thereafter, the heavens open, releasing heavy showers of rain. I gather my supplies, and go inside, where I ponder the names of the clouds I’ve just sketched.

And then I realize, they’re clouds, beautiful in their own right, with or without names. I am grateful for the brief moment outside, the morning’s sun break, the beauty of the day. I’ll look up the cloud names later. For now, I’ll make a cup of tea, and enjoy having the opportunity to learn something new without having to worry about being wrong.

* Various attributions, often to C.S. Lewis, but possibly a paraphrase of a Charles Marshall quote in Shattering the Glass Slipper

Don't be a Nurse Puppet. photo: J.Paradisi

Pauline Chen writes about doctors who make mistakes in the health section of the New York Times (When Doctors Make Mistakes )http://www.nytimes.com/2009/07/09/health/09chen.html?_r=1&partner=rss&emc=rss

On the same page of today’s on-line section, is a story about an ex-surgery technician who infected at least ten people with hepatitis C, by stealing drugs from patients, injecting them into herself, then reusing the needles and syringes on patients. http://www.nytimes.com/2009/07/10/us/10denver.html?ref=health

There is a huge difference between making a mistake and committing a crime. I think that point gets confused sometimes in the discussion of errors made in health care.

When I was going through chemotherapy for cancer treatment, I couldn’t work with patients in the PICU. Instead, I was assigned to Quality Insurance for the unit. The job involved reviewing error reports, identifying events leading to errors, and creating systems to prevent recurrence. I loved that job. A consistent thread running through virtually every report was rarely do single events lead to mistakes. Usually a series of events occur, like a stack of dominoes falling upon each other in a line, leading to Destination Error. Long hours, too heavy patient loads, extra shifts to cover short staffing, lack of appropriate mentoring for new nurses and doctors, and more, contribute to mistakes. There was always a surge in reports when census was high and staffing was low.

During the first six months of my nursing career, I thought I made a disastrous error: becoming a nurse. Fresh out of school, I worked on a high-acuity unit utilizing the team-leader model of care. I was a team leader for one LPN (if one was available) and one or two CNAs. If someone called in sick, I was also charge nurse, with a full patient assignment. I worked twelve hour nights and went home most mornings in tears, dreading the little notes I’d find in my staff box, notifying me of things I’d forgotten or mistakes I’d made the previous shift. It never occurred to me the assignments were unreasonable. Instead, I doubted myself, a competent young woman, managing a household and raising a family, feeling unable to do a job I worked so hard to excel at.

I was rescued by an expert nurse who befriended me and taught me what nursing is really about. If I could wish anything for new nurses, it would be for each to have that kind of mentoring, which for some reason came my way. I hope I gave some of that back when it was my turn to precept and mentor.

Be careful out there.