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Old 07-08-2011, 03:14 PM
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Default How to Recover from a Mistake at Work

July 6, 2011 - No one dons scrubs or a uniform and heads to work with the idea of making mistakes, but they happen--from life-threatening medication or procedure errors to misspeaking and alienating a co-worker, to coming in late and damaging a reputation.?

There is nothing more stressful and humbling to a nurse, than knowing that any mistake they make can cause risk to their patient,? said Lisa A. Roberts, BSN, RN, CCRN, nurse manager of the surgical ICU at Texas Health Presbyterian Hospital Dallas. ?If a nurse makes a medication error, for example, the nurse knows that the patient is, ultimately, affected by that mistake even though the nurse never meant to cause harm.?

Nursing comes with tremendous rewards but also with the responsibility to do everything possible to ?first, do no harm.?

Jim Beckman, M.D., CEO and medical director said he has found nearly 100 percent of errors at work are due to either lack of clarity from directions or orders given and/or a lack of understanding about the results expected. Even in the best designed systems, errors and mistakes will develop, he noted. When they do, he recommends truthful admission of one?s mistakes without shifting blame, humility and a sincere apology, before developing steps to prevent a repeat outcome.

Take steps to prevent a recurrence
Nurses should evaluate the root cause of the mistake, Backer advised.
?A nurse can ask questions such as: ?Was I distracted? Overworked? Didn?t get enough sleep? Made some assumptions that weren?t true??? Backer suggested.

Nurses must examine the mistake, understand where they went wrong, and learn from it, Roberts agreed. ?Understanding the error and realizing the risks involved to the patient will usually prevent a recurrence, and allows nurses to forgive themselves and move forward with confidence and self-respect intact.?

Roberts suggests nurse mangers can help nurses recover by coaching them to discover why the error occurred and to use the event to teach others about lessons learned from the incident through an inservice training program or creating a poster. ?Knowledge and confidence is learned best when one has to teach the topic,? Roberts said.

Cynthia Ekes, BSN, MA, RN, NEA-BC, director of nursing in acute medical/surgical/oncology/rehab units at Texas Health Presbyterian, agreed that presenting an educational event related to the error and what was learned is an effective away to address a mistake. In addition, the nurse manager can meet with the nurse and evaluate each step in the process to determine the window of opportunity that allowed the error.

If the mistake involves coming in late or being rushed, Backer recommends arriving early and bringing something to read or write before starting the day more calmly, as well as taking an honest look at one?s priorities.

Deal with the emotional aftermath

Making an error that could harm a patient weighs heavily on nurses.
?Nurses have a tendency to beat themselves up over mistakes that happen and to internalize what they did wrong,? said Wayne McIntosh, RN, BSN, a nurse at Chandler Regional Medical Center in Chandler, Ariz. ?That is necessary for the profession. But taking too much in is hazardous for us, because there is always a lingering amount that stays there.?

When anyone makes a serious error, they need psychological help or a coach to help the mistake-maker deal with the stress and anxiety, said Doris Jeannette, PsyD, a licensed psychologist in Philadelphia.

?They need to take responsibility for the mistake and be able to learn and grow from it,? Jeannette said. ?This process needs to be fully experienced and completed. Psychological help, support and advice are needed.?
Some people never recover. For instance, Kimberly Hiatt, RN, a 24-year nursing veteran in Seattle, killed herself months after inadvertently administering more of a medication than ordered.

A study reported in the January 2011 issue of Archives of Surgery reported that ?a major medical error in the previous three months was associated with a three-fold increased risk of suicidal ideation.?

Zane Wolf, Ph.D., RN, FAAN, dean of the School of Nursing and Health Sciences at La Salle University in Philadelphia, acknowledged suicides have occurred and suggested the profession needs to get rid of the infallibility model and move to a just culture.

?What happens is people who are very seasoned make mistakes that have an impact on the rest of their lives,? Wolf added. ?The pain does not go away. They live with it, and for a lot of them with serious errors, for the rest of their lives. They can remember incredible details about the errors.?
Wolf indicated that professionals who make mistakes are often called ?second victims? who need support and, sometimes, psychological counseling for a sustained period of time.

Ekes suggested nurses share their experience in a small peer group setting where they feel safe. ?They can express the emotions felt after making the error and what steps they took to identify how the error may have been prevented,? Ekes said.

Restore credibility

Donna Cill, RN, FNP-BC, DNP, assistant dean of student affairs and director of continuing education clinical faculty graduate programs at UMDNJ-School of Nursing in Newark, N.J., added that after taking full responsibility for the mistake, the nurse must take steps to redeem his or herself and restore trust. She suggested doing something amazing and measurable to make up for the mistake, perhaps recruiting new nurses or certifying a significant number of nurses related to something the mistake-maker did.
?Doing an amazing thing will turn you from a trouble employee to an innovative thinker, and before you know it, they will forget about the mistake,? Cill said.

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