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Nursing a Crisis

By Jock Hoffman, CRICO

Related to: Claims, Nursing, Teamwork Training


From 1998–2007, CRICO closed 339 malpractice cases involving nurses (or the nursing service) and paid plaintiffs more than $71 million. CRICO cases opened from 1998–2007 name 373 individual nurses as defendants and represent $173 million in potential losses. While physicians bear the brunt of malpractice allegations, the days of patients being reluctant to sue their nurses are gone.

And so are many of the nurses.

By some accounts, the 10-year-old nursing shortage will continue for at least 25 more years. One consequence of the struggle to hire, train, and retain competent nurses for direct patient care is that organizations may hesitate to assign them to quality improvement projects and patient safety initiatives that take them away from the bedside. However, when nursing is underrepresented in the patient safety arena, those efforts will likely fall short of expectations.

Nurses who achieve leadership positions are likewise frustrated by the fact that they are charged with implementing patient safety initiatives—such as eliminating never events— but not always adequately supported with staffing and funding. When nursing leaders find themselves in a lose-lose proposition, many begin to burnout.

Nurses who seek to advance themselves within patient care now have an expanding realm of advance practice nursing opportunities. But, as these specialist (e.g., nurse practitioners, nurse midwives, nurse anesthetists) seek and achieve increased authority, they often collide with opposition from physician organizations. With the emergence of the “doctor-nurse” degrees now being offered, those conflicts are likely to continue.

Our Recommendation

As the once sharp delineation of roles and responsibilities continues to blur—both on the front lines and in the corner offices—nurses and physicians will need to master the art of collaboration and teamwork. Institutions in which nursing has prominent role in planning and designing—not just implementing—key patient safety initiatives are more likely to see those initiatives succeed. Shared training and quality improvement project work help refine collaboration skills and systems. Empathy and support from colleagues “across the aisle” can help both physicians and nurses rediscover the upside of their careers. Caregivers with a more positive mindset and the ability to focus on their clinical duties are a foundation for safe and effective health care.

May 1, 2008
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