A new study shows nurses are held accountable for most medical errors, even though physicians rarely consider them part of the decision-making team.
Two members of the University of Montana team that conducted the study said that disparity could help explain the high turnover among nurses.
The study, published in the June issue of the American Journal of Nursing, surveyed nurses, physicians, pharmacists and administrators at 29 small, rural hospitals in nine Western states over a three-year period.
All were asked what kinds of errors are reported in their hospitals, along with monthly case studies asking respondents to identify errors and describe better ways to handle them.
According to the study, 90 percent of physicians, administrators and pharmacists and 96 percent of nurses place primary responsibility for patient safety on nurses, even though only 8 percent of physicians identify nurses as part of the decision-making team.
Diana Mason, editor of the AJN, said she found those statistics appalling. She said she believes circumstances may be even more extreme in urban hospitals because often nurses in rural hospitals have more authority -- because there may be fewer physicians --than their urban counterparts.
"The authors are making this leap on this study that it affects nursing recruitment and retention," Mason said. "And I understand why. It's because of nurses these days looking for the respect that should be afforded to them as a key member of medical teams. If you didn't need nursing care you wouldn't be treated in the hospital, you would be treated as an outpatient."
Ann Freeman Cook and Helena Hoas, psychology professors at the University of Montana and members of the study research team, said they would like to see physicians, pharmacists, administrators and nurses equally share the responsibility for patient safety. But that's no simple task, Cook said.
Chandra Snyder, director of nursing at the Helena, Mont., Veterans Affairs hospital, agreed.
Doctors are often resistant to giving up "the wheel of the ship," Snyder said. "They pretty much want the control."
Mistakes typically thought of as related to nursing, like giving the patient too much medication, are more likely to be reported as "errors," the study said. However, a doctor's misdiagnosis, for example, is more likely to be considered a difference in "clinical judgment," rather than an error.
"People have learned to be able to identify and recognize medication-related errors and they attribute them to errors that occur in nursing care," Cook said. "They tend not to look deeply into what is jeopardizing patient safety and what will increase patient safety. They tend to look at what they expect to see."
Claudia Clifford, executive director of the Montana Nurses Association, said the study rang true for her.
"Nurses really do feel responsible for patient safety," Clifford said.
Forty percent of nurses report job dissatisfaction, according to a report cited in the study, and two in 10 nurses in the United States plan to leave their jobs within the next year. The authors of the report said that while they set out to explore medical errors, they found that errors may be linked to nurse job satisfaction.
"If our perception is that responsibility for patient safety belongs to nurses and that most errors are created by nurses, it certainly does not put the profession in a positive light," Hoas said. "Beyond that, the real problem here is that by our selective looking, we may fail entirely to understand what it is going to take to increase patient safety, and that has an implication for all health care providers."
