An investigation into the management of clinical incidents involving qualified nurses

• Main Author: Miller, James Alexander
• Published: University of Edinburgh 2005
• Subjects: 615.5
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.657789

Background: The researcher’s interest in the emerging areas of clinical governance and risk management within the National Health Service (NHS) was the genesis of this study. A growing concern about the apparent exponential rise in the number of untoward clinical incidents, the lack of studies of such incidents involving nurses and the developing interest in the apportionment of blame, were the basis of this research study examining the management of untoward clinical incidents involving qualified nurses. Conclusions: A number of conclusions were drawn from the data using these principle sources. Throughout the study the policy framework changed, reflecting the dynamic nature of this matter within the NHS. 1. There was a perception among qualified nurses that senior nurses involved in the investigation of an incident sought to blame and punish a nurse for their role within an incident as opposed to reviewing systems and processes potentially contributing to an error. 2. Nurses attributed different approaches to different ‘types’ of nurse mangers. It was evident that such punitive approaches prevented nurses from reporting incidents for fear of the reprisals. Some nurses attempted to deflect blame away from themselves and to attribute it to organisational issues whilst others accepted blame as a result of their involvement in an incident. 3. A consistent finding was nurses reported a blame-free culture was neither realistic nor desirable but described a ‘just and fair’ culture as being more appropriate. Such a culture recognising that errors are part of everyday life and should be seen within this context whilst ensuring that patients remain protected by calling nurses to account for any actions which may be regarded as negligent. 4. It was regularly reported that the lessons learned from such incidents were not disseminated either within the managerial units or across the organisation as a whole. Maintaining confidentiality in relation to the nurses involved was cited as the main reason for this lack of sharing. 5. There is little evidence that the wider literature available in respect of error management has been incorporated into policy development. The pre-determined standards in relation to this area of corporate governance, although at an embryonic stage have attracted significant criticism. 6. The determination produced from Fatal Accident Inquiries (FAIs) highlight shortcomings and within systems and processes likely to have contributed to a death. Sheriffs’ have used the determinants to redress the balance of some of the very negative and unjustified reports in the media. There is little evidence that these determinations are used as learning opportunities.