Why nurses are raging and quitting after the RaDonda Vaught verdict

B. Kelman & H. Norman

www.npr.org

Originally published 5 APR 22

Emma Moore felt cornered. At a community health clinic in Portland, Ore., the 29-year-old nurse practitioner said she felt overwhelmed and undertrained. Coronavirus patients flooded the clinic for two years, and Moore struggled to keep up.

Then the stakes became clear. On March 25, about 2,400 miles away in a Tennessee courtroom, former nurse RaDonda Vaught was convicted of two felonies and now faces eight years in prison for a fatal medication mistake.

Like many nurses, Moore wondered if that could be her. She'd made medication errors before, although none so grievous. But what about the next one? In the pressure cooker of pandemic-era health care, another mistake felt inevitable.

Four days after Vaught's verdict, Moore quit. She said the verdict contributed to her decision.

"It's not worth the possibility or the likelihood that this will happen," Moore said, "if I'm in a situation where I'm set up to fail." In the wake of Vaught's trial ― an extremely rare case of a health care worker being criminally prosecuted for a medical error ― nurses and nursing organizations have condemned the verdict through tens of thousands of social media posts, shares, comments and videos. They warn that the fallout will ripple through their profession, demoralizing and depleting the ranks of nurses already stretched thin by the pandemic. Ultimately, they say, it will worsen health care for all.

Statements from the American Nurses Association, the American Association of Critical-Care Nurses, and the National Medical Association each said Vaught's conviction set a "dangerous precedent." Linda Aiken, a nursing and sociology professor at the University of Pennsylvania, said that although Vaught's case is an "outlier," it will make nurses less forthcoming about mistakes.

"One thing that everybody agrees on is it's going to have a dampening effect on the reporting of errors or near misses, which then has a detrimental effect on safety," Aiken said. "The only way you can really learn about errors in these complicated systems is to have people say, 'Oh, I almost gave the wrong drug because ...'"

"Well, nobody is going to say that now."

The info is here.

The Moral Injury of COVID: How Will Nurses Survive?

Diane M. Goodman

MedScape.com

Originally posted 11 FEB 22

Here are some excerpts:

According to recent statistics, 1 in 5 nurses have retired from active duty since the pandemic began. Far from feeling like heroes, nurses now feel exhausted, demoralized, underappreciated, and severely overworked. They are broken in ways that cannot be repaired.

Recently, an intensive care unit nurse abandoned his shift in the middle of the night and walked off into the unknown only to be found deceased 2 days later. What happened to this caregiver? Was his distress so severe he could not communicate pain? One can only wonder.

Nurses across the country are suffering from moral injury.

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This is what nurses feel prepared to do, but it violates their moral code.

Nurses may be unfamiliar with the process of rationing care, but the pandemic has changed that perspective. Nurses are now dealing with a form of rationing that leaves them miserable, in tears, and in persistent distress.

Providing care for 10 patients as opposed to a maximum of five forces nurses to make appalling decisions. Which patient needs my attention now? Will another patient die while I am in this room? How can I choose without suffering lasting trauma from my decisions?

Nurses have repeatedly been placed in impossible situations throughout the pandemic.

Remember the early days of PPE shortages? Nurses went without appropriate attire to protect their peers, at times with fatal results. 

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The profession prides itself on delivering the highest quality care it can. But when was the last time nurses felt that they were meeting this standard? How can they? They are working in a system where their own needs are minimized to meet the demands of an ongoing COVID patient population.

Moral injury, which can lead to moral trauma if unresolved, is different from burnout. 

Moral injury affects our sense of right and wrong. Moral injury is different because it represents a situation of witnessing care or offering care that conflicts with our internal compass. It is witnessing patients die without loved ones, repeatedly, or instituting a crisis standard of care that feels endless, although no earthquake, tornado, or bus accident has occurred. It is a feeling of running behind without the possibility of ever getting a break.

Moral injury is lasting distress that leads to feelings such as guilt, anger, and shame. There are true psychological implications for this type of angst. 

The info is here.

Nurses Continue to Rate Highest in Honesty, Ethics

RJ Reinhart
news.gallup.com
Originally posted 6 Jan 20

For the 18th year in a row, Americans rate the honesty and ethics of nurses highest among a list of professions that Gallup asks U.S. adults to assess annually. Currently, 85% of Americans say nurses' honesty and ethical standards are "very high" or "high," essentially unchanged from the 84% who said the same in 2018. Alternatively, Americans hold car salespeople in the lowest esteem, with 9% saying individuals in this field have high levels of ethics and honesty, similar to the 8% who said the same in 2018.

Nurses are consistently rated higher in honesty and ethics than all other professions that Gallup asks about, by a wide margin. Medical professions in general rate highly in Americans' assessments of honesty and ethics, with at least six in 10 U.S. adults saying medical doctors, pharmacists and dentists have high levels of these virtues. The only nonmedical profession that Americans now hold in a similar level of esteem is engineers, with 66% saying individuals in this field have high levels of honesty and ethics.

Americans' high regard for healthcare professionals contrasts sharply with their assessments of stockbrokers, advertising professionals, insurance salespeople, senators, members of Congress and car salespeople -- all of which garner less than 20% of U.S. adults saying they have high levels of honesty and ethics.

The public's low levels of belief in the honesty and ethical standards of senators and members of Congress may be a contributing factor in poor job approval ratings for the legislature. No more than 30% of Americans have approved of Congress in the past 10 years.

The info is here.