Client Safety as a Public Health Issue in Nursing

Medical errors have always been the plague of medicine. They cause unintended damage, loss of time, medicine, health, and even can cost patients their lives. In addition to that, medical errors severely undermine the credibility of modern medical methods and reduce the patients’ faith in their doctors. According to Huffington Post, medical errors have always been the third leading cause of death in the USA, causing over 251,000 fatalities (Presant, 2016). This data is backed up by medical studies and statistics done by the BMJ (Makary & Daniel, 2016). To address the issue, the international medical community is always looking for ways to improve itself and reduce the number of medical errors, thus promoting health and saving patients’ lives. Nurses play a paramount role in this effort. Due to being present in virtually every field of medicine in large numbers, they have a unique perspective on the nature of medical errors and a hands-on approach to solving medical problems. The purpose of this paper is to investigate possible solutions to medical errors on an individual level, health system level, and community level.

Counteracting Medical Errors on an Individual Level

There are several types of errors that occur on an individual level. These are errors of planning, errors of execution, and deviations from the process that may or may not harm the patient (Garrouste-Orgeas, Philippart, Max, & Misset, 2012). While reasons for such are numerous, ranging from lack of experience, incomplete education, human error, and others, one of the most prominent factors that contribute to these errors is human exhaustion. This is a particularly frequent situation among nurses. Although the laws have established an 8-hour working week, most medical professions are far from that notion. Nurses tend to work 3 days a week, doing 12-hour shifts (Stimpfel, Sloane, & Aiken, 2012). In theory, this system was supposed to bring balance to the work-life schedule. In reality, it did the exact opposite – due to the emergency situations and patient demands, many nurses are forced to work overtime, spending far more than 12 hours per day doing their shift. As a result, mounting exhaustion causes burnout, apathy, and human error due to lack of sleep (Stimpfel et al., 2012). The press is filled with stories of nurses falling asleep on the job or at the wheel, which inevitably leads to disasters.

There are several things that nurses could do to avoid these issues. Assuming that the situation will not change in the next few years due to how long legislative and reformative efforts usually take, it will be upon nurses to protect their patients on an individual level. The most important behavior to learn in this situation is constant vigilance of oneself and of others. Since shifts often take longer than they are supposed to, nurses are expected to evaluate their own physical and mental states constantly. If they feel they are about to pass out, it is their duty to approach their superiors and inform them of their condition. This is especially true for nurses working in emergency wards and post-operational care.

Other than watching themselves, nurses must also watch each other. Self-diagnosis is a complicated thing, and often, nurses misjudge the extent of their own fatigue. Thus, it is necessary to watch each other, and in case one or several nurses seem to be sluggish and slow in response to external stimuli, it is the nurse’s duty to report to their superiors and request the fatigued nurse to be relieved of duty. These measures would reduce the number of medical errors committed as the result of exhaustion and fatigue. The hospitals would be forced to adapt to these measures, as no schedule is more important than the well-being of the patients.

Counteracting Medical Errors on a Hospital Level

As it stands, hospitals take a reflective approach to dealing with medical errors. Most healthcare institutions state that more control over what nurses and doctors are doing, and believe that additional training would reduce the number of errors committed by the hospital staff. The most common recipes to dealing with nurse burnout are stated to be emotional support, effective leadership, and balanced work-home schedules. While these measures are all legitimate, they do

Changing the schedules, practices, and habits of leadership on a hospital-level is a task that no single nurse can undertake on his or her own. However, as a collective, nurses have the opportunity to change and alter practices by promoting viable alternatives to healthcare managers and senior hospital staff. In lieu of the burnout and exhaustion problem mentioned in the previous section, nurses could and should promote better schedules and fight the necessity to work overtime on a regular basis.

To do so, nurses must band together and come up with a proposal to alter the existing practices and schedules to accommodate both the patients and the nurses better and prevent extensive exhaustion that could affect the quality of care and lead to medical errors. One such proposal that could solve the situation could be the return from two 12-hour shifts to three 8-hour shifts. While this strategy may be considered costly from a short-term perspective, it might save money long-term, as not only it will reduce the number of medical errors and save lives, but would also reduce the number of nurses leaving their jobs due to burnout and save money that would be spent on hiring new nurses and getting them involved in the standard nursing schedule. As it stands, the turnover rate among nurses is at circa 25%, which is enormous and leads to significant financial losses (Duffield, Roche, Homer, Buchan, & Dimitrelis, 2014).

Community Actions to Counteract Medical Errors

On a community level, there are several groups of stakeholders that can contribute to improving patient safety. These stakeholders are legislative agents, healthcare agents, and patients themselves. The groups are not set in stone, as any individual could at some point belong to all three of them at the same time. Legislative agents involve local politicians and political activists that can promote certain laws in order to improve patient care and patient safety. Nurses can be part of this group if they join a nursing union or any other organization that represents them on a political level. Through legislative efforts, it is possible to introduce healthy practices and dispose of those that directly or indirectly endanger the patients (Dube, Kaplan, & Thompson, 2014).

As healthcare agents, nurses can promote healthy practices and customer safety through education and example. They can work with other nurses and teach them to avoid the common pitfalls that could lead to medical errors and endanger the patient. In addition to that, nurses can educate the patients about the state of affairs in the medical industry, and encourage them to get involved in their own healthcare. Patients are, by far, the most interested stakeholders out of all three groups, as it is their health that is on the line.


Dube, A., Kaplan, E., & Thompson, O. (2014). Nurse unions and patient outcomes. IZA, 8259, 1-33.

Duffield, C.M., Roche, M.A., Homer, C., Buchan, J., & Dimitrelis, S. (2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 70(12), 2703-2712.

Garrouste-Orgeas, M., Philippart, C.B., Max, A., & Misset, B. (2012). Overview of  medical errors and adverse events. Annals of Intensive Care, 2(2), 1-9.

Makary, M.A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. BMJ, 353(2139), 15-23.

Presant, C.A. (2016). Medical errors are the third leading cause of death — how you can avoid them. Web.

Stimpfel, A.W., Sloane, D.M., & Aiken, L.H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509.

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