A patient advocacy manifesto.
Preventable medical errors and adverse events are widely believed to be the third leading cause of death in the United States. Yet, some people deny there is such a national health crisis. While the topic of medical errors continues to ride the waves of political correctness and moral outrage, overall it tends to keep a low profile. Hospitals shun publicity and physicians are often defensive. Change is needed. Since nurses are the largest group of medical clinicians in a hospital system, they can improve patient safety and affect public awareness. Right now.
The Institute of Medicine’s (IOM) 1999 report, To Err Is Human
, generated a national conversation by stating that 98,000 people die every year because of medical errors in hospitals (Kohn, Corrigan, & Donaldson, 2000). Since then, various studies and reports have estimated yearly patient deaths to be in the hundreds of thousands. Because research analysts at the Centers for Disease Control and Prevention (CDC) do not consider medical errors a cause of death, it is not possible to know how many patients die from human and system errors. In their 2016 analysis of medical errors, Martin Makary and Michael Daniel wrote that, when death results from medical error, “both the physiological cause of the death and the related problem with delivery of care should be captured” (p. 2).
Although it will take years for medical care to come fully into the light and be practiced with transparency and ownership of errors, nurses can do something about this crisis now. By being vigorously brave and assertive in providing safe care to patients, nurses can become warrior nurses who take action when something is wrong. If they witness or identify medical errors or adverse events, these fighters say something, do something, find somebody, go up the chain of command, and never give up until appropriate actions are taken and the patient is protected or stabilized.
Warrior nurses work on the front lines of protection and safety. They focus on the details of each patient’s complex and ever-changing clinical picture. They are critical thinkers. They listen to their patients and the patients’ families, as well as other staff members. They remain vigilant and engaged as they meticulously administer medications and treatments. They seek clarification or amendment if required. They carefully monitor and hold cautious watch over patients after a procedure or surgery.
Warrior nurses are first and foremost patient advocates. They protect their patients and go the extra mile. They keep their promises. They operate as caregivers, protectors, educators, gatekeepers, medication nurses, and guardian angels. They anticipate problems and ask questions if something seems wrong. They do not hesitate to call a peer, supervisor, or physician to request assistance or additional support for their patients.
Warrior nurses are scientists. They pay attention. They continually learn and ask questions, realizing things can change in a moment. They integrate best research evidence and patient values with their clinical expertise. They approach each patient’s scenario with fresh eyes. Does this patient need a medication change? Why is this patient’s pulse so high? Did something go wrong in this patient’s surgery? Nurse scientists operate outside the proverbial box, ever poised to consider what may be overlooked, newly relevant, or in need of more scrutiny.
Warrior nurses are familiar with and follow all workplace policies and protocols. If something needs to be added or revised, they communicate with others. They refuse to accept the status quo if it fails to serve the highest patient good. They practice horizontal leadership. They respect patients, families, and staff members.
Warrior nurses maintain safety for themselves and others. They have clean hands. They scrupulously follow protocol when performing wound care. They are well-trained and careful when using devices or equipment. They remain watchful to minimize any risk of a patient falling or acquiring an infection. They look for potential problems instead of reacting only when something goes wrong. They document thoroughly, appropriately, and in a timely fashion.
Warrior nurses practice the art of nursing. They are humbled to work with human spirits, not just bodies. They share humanity with their patients. They protect the personhood of each patient, knowing that sickness can alter one’s sense of self. They understand an open heart sometimes sees what the mind cannot. They recognize and seek to ameliorate each patient’s suffering, in body or spirit, whether silent or invisible.
Warrior nurses practice kindness, compassion, and moral courage. They hold hope for their patients in despair. They know how to identify ethical dilemmas and support patients and their families when difficult challenges arise. Sometimes they respectfully disagree with others in order to do what is right for their patients, never forgetting the patient comes first.
Warrior nurses can change medical culture now. They need not wait for corporate restructuring or a paradigm shift in how medicine is practiced. They know patients are unnecessarily dying—that each death produces ripples of heartbreak and loss throughout families and communities. Right now, warrior nurses can focus on what is best for each patient. Leaving the bruising or blindness of ego aside, they are governed by excellence, not by fear. This is what warrior nurses do.
Donna Helen Crisp, JD, MSN, RN, PMHCNS-BC, a resident of Asheville, North Carolina, USA, is a nurse ethicist and author of the memoir
Anatomy of Medical Errors: The Patient in Room 2.
James, J.T. (2013). A new, evidenced-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9
(3), 122–128. doi:10.1097/PTS.0b013e3182948a69
Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (2000). To err is human: Building a safer health system.
Washington, DC: National Academies Press.
Makary, M.A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ.
Anatomy of Medical Errors: The Patient in Room 2,
by Donna Helen Crisp
ISBN-13: 9781940446844. Published by STTI, 2016
Price: US $29.95. Soft cover, 228 pages. Trim size: 5 3/8 x 8 3/8