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Reasons Why You Shouldn't Stay Quiet when it comes to Patient Care

Working as a nurse speaks volumes about you in the sense that it says you care about people and want to help them.  That being said, all nurses have different personalities, and different methods of caring for their patients.  Some nurses may be very nurturing, while other nurses, although good at their job, may not display that nurturing side as often.  It does not indicate one way is wrong, or one way is necessarily better than the other, they are just different.  With physicians it's often referred to as “bedside” manner, and the same could be said true of nurses, as not everyone offers the same level of compassion to the patient.  That in itself is not a mistake, providing the patient is receiving proper care and not being treated in a disrespectful manner.

  A medical mistake should be covered extensively in your nursing trainings, as well as your medical facility orientation and ongoing trainings.  If you have any question as to whether something you observed was in fact a medical mistake, bring it to the attention of your supervisor or Human Resource department, and never let it go.  If there is the slightest question in your mind, then it needs to be addressed. 

Situations to Observe Closely

There is a very fine line when it comes to the care of patients, and as a nurse, you are expected to walk and watch that line.  It’s a balancing act so to speak, you need to show compassion and concern without conveying the message that you are overly involved with your patient.  The patient needs to see you as their nurse and care provider first, and a person that cares about them second.  Some situations with family members or your co-workers may require an intervention on your part.  In the event something seems slightly off where the patient care is involved, providing the patient is not being abused or in danger, you can be observant and pay extra attention to the area you are concerned over.

Say a patient doesn't get their bed linens changed as quickly as they should be, that requires attention, but not necessarily a write up to a supervisor.  Talk with the co-worker responsible, one time and remind them of the importance of their job.  Should the same thing occur a second time, then it should be brought to the attention of a supervisor.  Should you ever observe a co-worker, or anyone in your medical facility mistreat the patient, verbally, physically, or mentally, it should be reported instantly, it is your job to do so.  Many states designate nurses as mandated reporters, but regardless if your state requires that, it is the right, and only thing to do. 

Family of patients

When it comes to family members, it's not uncommon to see a multitude of interactions.  Many family members may do too much for your patient, and prevent the patient from doing what they can to care for themselves.  That is not good for the patient, but it's not a form of abuse or mistreatment either.  Family members that are caring for a loved one may be full of a wide range of emotions.  Guilt, anger, sadness, and grief are common emotions when a loved one is very ill and needs constant care.  The family may be emotionally drained, and physically exhausted, which at some point could take its toll on them.  Suppose you went to work one day to care for your patient, and as you walk up you the first thing you observe is the family member being rough with the patient or actually hitting them.  Do you understand that the caregiver is tiring?  Of course you do.  Do you step in and report their actions?  Absolutely, it’s not your job to determine if that person had a one time lapse in judgment; it is your job to put the patient's best interest first, regardless of anything else. 

Co-workers

As you work to develop a good rapport with your co-workers, as you should, it's important to be a team player.  Everything seems to be great in your department, you are friends with co-workers and you could not ask for a more pleasant work environment.  Then one day something happens that you observe.  A coworker is mistreating a patient.  This could put you in a very bad predicament, of course you hate to report your coworker, but it is what you absolutely have to do.  Think of the repercussions if you did not.  Suppose the coworker explains it was a one time lapse in judgment, it will never happen again, and they are extremely sorry.  So just this one time, you look the other way.  3 days later you learn this patient has passed away, and there are some unanswered questions about their passing.  Aside from the fact that it is morally right, and your responsibility as a nurse to report inappropriate care of a patient, the legal repercussions could end your career as well.  The hospital could face a lawsuit; the list goes on and on.  Of course that would be a worse case scenario, but you get the point. 


As a nurse you are going to have bad days with the good.  You are going to get tired, stressed, and just be in a bad mood.  Take a break if you need to, talk to someone about your problems, however, and don’t take it out on the patient.  The patient looks to you as the nurse for care, compassion, and potentially a cure for their ailment.  They are most likely going to take it personally if you take your bad mood out on them.  Try to stick to the rule of leaving your bad mood at the door of the patient's room, don’t let them see it.    In the event that you are aware of a medical mistake, make sure it is reported to the appropriate people only.  Do not discuss it with the patient's family or even the patient themselves.  The person you report it to will assign the appropriate personnel to approach the patient and their family.  There are strict rules and guidelines in cases such as this, so it's very important that you follow the protocol. 

Superiors and Supervisors

You look to your supervisor for direction, support, instructions, and a general turn to person when you need something at work.  In the unlikely event that you noticed your supervisor taking short cuts, or ignoring the medical needs of the patients, it then becomes your responsibility to report this situation to either a higher authority, or your Human Resource department.  The best thing you can do is to transfer this “problem” over to a higher authority. 

Repercussions of Not Speaking Up

There are a number of consequences that can occur when a nurse observes an incident that needs to be reported, and opts not to do so.  Loss of life would obviously be number one, with lawsuits and loss of licenses to follow.  There are many jobs a nurse is responsible for, and reporting a mistake or inappropriate action with a patient is also your job and should be taken seriously. 
It can be an extremely difficult situation when you are faced with speaking up regarding a medical error that occurred with a patient.  No one wants to be viewed as a “tattle tale” per say, however a patient and a medical error do not fall into that category, and it is an obligation of anyone that observes a medical mistake to report it.  Most nurses love their jobs, and the good they provide to their patients.  You anticipate years of devoted nursing service, however, one incident of not reporting an incident could cost you your nursing license and end your career.  

The above discussion basically pertains to the nurse and care providers.  What can happen as a result of their actions, or lack thereof?  Now it's time to consider an incident from the patient's perspective.  A sick patient lying in a bed, assuming any and all medical care that they are receiving is appropriate.  In the event of that not being the case, the patient could suffer physically and mentally as well.  It would not take much for a patient to lose confidence in their health care team, which could result in lack of care for the patient.  The patients put their trust in doctors and nurses, and it is vital that their trust be taken seriously, they count on it.  A patient may not even know a mistake was made in their care, so it is up to the staff working with them to speak for them. 
It is assumed that if you work in the medical profession in any capacity, you care about your patients.  A mistake can happen regardless of what profession you are in, the difference is, a medical mistake can prove fatal or very serious for the patient.  Consider the patient, consider the law, consider the consequences of not reporting and incident, and consider your license and career. 


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