Recent Paper on Nurses and Disclosure & Apology
A couple months ago a paper was published in Nursing Management entitled, "Disclosure and apology: Nursing and risk management working together" by Denise Russell. This brief paper is an important reminder that nurses play a critical role in the disclosure process.
Too often, physicians are the focus of most disclosure training efforts. Whenever I am asked to provide a Grand Rounds presentations for the docs, I always ask, "Can I speak to the nurses too?" The risk manager or general counsel on the other end of the telephone is usually surprised by my request.
I love speaking to nurses. They get this issue, and nurses desperately want tools, information, and even sample speaking points to help them navigate life between docs who may not want to talk about events and families that can't let it go. Nurses need to be trained on disclosure and apology!
I'll never forget a conversation with a risk manager friend from a Cincinnati hospital, my hometown. My friend said his hospital does a good job at disclosure, especially when cases make it up to risk management and c-suite level. Where they were failing, however, was with the nurses because nobody had bothered to train them. My friend said when an event happens and the patient/family stays with their hospital, the nurses usually do one of three things: 1) avoid the patient's room like a nuclear waste dump; 2) when nurses do enter the patient's room their body language is terrible, there is no communication or empathy, and they get out quickly (i.e, they look guilty); 3) if pressed for information by the family, too often nurses will start speculating and even joust: "I would get the chart and hire a lawyer!"
While nurses should not be apologizing for doctors, they must be given tools how to engage with patients and families when something goes wrong. Nurses are naturally empathetic people, and we must double-down on these traits following adverse events. Nurses need to know it's OK to tell patients and families "sorry this event happened" and "how can I help you right now?" They also need to know how to answer tough questions: "So, Mrs. Smith, you are upset about X with your husband's care....let me raise this concern to my manager and we will get back to you shortly." And then make sure someone gets back to Mrs. Smith in quick fashion. Most importantly, as the face of the organization, nurses need to be encouraged to spend even more time with patients and families following adverse events. However, nurses need to be trained for these difficult scenarios. Training requires time and money, yet, if you avoid just one lawsuit the investment will be recovered and then some.
Sorry Works! can help train your nurses -- and docs too! For more information, call 618-559-8168 or firstname.lastname@example.org.
Doug Wojcieszak, Founder
618-559-8168 (direct dial)
email@example.com (direct e-mail)