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Everybody makes mistakes, since we are human beings. Nurses and medical staff in general are not an exception. However, there is a great difference between just receiving an «E» for a poor grammar and confusing prescribed drugs. That is why identifying, analyzing, learning from the cases and involving actual breakdowns in the nursing process seems to be of great importance nowadays. The episode I am going to talk about may also become quite an instructive lesson. At least, it has become for me as a witness. At 10:30 a.m. on Sunday, the 27 years old woman on the 34 week of pregnancy phoned her neighbor and asked to visit her as soon as possible. He was a registered nurse (RN), working in an intensive care unit. The woman complained of pain adown belly. It was not severe but annoying. She also rejected the proposal to visit a doctor immediately because she had a plan to celebrate her marriage anniversary at home. The same reason caused hiding the fact of some blood-tinged discharge. Besides she had some financial problems. The woman also assured that the pregnancy had been running well and it was just a matter of a little excitation about the celebration. It sounded quite persuasively. As a result, she was prescribed nifedipine in an appropriate dosage as a tocolytic therapy and vitamins to improve the ceotrophy. As the general state kept growing worse, women decided to increase the dosage. In 6 hours she had to call an ambulance. The obstetric ICU diagnosed anomalous uterus tonus and began the hexoprenaline infusion while transferring her to the hospital. Due to the calcium presence in vitamin pills, they faced the blood pressure increasing, which resulted in vaginal hemorrhage. Hexoprenaline was replaced with magnesium sulfate. But it was interaction with nifedipine that caused cardiovascular system failure and resuscitation necessity, which luckily was successful. The uteroplacental apoplexy (Couvelaire uterus) was diagnosed in the hospital in 10 minutes after the arrival of the ICU. The urgent hysterectomy was the only chance to save the mother and her child, and it was performed immediately.
The whole situation illustrates greatly the possibility of medical staff personal mistakes, as well as problems in the system operating in general. Incidentally, the National Council of State Boards of Nursing (NCSBN) reports the increasing of the level of nursing mistakes. The question arises whether the contemporary medical management system is worse, comparing to the traditional one. The answer is rather negative. In fact, the actions performed by the RN in this case are actually much more suitable for the traditional system. It means that the medical staff should be maximum universal; the specialization and medicine branches diversification are not so deep and broad; physical examination is of higher importance than an instrumental one; the actions amount is set only by the physician himself, etc. Even if such mistakes as poor interviewing, examination, drugs prescription, and observation in this case could have been excluded, the results of the contemporary management system would certainly be better on the population level. Traditional system cannot cope with the progressively increasing needs in medical assistance and use all the pros of science development, for it is too clumsy. To illustrate this, we can imagine that the actions of the NP were more up-to-date. Firstly, he would ask for help of a more specialized worker. He would also insist on instrumental fetus condition examination. The next thing to do would be to leave appropriate documents about conducted actions or just to observe the condition changes. As one can see, any of these measures, which are natural for every contemporary nurse, would certainly turn the situation to finish much better. The list of procedures is simple, but all of them are of vital importance. However, the contemporary management system is also not perfect and needs to be developed. For instance, the Vermont Single-Payer health care system is much more tolerant to patients’ solvency. Unfortunately, financial factor is the most often cause of medical care actions lateness. Secondly, the mistakes amount grows exponentially due to the increasing number of unskilled and inexperienced workers. Thus, the conclusion is obvious. Thirdly, 70 percent of medical mistakes are provoked by the wrong documentation filling. This means, that employees should have more time to pay attention to it without being distracted. Statistics also states that mistakes amount correlates with the increasing number of medical staff, which means that excessiveness is not always good
Thus, the model of health care departments’ personnel organization should be revised. There exists a popular opinion that the personal responsibility of every unit in it should also be increased significantly. It is explained with the fact that one of the main defects of contemporary medical care system is the decreasing of personal accountability due to the defendant number growth. However, responsibility is surely the best motivator to be a professional.