Recently on the television show “ER,”
nurse manager Carol Hathaway, MS, RN, made a
serious mistake. When she discovered her error she
was justifiably horrified. She was even more horrified
by the reaction of others, which was essentially to say
that she should not worry about it and they wouldn't
either. I felt horrible about her mistake, too, and I too
was appalled at what people said when she told them.
But I have nothing but praise for Carol and the
way she handled herself. For me, this episode is more
about heroism than the ones that focus on risky,
high-tech procedures that save lives against the odds.
Mistake notwithstanding, Carol's actions in this episode
exemplify one of the characteristics I think makes a
great nurse.
Carol was working in a phenomenally high-stress
situation when she made the mistake. The nurses on her
staff had staged a sick-out, and although the ER was
closed to trauma, someone with severe injuries came in
off the street. Carol held together with her usual
aplomb, managing things efficiently and performing
multiple duties at once. But she made a mistake
administering blood, and the patient died.
At every stage of the aftermath of her mistake,
Carol was shocked by people's response. Two ER
physicians suggested that she keep her mistake quiet,
pointing out that the circumstances were extraordinary,
that she could have covered up her error, and that the
indigent patient did not have loved ones to mourn his
death. The director of nursing and another
administration official said they felt the nurses union
was to blame for staging an illegal sick-out. When
Carol filed an incident report anyway, the hospital
administration released the information about the
accident to the newspaper without Carol's name.
Essentially, they were seeking to turn public opinion
against the union by saying that the sick-out was to
blame for the patient's death.
Carol wasn't happy with this result either, and she
called the paper and went public with her error. She
gave her name and made a point of saying she did not
blame the union for her actions, and she got suspended
immediately. Later, she was reinstated.
This case was anything but cut-and-dried. The
physicians saw the complexity of the situation when
they urged Carol not to blame herself. They pointed out
that the patient might have died anyway. They valued
Carol's nursing skills, too, and probably didn't want to
lose her to disciplinary measures. They knew it wasn't a
pattern of inattention, after all. As a viewer, I was
certainly sympathetic to Carol as she raced around
helping physicians troubleshoot a malfunctioning
defibrillator, telling replacement nurses where to find
basic supplies, and performing the jobs of an entire
nursing staff.
To Carol, however, everything was clear. It's not
that she saw the situation in simplistic terms; she knew it
was complicated, and she considered her options
carefully. But although her job was beyond hectic that
day, she clearly saw that her actions were her
responsibility.
She also clearly saw the value of the patient's lost
life. The likelihood that the homeless man's friend
would sue the hospital simply wasn't part of the picture.
For her, a death was a death, and she felt terrible that
she may have helped cause it.
At the end of the episode, I was left with one
overwhelming feeling: deep respect for Carol's
principled stand. When a nurse later thanked Carol for
“sticking up for them” by going to the paper, she was
missing the point. Carol wasn't taking sides, she was
doing what she thought was right. And she wasn't
making empty gestures, either; she put her job on the
line. What I admire—and what I think helps make
Carol the terrific nurse she clearly is—is that she knew
what she believed, she acted on her convictions, and she
took responsibility for her job.
Doing what's right when even when it's difficult
isn't new for Carol. Like other good nurses, she stands
up for her patients' needs every day. She urges interns
to do another exam, monitor a symptom more closely,
or order a better test. She argues and persists until her
patients get the resources they need. She's used to
letting her beliefs guide her actions; that's part of what
good nursing is. I think it's that pattern that made her
response to this situation come so naturally. If I were in
Carol's shoes, I hope I would have the courage to act as
admirably as she did.
Whitney Wood
Managing Editor of NURSEWEEK's print publication
