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When is Enough, Enough. Nursing and the Culture of Fear

This week I heard from more nurses who "just can't take it anymore." These nurses have struggled with the difficult decision to leave the profession because of persistent unsafe conditions related to under staffing, and overly burdensome patient assignments of too many and too acute patients. One nurse put it this way: "I'm not allowed to really care for my patients. I do not have time, and nothing is going to change." Another nurse stated: "I'm done. It's all about money not the patient. I fear for my license every day." And it is not just nurses who daily face unsafe practice settings and risk being retaliated against for speaking up and advocating for a culture of safety. A jury recently awarded an ER Physician a large verdict award after he was retaliated against, and fired for reporting unsafe staffing levels (

Nurses in Texas have been intimidated not to report hospitals that allow unsafe practice settings or dangerous providers. In 2010 two nurses in Kermit Texas faced prison sentences because they had reported a dangerous physician. They were terminated and reported to law enforcement. Charges against them were filed for felony harassment. Charges were dropped against one of the nurses but the second was prosecuted. A jury found her not guilty but not before her and her family’s life had been torn apart.

After this case the Texas Medical Board made it mandatory to reveal your identity if you report a provider. Who frankly, in their right mind is now going to report a negligent provider knowing their identity will be revealed and they will likely have their career leveled? Nursing is a profession steeped in fear. Nurses know they will experience retaliation up to and including being reported to the Board of Nursing if they report a Physician or provider with a consistent pattern of injuring or even killing patients.Nurses who reported the Neurosurgeon who has been called Dr. Death suffered reported retaliation by the Nurse Administrators they repeatedly reported to.

Nurses in positions of leadership in at least two Dallas hospitals were complicit in allowing Dr. Death to continue to maim and kill patients. These nurse administrators failed to do their duty and protect patients even though they were aware of Dr. Deaths horrific operative results. Yet the Texas Board of Nursing never investigated these nurses for willful violations of the Texas Nurse Practice Act. The Board has a duty to protect patients, yet they consistently are made aware of nurses in positions of leadership allowing or even creating unsafe conditions on hospital units. The Board hears frequently from the fall guy nurse facing Board charges, that they made an error, or something fell through the cracks because of mitigating circumstances such as gross understaffing and being assigned unmanageable assignments. The Board will go after a nurse who is a victim of system failures yet fail to investigate the root cause of patients being injured. This failure to hold nursing leadership also accountable to adhering to the NPA allows for patients to continue to be at risk of harm. The Texas Board of Nursing could and should advocate for patient safety. Just imagine the changes the Board could force by holding nursing directors, supervisors and CNOs accountable for their decisions to allow unsafe patient loads, or failures to ensure critically ill patients are transferred to the ICU or assigned a 1:1 nurse who can deliver the level of care needed. Instead hospital emergency rooms and non-critical care units frequently allow patients to be cared for by emergency or floor nurses who already have four to six patients. Nurse administrators and even charge nurses know such conditions are likely to result in errors and failures to rescue. Yet the trend continues forcing nurses away from the bedside out of fear and the lack of support from their leadership.

So, my question is, when is enough going to be enough? Preventable medical error is already the third leading cause of death. Are 250,000 lives lost yearly not enough to mobilize nurses to fight back? Can we face the fear of retaliation and do it anyway? I did, and I admit I paid an enormous price. My family paid an enormous price. But I continue to believe that if nurses join forces, speak up and speak up loudly, we can create change and protect our patients. If you have a story to tell or want to have a voice start on this site. It's a first step, it's something. Let's rally and stand up for our patients. Enough is enough.

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