Do Nursing Mistakes Make or Break a Nurse? Dr. Marie Prothero’s Research on Medical Errors
Picture this: you’re a brand-new nurse and are transferred mid-shift to the ICU, a location you have not been oriented to. While you are assured that another nurse will be working with you, you are left alone with a patient. Suddenly, another critical patient is assigned into your care because you are the only available nurse. You now struggle to manage both patients’ urgent needs and treatments and are unaware that the new patient should be treated with the Sepsis protocol. The new patient ultimately passes away on your watch.
Scenarios like this happen from time to time in the medical industry and results in what is called a “medical error.” Medical errors happen in a myriad of ways, and in some instances, nurses don’t receive the support they need to improve or cope with the guilt they may feel about their mistake.
Dr. Marie Prothero of BYU College of Nursing researches what causes these errors, how nurses react to them, and what methods of teaching nursing students to proactively avoid them work best.
To conduct this research, Dr. Prothero and her students surveyed and nurse leaders across the country using a tool called the Medical Error Attitude Scale (MEAS) that scores on medical error perception, approach and cause.
Beyond the attitude test and quantitative questions, she and her team asked open-ended questions to collect how nurse leaders support nurses following an error.
In a more recent study, they surveyed and interviewed hospital administrators and CEOs to uncover why caregivers lack support when mistakes happen.
As they analyzed and coded responses, they found that only about 60% of hospitals had some form of formalized caregiver support to help nurses and other providers when they had made a mistake.
The problem stems more from the system than any individual nurse. Hospitals either had a robust caregiver support system, or they didn’t have one at all.
There are several reasons behind this. Sometimes rural hospitals are facing budget issues, so they aren’t able to offer as much aid to their nurses. Others just didn’t feel that errors happened frequently enough to start a system.
It seemed from the results that there is a disconnect for error-management from in-hospital systems. Nurses don’t always receive the support they need to cope, or the training needed to improve so the mistake doesn’t happen again.
“I think we really need to give nurses the confidence to set limitations and say what they will and won't do,” said Dr. Prothero. “Many times, nurses find themselves in situations where they haven't been properly trained on something, and we say 'yes' because we are caregivers. We have empathy, and we want to help our team. We say 'yes' when we should say 'no'. We may also be fearful to ask for help...because we don’t want to appear incompetent...[M]istakes are made when all these circumstances convolute together.”
So, how do you change this system? One approach already implemented by BYU College of Nursing is the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program. The goal of the training tool is to increase communication between nurses, physicians, and other caregivers to improve care of the patient.
“When [nurses] are in a difficult situation or feel they need to speak up, it helps them do that in a confident, efficient, graceful way that helps keep good relationships and build good relationships,” said Ella McKee, one of the students who worked on the research. “Having practiced TeamSTEPPS in simulation really helps you just click into gear really fast, because you've already practiced it over and over again.”
To gauge the effectiveness of this training, Dr. Prothero and her team surveyed and interviewed BYU nursing alumni exploring how TeamSTEPPS help them with patient safety, error prevention and communication. She asked BYU College of Nursing alumni questions to see if the tools they were taught in the classroom or clinicals were useful.
The response was overwhelmingly positive. “The [alumni nurses] felt more confident to be able to communicate with not only their patients, but with the healthcare team and with other nurses,” Dr. Prothero said. “They could name the tools that they learned in the nursing program and those things that they are still using today in their clinical practice. That was super encouraging.”
From their studies they were able to identify three ways that the TeamSTEPPS program improved communication: the nurses' internal confidence or self-talk, the nurses' communication with their patients, and the nurses' communication with their team. Patient safety improved and team synergy also improved because of the training and simulations.
Emily Lewis, another student who studied TeamSTEPPS, shared that “this research has deepened my understanding of the critical role communication tools like TeamSTEPPS play in enhancing patient safety and supporting new nurses as they transition to clinical practice. The concepts we learn throughout the nursing program are incredibly applicable, and they will help us become better nurses and members of the healthcare team.”
This research was presented at a research conference for nursing educators in New Orleans. Dr. Prothero, Ella, Emily, and other students synthesized the research into a clear presentation and are also publishing a paper on their results.
In the future, Dr. Prothero hopes to continue to evaluate the effectiveness of error prevention tools and hopes to more fully document what kind of errors are occurring in the hospital setting.
Spiritual Connections for This Research
Dr. Prothero sees this research as inspired. She started these studies back during her PhD program when she felt the Spirit nudge her to leave her job as hospital CEO to instead work as the Vice President of Quality and Patient Safety at St. Mark’s Hospital in Salt Lake City. While a difficult transition, she ultimately found that the decision was an act of God. She loved the work she did, and the initial research during her PhD studies enabled her to become a full-time faculty member at BYU.
“The work that I'm doing right now is so important in today's time where we're so focused on how we reduce harm to our patients and how we help our nurses be safer clinicians,” said Dr. Prothero. “If I didn't have that job in patient safety and quality, I wouldn't be doing what I'm doing today.”
Through a gospel perspective, she feels that the Atonement of Jesus Christ helps when coping with the guilt that comes from mistakes. She also finds it is crucial for nurses to accept responsibility, so they can learn how to avoid the same mistake going forward.
“In healthcare, we've been taught that if we follow all the rules and procedures, then we won't make mistakes. That's not true,” mused Dr. Prothero. “We are human, and humans make mistakes. We're not robots. If we follow all the procedures and safety protocols that are put in place, will it reduce the number of mistakes that are made? Absolutely, but it won't ever eliminate them.”
From this research, Dr. Prothero has found that nurses need more support to make a positive difference in the lives of their patients, especially after mistakes happen. Read more from the full studies here and here.