In 1999, the Institute of Medicine released a report called To Err is Human. This report estimated that 44,000 to 98,000 hospitalized patients die each year as a result of preventable medical errors. But how do medical errors affect healthcare workers?
A recent article by Van Gerven and colleagues, published ahead of print in Medical Care, addresses that question in the title:
Increased Risk of Burnout for Physicians and Nurses Involved in a Patient Safety Incident.
Van Gerven and colleagues, a team of Belgian researchers, physicians, and nurses, discuss how nurse and physician involvement in a patient safety incident makes them the “second victims” and can potentially lead to several different types of negative consequences.
Following the International Classification for Patient Safety, the authors defined a patient safety incident (PSI) as an event or circumstance that could have resulted, or did result, in unnecessary harm to a patient – for example, falls, medication errors, wrong-site surgeries, and healthcare-acquired infections. They categorized harm as no harm, temporary harm, permanent harm, or death.
The article describes a convenience sample of 5,788 Belgian healthcare workers (79% nurses and 21% physicians) surveyed over a two-month period in 2012, with the majority of respondents employed in an acute-care hospital. Of those surveyed, 9% were involved in a PSI within the past 6 months. The authors found that PSI involvement was associated with greater work-home interference, higher risk of burnout, increased turnover intention, increased likelihood of problematic medication use, and excessive alcohol consumption (specifically for nurses).
The incident occurred several years ago, and I still remember everything.
While working as a nurse, as much as my colleagues and I tried to prevent and avoid PSIs, they did occasionally happen. In fact, during my first six months as a nurse, I was involved in an error that resulted in unnecessary harm to the patient. It certainly wasn’t intentional, but it just so happened that everything aligned perfectly to create a terrible outcome. As a nurse, and especially as a new nurse, this was devastating.
The incident occurred several years ago, and I still remember everything. I remember the patient, their diagnosis, the patient’s family, the time it happened, and even which hospital room the patient was located. The research shows that involvement in a PSI may also result in loss of appetite, insomnia, depression, and self-blame. Personally, I can relate to all of these findings.
Afterwards, I remember vividly how much my work and home life suffered. When at home, I didn’t eat or sleep for days because I constantly went over the incident in my head. What could I have done differently? How could I have changed what happen? I blamed myself for the outcome, and felt like a failure at my profession. I suddenly became terrified to do my job — terrified that a similar incident might happen again. Despite four years of schooling leading up to becoming a nurse, I was only six months in and I already wanted to quit.
I’m unable to speak to how PSIs may affect physicians, but as a nurse, I internalized my errors and felt as though they only reflected my shortcomings and signified my inability to care for patients effectively. Mistakes happen in healthcare for a variety of reasons, and despite the fact that many nurses and physicians may blame themselves, the occurrence of every error shouldn’t solely be placed on their shoulders. This is just too big of a burden to take on.
Van Gerven and colleagues conclude their article by asserting that an organizational response is needed to reduce the effects of PSIs on physicians and nurses. To be honest, until reading this article I had never even considered the option of an organization offering support or counseling for healthcare staff involved in a PSI. The idea was certainly never mentioned during nursing school, and as a practicing nurse, I was always told to just “move past it” or “don’t dwell on it”, but that’s much easier said than done. After the PSI in which I was involved, none of my supervisors or co-workers followed up afterwards to see how I was coping with what happened.
I understand and fully agree that in an emergency, the patient is always the number-one priority. However, when the dust finally settles, healthcare organizations and the medical profession as a whole have to consider the mental health of healthcare employees and how what they experience at work affects their daily lives. Organizations that don’t respond, or respond ineffectively, are potentially placing future patients at risk from staff burnout and turnover and/or error-prone processes that are never fixed.