Thursday, February 23, 2012


There's a good article by Kevin B. O'Reilly of about the fear of being punished leading to a continuation of underreporting of medical errors in hospitals.

Numerous studies have shown that when people are afraid of getting in trouble the will not tell on themselves or friends.  This leads to mistakes being repeated because often it is a system problem that could be improved.

For more than a decade, patient safety leaders have pushed for this culture to change but little progress has been seen.This article and other reports show that "most physicians, nurses, pharmacists and other health professionals working in hospitals believe their organizations are still more interested in punishing missteps and enforcing hierarchy than in encouraging open communication and using adverse-event reports to learn what's gone wrong."

Underreporting errors is bad for patient safety, and the underlying problem, fear of retribution, causes a multitude of other problems in hospitals and all businesses.

Say you have what you think is a good idea of a new way to do your job.  You go to the BOSS and share it.  What if the BOSS is put off by your suggestion?  Maybe he or she thinks you're trying to move up in the organization and feels threatened that you could replace them.  Maybe they go to their boss (the BIG BOSS) and tell them you are being disruptive or a problem.  The BIG BOSS tells them to do what they think is best.
And you're fired!

Your friends at this workplace hear the story and no one ever goes to the BOSS with improvement ideas again.  Every time the BIG BOSS visits and asks people how things are they all smile and say "great", but things aren't great and they never will be becasue of the culture of fear of retribution.

If you've never seen this happen then you and I have never worked in the same place.

This is a big problem in coporate America today.  It is a HUGE problem when patient's lives are at stake.

I cannot be a good nurse if I am afraid to advocate for my patients.

A part of every union contract is this line:
"No employee shall be disciplined or discharged without just cause"

For a nurse it means having the ability to speak up and to advocate for my patients without fear of retribution.

It is important for any worker, it is vital for a nurse.  Without this line in a contract a worker is an "at will" employee, able to be discharged for any reason the BOSS sees fit.  With it, the burden of proof is on the BOSS to show that there is a legitamite reason for any discipline or discharge, and the union retains the right to grieve any discipline, to defend the employee.

When patient's lives are at stake, this one line in a contract is the most important line, more important than any benifits, econonomics, or other issues.

Alone, it is reason enough for organizing, reason enough for all this hard work by so many people, reason enough to have endured the threats against our livelyhood when we stood up, stood together, and stood tall.

"Just cause" is the foundation upon which a union is built, patient's are kept safe, hospitals become better.  Maybe someday it will be law, available to all workers. 


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