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Nurses know that communicating errors is important. However a study conducted by Suzanne Brungs, RN, MSN, MBA recently published in the Journal of Patient Safety explains that nurses provide several reasons as to why they fail to report medical errors. Time for actually filling out error reports, not thinking the error warrants a report, or lack of knowledge regarding what happens to error reports once they are made are all indicated as barriers to error reporting.


Brungs, coauthor of the study and healthcare system specialist with the VA system of Ohio, conducted 8 focus groups with 33 participants from intensive care units from 4 different hospitals along with random surveys of 92 nurses from these same units. The emphasis of the focus groups and surveys was on error decision-making. Members of the focus groups felt that error reports fall "into a black hole". They noted that patient harm was a factor when they decided whether or not to report an error. They also reported time to simply write the report became a factor in error reporting. The nurses also felt that error reporting was simply not meaningful.


Interestingly, nurses responding to the random surveys reported a more socially desirable response saying that they almost always filled out error reports and received feedback regarding these reports. However, 22% of these nurses had not filled out an error report in the last year in spite of the fact that ICU errors have been reported to occur as often as one error per patient per day.


Brungs notes one over-riding concern is that "there is a stigma" when nurses file error reports. Nurses attribute errors to failure of skill, motivation, or knowledge as well as blaming themselves or another person.


Brian Lokar, RN (a staff nurse in the emergency department at the University of California, San Diego Medical Center-Hillcrest and an adjunct clinical instructor at Southwestern College) emphasized that nurses are concerned that job loss might occur if they report errors. Lokar also said that camaraderie and trust of health care team members help to determine whether or not a nurse reports an error.


Additionally, researchers note that nurses often "play a game" when confronted with a physicians error to try to get the physician to note his/her own error. This strategy creates a power distance or an authority gradient and has been shown to contribute to medical errors resulting in harm.


Lillee Smith Gelinas, RN, BSN, MSN, FAAN (vice president and chief nursing officer at VHA Inc.) recommends that hospitals create a "Just Culture" where in people are not punished for honest errors, are held accountable for reckless behaviors, and allowed to learn from reported mistakes. Gelinas notes that nurses speak up more in cultures where these actions are interpreted as patient advocacy.


When dealing with errors made by nursing students, we need to incorporate these same guidelines and consequences. Nursing students socialized into the nursing role in a "Just Culture" will hopefully carry these values into their work environments.


Source: Wood, D. Nurses hesitate to report errors. NurseZone.Com: Nursing News. Available at Accessed March 27, 2009.