Prosecuting nurses for honest mistakes will make the nursing shortage worse

Nurses across the country are wondering if the profession is worth the risk after a Tennessee nurse was convicted in a case involving an accidental injection that resulted in a patient’s death.

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Demonstrators are seen outside the Nashville, Tennessee courthouse during the sentencing hearing for former nurse RaDonda Vaught, who was found guilty of criminally negligent homicide in the accidental death of a patient in March.

Demonstrators are seen outside the Nashville, Tennessee courthouse during the May 13 hearing for former nurse RaDonda Vaught, who was found guilty of criminally negligent homicide in the accidental death of a patient in March.

Mark Humphrey/AP

The recent case of RaDonda Vaught, the Tennessee nurse who was found guilty of negligent homicide after accidentally administering the wrong medication to a patient who subsequently died, has nurses and nursing students rethinking if this profession is worth their own personal risk.

To be sure, working in health care comes with great responsibility. Any mistake can impact the lives that health care workers entered the profession to protect. However, there are an estimated 250,000 medical errors every year — so is Vaught a dangerous exception or simply the face of fallible humanity?

And if we criminalize unintentional mistakes, who will sign up to be our caretakers?

Nurses everywhere are not just looking at Vaught’s scenario in isolation. They are applying it to the larger context of the current climate of nursing, including the ever-growing nursing shortage.

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Studies completed prior to the “great resignation” estimated there will be a shortage of over 500,000 nurses by 2030. Research has shown that nurse-to-patient ratios directly impact patient outcomes, including the prevalence of errors. When ratios are high, it creates a high risk for mortality, increases length of stay in hospitals and leads to preventable events like falls and infections. Appropriate nurse-to-patient ratios are a “safe culture” practice.

Nurses are sounding the alarm in regard to staffing shortages, using all types of mediums. The American Nurses Association has highlighted the nurse staffing crisis and outlined proposals for safe patient ratios to be incorporated in state and federal legislation.

Recently, nurses have rallied around popular social media influencers to demand safe staffing. Nurse Blake Lynch, who normally produces humorous content, targeted this serious issue and garnered over 500,000 signatures on a change.org petition demanding the Joint Commission, the organization responsible for accrediting and certifying over 22,000 health care organizations, require safe staffing ratios.

Part of my role on the nursing faculty at Rush University is to prepare the very nurses who are being added to the work force to address the worsening shortage. Patient safety is at the forefront of our curriculum.

In the past, I have emphasized to students that they should advocate for an appropriate patient load or ask for help from their coworkers if they are overwhelmed. I urge them to let leadership know when they cannot safely complete all the expected care within a shift.

Unfortunately, given the chronic national nursing shortage, these solutions might become hypothetical and unrealistic. In the meantime, I will continue to educate them on the health care industry standard on how to address that.

The health care industry recognizes the gravity of medical errors and has made efforts to determine solutions to reduce inevitable mistakes made by humans who deliver care. To Err is Human, a study published in 2000, focuses on systemic strategies to reduce errors instead of focusing on individuals. This aligns with the Culture of Safety in health care, which promotes honest mistake reporting that is blame free.

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In the case of Vaught, nurses reported the medication dispensing machines at their hospital were requiring daily overrides to access patient medication, and overriding was even suggested by the hospital to prevent patient care delays. A Culture of Safety would look at the machines and the larger system, instead of blaming a nurse who had to navigate the malfunctioning system and thus retrieved the incorrect medication.

This does not mean there are never consequences. In severe negligence cases, nurses may lose their license or go to civil court. But the criminal aspect of Vaught’s case is unprecedented.

Given the nursing shortage and the challenges facing nurses today, nurses recognize Vaught was not an anomaly.

In fact, unless safe patient ratios are established, they could be the next headline nurse in handcuffs.

Amanda LaMonica-Weier is a family nurse practitioner and instructor at Rush University and a Public Voices Fellow of The OpEd Project.

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