“The argument here is not about whether nurses should be held accountable for their errors; everyone I spoke with about Vaught\u2019s case agrees she bears responsibility for her actions and should face consequences. The real issue is that criminalizing a nurse\u2019s error lets hospitals off the hook for the systemic changes that would improve patient safety.<\/p>\n\n\n\n
\u00a0\u201cAlmost no mistakes happen in a hospital by just one person,\u201d said Gatter. Systems exist to prevent medical errors, he said. If those systems don\u2019t work or exist only on paper, errors will happen.
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In this case, the system failures were clear: During an unannounced visit to Vanderbilt University Medical Center in late 2018, federal investigators found multiple deficiencies, some of which placed patients at \u201cserious and immediate threat,\u201d according to the 105-page memo documenting the details<\/a>. For example, hospital policies didn\u2019t require that a second nurse sign off on the use of a highly dangerous medication like vecuronium, nor did it require that patients receiving sedatives be hooked up to a heart and lung monitor. Focusing the blame on one nurse\u2019s error shifts the attention away from those deficiencies.\u201cI\u2019m quite concerned that this nurse is getting thrown under the bus, and in the hubbub of giving her a jail sentence, that the system itself will escape close examination,\u201d said Gatter. Even if a nurse were solely responsible for a medical error resulting in patient harm, the way to prevent that nurse from causing further harm is to revoke their license, said Gatter. It\u2019s much harder to explain how punishing a nurse with jail time further prevents them from endangering others.<\/p>\n\n\n\n However, it\u2019s easy to see how that type of punishment can itself create and compound safety risks<\/a>, he said.That\u2019s because severely punishing individuals for systemic problems has a chilling<\/a> effect on others\u2019 willingness to report mistakes.” The last thing the profession needs is another reason for nurses to leave jobs providing direct patient care, but that\u2019s exactly the effect the Vaught ruling is having”<\/p>\n\n\n\n
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“Less transparency in error reporting also means hospitals have fewer opportunities to correct big problems. That means faulty systems stay in place, which translates into more vulnerability and stress for health care providers and less safety for patients.”
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“The consequences for professional malpractice should ideally deter wrongdoing without discouraging people from entering the profession altogether \u2014 but finding that balance is challenging.”
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“American nursing was under enormous strain<\/a> well before the pandemic. But with the US population aging, surging retirements among bedside nurses and nurse educators, and nurse staffing levels reduced ever lower to contain costs, the pandemic has tipped parts of the country into a full-on nursing shortage<\/a>.<\/p>\n\n\n\n