Deadly Nursing Decisions

Deadly Decisions. Have you ever worked with someone who is incompetent or disrespectful? How about someone who purposefully decides to ignore protocol and take a dangerous shortcut, putting lives at risk for their own selfish gain?

Sadly, you are not alone. Hiring practices can only weed out so much. The company relies on you to help them identify gaps.

What is more alarming is that most workers choose to stay silent and ignore problems. For many people, there is something intimidating about speaking up that has nurses facing ethical and moral dilemmas on a regular basis.

The American Association of Critical Care Nurses in 2010 (The Silent Treatment study) found that 4/5 nurses have concerns about another person’s work as it relates to witnessed moments of dangerous shortcuts, incompetence, and disrespect. Over 50% of these nurses chose not to speak up and cited disrespectful behavior as the reason influencing their decision. In looking at that data on dangerous shortcuts alone, it is clear that nurses need support in the trenches as 84% of the 4,235 nurses surveyed reported witnessing dangerous shortcuts; that is 3,557 moments. Of these, 924 patients were harmed (26%) and a further 3,012 were at risk due to the decision to stay silent.

I know nurses. I know the heart of a nurse. I am a nurse. This is not something we actively choose when we wake up in the morning. We don’t say … “well, it’s time to go to work and see who we can harm today.” In fact, 31% of nurses do address their colleagues when concerns arise. In general, nurses are feeling lost in how to deal with it and need support. Cue the manager.

Less than half of nurses report their concerns to the manager, and the reason may shock you.

Not all managers are equipped to deal with these issues. Managers are often promoted from within and receive little to no training. Their true worth shows up when they are faced with, and manage, conflict. A manager quickly establishes the acceptable behaviors within a nursing unit by how they receive, investigate, and manage conflict. This study found that “managers do not appear to be a reliable path for resolving concerns about dangerous shortcuts, incompetence, or disrespect”. With only 41% of nurse managers reportedly addressing dangerous shortcuts, staff quickly learn that reporting deficits will not change outcomes. The real harm comes when the manager sees a decreased number of complaints being brought forward. They may be lead to assume that their own response has led to this outcome, but they are fooled into a false sense of safety.

When we add the stats around incompetence and disrespect, they are not encouraging. Only 35% of disrespectful moments were addressed and 28% of incompetency concerns. When staff members lose faith in the processes and people who are supposed to help them, our patients suffer.

The silver lining

This can be turned around and you do have the skills. When we create a culture of safety around speaking up, we create a culture of safety for our patients. If it is okay for patients to ask us if we have washed our hands, we can create the culture where it is safe for another colleague to inquire about something concerning.

Tammy Dunnett is a communication specialist, speaker, and strategist and she can help you create the culture of safety. She specializes in creating safe spaces for difficult conversations.

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