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  • A reflective account of the culture of fear

    • UK
    • Accounts and narratives
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    Summary

    This is my story of how one bad experience can lead to another. We talk a lot about patients and their safety (quite rightly so) but very rarely do we hear about the healthcare professional who is going through turmoil and their mental health.

    This is my story.

    Content

    I started my career in a care of the elderly ward (geriatrics), which was exciting as my first job, and I felt that my time management needed to be worked on prior to me starting my career in what I knew at the time to be emergency nursing. I stayed in this area for a year, taking charge of the shift and also managing a bay of eight patients, which was the norm (or so I thought). After about 1 year, I thought about moving on, continuing to learn, and I started working in an intensive care unit (ICU).

    During my time in ICU, I made a drug error involving a controlled drug. Without going into too much detail, there was a lot of factors involved in this case and I was told I was going down the disciplinary route. This was a real low point for me and I felt like I really needed support, not only to come to terms with the error itself, but also support from a reflective side  what I can do, so this doesn’t happen again.

    I was a new band 5 nurse in the department with no previous ITU experience, with a new Band 6 and Band 7 leading the team which we were working with solidly. They chose not to suspend me, but keep me working without being able to complete medications. I continued to work as per rota, never taking a day off sick, etc. This continued for about 3 months unable to complete my job role to its full potential, and continuing the days and nights and the weekend shifts, along with personal issues of my own to contend with also.

    I thought at the time it was normal to feel like this post an error, but in hindsight, the support I received was not adequate. In fact, I would go as far as to say I didn’t get any support, other than the normal "are you okay" at the start of each shift. 

    By the time the disciplinary happened, I was 'rock bottom', which is banded around a lot, but I didn’t see a way out, without my family and partner saying that I needed to get out, I don’t know what I would have done. Nevertheless, I left for new horizons, and changed my speciality. I went to A&E where I knew I wanted to be, with a great team, with great management and culture.

    However, one day I let them down. I completed a second drug error. This was involving an insulin/dextrose infusion for hyperkalaemia, which I mixed up for hyperglycaemia. This error rattled me again. I felt like I was going down that 'rabbit hole' yet again, becoming more and more anxious and needing extra support, more than ever. Fortunately, the patient was okay and was identified quickly.

    The error was serious and after talking to my manager, they suspended me from clinical duties whilst the investigation was occurring. This was absolutely devastating to me. I felt like I was just settled in my job, feeling more positive about my career that I love so much. 

    Whilst the investigation was going on, I continued my non-clinical work, completing various tasks that would normally take an age to complete. This is where I fell in love with the non-clinical side of the department and continue to work in this area today.

    However, in contrast to the first incident, I was asked whether I was okay, but also followed up with regular 1:1 welfare meetings, and felt like my manager was actively supporting me. I also started a piece of work on preventing this incident happening again. 

    I have now gone up the ladder in the same organisation, and continue to feel settled. However, this really put the importance of supporting people as one of the main priorities in my daily practice. It also put into context the real need for establishing and integrating a no blame culture and getting rid of the culture of fear. It is very easy to forget the mental health aspect. Patient safety is aimed at patients (quite rightly so), but I think somewhere in the mix, we forget about that individual who takes this home day in, day out.

    I understand that there is accountability and there is taking responsibility for your actions as per the Nursing & Midwifery Council (NMC) Code of Conduct. But I think we forget about humanity and the need for support and coming together when one of your team is 'down'. I can honestly say, without my team and my managers, I wouldn’t be the nurse I am today, and I am forever grateful. And those people who have done errors or know what this is like, maybe you’re going through this today; there is light at the end of the tunnel.

    I share my story with the upmost respect and apologies to the patients involved and also to my team!

    About the Author

    I am a nurse who works in the NHS and very proud to do so. I like to think I am a good nurse, but I am human, and we all make mistakes.

    Please be nice ?

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