Written by Samantha Wall, LCSW
Edited by Joe DeNoon
*Trigger Warning: Death of patients is brought up in this blog.
Making mistakes—as humans we all make mistakes, but when nurses go to work, mistakes can mean life or death. With how much goes on in a hospital and how many people are there to take care of patients, there is so much room for error. Since nurses are the ‘last line of defense’, many times a mistake is put on nurses, no matter what part of the process the error was made in. When we work in an environment where a second can mean life or death, many of the procedures that have been put in place to check for mistakes are not able to be checked off the list. It just happens… With a culture that shames us for making a mistake on all ends, from our bosses, coworkers, patients, and their families/friends, there is a justifiably huge fear of making a mistake.
In addition to working long shifts, where things blend together, it can be so easy to forget one step in the processes you all follow. The scare tactics teachers, supervisors, and educators use when they teach you about mistakes are damaging to people who already struggle with anxiety. Wanting to help, not harm, people is a big reason to get into nursing. When we are told not to do something, like “Don’t talk”, we have to imagine talking, so the likelihood of us talking actually goes up, especially when we are young. Once we are older, we are able to filter out the want to talk, but we still have to imagine talking. So, in the way that we teach nurses to not make mistakes, you have to imagine making a mistake. I understand why they teach you what can go wrong, because they don’t want it to happen, but it is not the best way to learn. That is also why you all learn about the procedures put in place not only to keep the patient safe, but yourself and your career as well.
There are many ways we can cope with mistakes, that include positive self-talk, self-care (before a shift and after a mistake), as well as increasing separation from self and work. These are all amazing coping skills, which I will discuss later in the blog. While all of these can be used to help us regulate, the bigger discussion I want to have is a shift in the culture of mistakes at work. When you hear others talking about a mistake that is made, shift the conversation to a supportive, inclusive conversation versus judging language about the nurse who made a mistake. An example is when you hear about a nurse that made a mistake saying something like, “It must be hard for them to have made a mistake like that, I know I always think about mistakes I make.” In this statement we are redirecting the conversation as well as acknowledging how difficult it is to cope with making a mistake.
In addition to shifting the conversation in the moment, we can also grow to focus on the system versus the individual. I assume that, many times, it is not just the mistake of a nurse that occurred. With the amount of systems in a hospital setting and the amount of people working with just one patient, that system many times does not work smoothly. An example of this is directing the discussion to the system. “What part of the system affected this mistake? What can we do to increase the effectiveness of the system to decrease the chance of a mistake like this?” This type of conversation is also not one that nurses need to facilitate alone, this is a larger hospital system conversation where all the systems can work together.
Ways that we can try to cope more individually with mistakes include challenging negative thoughts, increasing positive self-talk, and increasing self-care overall. Challenging negative thoughts can look like: you made a mistake, you feel anxious about the mistake, your thoughts are focused on the mistake, and then, because of your thoughts and feelings, it is hard to concentrate on your next task. We can shift that thought pattern, and this can help shift our feelings with practice. When you start to notice the overthinking starting, pausing and challenging the thoughts with either ability talk, effort talk, or self-talk.
- Ability-talk: “I am good at my job”
- Effort-talk: “I am doing my best”
- Self-talk: “I always do my best at every moment”
By starting to shift our thinking and our thoughts, it begins to ‘rewire’ our brain, which helps us shift the way we think and react to mistakes we make on the job. It is so important that we believe what we are saying, so, if one statement feels more true than another, use the one that feels true to you!
Overall, mistakes are something that everyone makes. Just because mistakes can be life and death when you are a nurse, it does not mean you don’t and won’t make them. We are all human, and we put things into place to decrease mistakes, but they will never fully go away. You are not the reason that patient is there, and you are doing your best at all moments to take care of the patients that you see. Your best, because you are human, looks different from moment to moment based on what you are experiencing. We all are trying our best to take care of patients, that is why we got into the job, and it is so important to start taking care of each other and ourselves too!
If you find yourself struggling to engage in shifting thought patterns, I recommend seeking weekly support from a therapist to help support you in shifting those negative thought patterns!