When a Nurse Colleague's Practice is Misguided

Keith Carlson, RN, BSN, NC-BC - 07/06/19

For any nurse, the question of what to do when a nursing peer makes an error is crucial to consider. We never want to throw our nurse brethren under the bus, but bad clinical practice or misguided decisions need to be addressed. How do we go about it in a way that’s constructive and kind?

Identify the Behavior

The first step in calling out errors is to identify what went wrong. It may be obvious (e.g.: your colleague broke the sterile field and ignored that fact) or not so obvious (e.g.: you feel uncomfortable with the tone your peer used with a patient but you aren’t sure she actually did anything wrong).

Whether blatant or subtle, we all know that the stakes climb higher when clinical safety has been breached. Nosocomial infections are all too common, and the poor treatment of patients also calls for a response.

As a conscientious nurse, your first duty is to protect patient safety and quality of care; your duty to protect a colleague is significantly less compelling when that nurse has made a misstep begging for correction.

Silence = Complicity

Even if you didn’t commit the error, you’re still responsible for bringing attention to what occurred. The thought of covering for another nurse’s error shouldn’t enter your mind; as noted above, your duty rests elsewhere, and you must shine light on the situation or your silence is simply complicity with whatever occurred.

We’ve all likely heard of the “Blue Code of Silence”, wherein a police officer makes the choice to protect another officer, even when a grievous mistake took place. In nursing, our own code of silence can hold away if we’re not strong enough within ourselves to act; choosing to call another nurse out can feel terrible, even when we know our silence will solve nothing.

To Whom to Turn

In most situations where an error has been made, the first choice can be to privately address the issue with the nurse in question. If you choose this route, the nurse’s response may range from denial and/or defensiveness to acceptance and the admitting of wrongdoing. And of course, based on the nurse’s response and the severity of the error, further action may be called for.

If the nurse who made the error is someone with whom you lack a positive rapport (or any relationship at all), direct private communication may not be effective. It’s truly in your hands to decide if your colleague is approachable or if you need to speak to a supervisor. And if you’re a novice nurse who’s new to the unit or facility, you may lack the confidence or the credibility to privately address the situation in an effective manner.   

A trusted colleague can sometimes provide you with advice on how to follow up the situation. However, you must realize that any nurse you inform about the error will also be bound by their oath to provide the best possible patient care and uphold the standards of the profession and the facility.

In many circumstances, bringing the error or lapse of judgment to the attention of a manager will likely be necessary, even if it means your relationship with the other nurse may be compromised, temporarily or permanently. There are situations where certain cohorts of nurses will protect one another no matter what, including using tactics of intimidation or bullying to pressure you into silence; this is where strength of character and personal resolve will keep you on the right side of history. 

Doing the Right Thing

In order to do the right thing, you first need to recognize what went wrong and if your colleague made an innocent error or flagrantly defied policy or procedure; this may or may not become clear. The realization that your silence equals complicity is an important part of the puzzle, and next comes action.   

Once you’ve identified an error, documentation of your observations are the natural next step; and if someone else was a witness, you should ask them to corroborate your account.

If you have highly developed skills of emotional intelligence and communication, an initial conversation with your peer may be all that’s needed to set things right; however, medication errors or violations of policy or procedure should be officially documented and reported, no matter how much those involved may be tempted to sweep it under the rug.

You may find yourself disagreeing with the nurse who made the misjudgment, even as they attempt to silence you. If you choose remain mum, you must keep in mind that, if the situation ever comes to light, failing to report it could get you in as much hot water as the offender; is your license worth the risk?

As a nurse, you swore an oath and you’re expected to always do the right thing. Remember how hard you worked to earn your license, as well as your obligation to protect patients, maximize quality of care, and uphold the duties of your profession. When you keep these factors in the forefront of your mind and act accordingly, doing the right thing should be the only route worth taking.