Regarding your opinion of March 4, 2019, on the Tennessee nurse indictment, as a nurse and patient safety professional, I have a few points for your consideration. 

While the nursing profession has standards of care and healthcare institutions have protocols in place, there is a lack of strict adherence to these standards and protocols in nursing practice. Nurses have huge workloads and do workarounds in an effort to get everything done. While it may not be what is taught, it is what happens. Most of the time these workarounds do not result in a bad outcome for the patient.

Hospitals and healthcare organizations themselves often fail to hold nurses and other health professionals accountable for following the many protocols and procedures.

After an adverse event in a healthcare setting, three questions should be asked: 1) What happened? 2) What normally happens? and 3) What is supposed to happen? 

As you pointed out in your article, this nurse did a workaround on the medicine dispensing machine, as nurses frequently do. This is not the proper standard of care and fails to meet the requirements of the protocol.

You indicate health professionals need to be held to a higher standard. 

One of the problems with the standards and protocols is the system health professionals work in does not hold them accountable. Should the chief nursing officer from Vanderbilt instead be on trial for failing to hold the nurses accountable? 

Nurses make medication errors in their careers without a poor outcome. You advocate punishment for the adverse outcome, but you are ignoring the healthcare organization’s failure to enforce the standards and protocols. The culture in hospitals, as in many healthcare organizations, is a huge part of the problem. 

I would submit to you that criminalization of bad outcomes is a grave mistake. Consider that the next time you are facing a publication deadline. With too much to do in the short time available, will you cut any corners? 

Just my thoughts. 

Faye Sheppard, Registered Nurse

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