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Physicians do not see themselves as sharing an equal responsibility in patient safety, and instead are more likely to blame nurses for medical errors

Patient Safety Monitor Alert, June 17, 2004

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Physicians do not see themselves as sharing an equal responsibility in patient safety, and instead are more likely to blame nurses for medical errors, according to a study published in the June issue of the American Journal of Nursing.

Researchers interviewed physicians, nurses, pharmacists, and administrators at 29 small, rural hospitals in nine Western states over a three-year period. They asked each of them about the kinds of errors that are reported in their hospitals. They also reviewed monthly case studies and asked respondents to identify errors and describe better ways to handle them.

Result: Nurses were held responsible for most medical errors, even though physicians usually didn't consider them part of the decision-making team. About 90% of physicians, administrators, and pharmacists--and 96% of nurses--said that a nurse was ultimately responsible for the error. Meanwhile, only 8% of physicians considered nurses to be part of the patient's decision-making team.

Diana Mason, editor of the AJN, said that although the statistics are appalling, she believes that circumstances may be even more extreme in urban hospitals where nurses often have more authority.

Respondents were more likely to refer to so-called "nursing-related" mistakes-such as giving too much medication-as "errors," the researchers found. However, they more often referred to physician-related errors, such as a misdiagnosis, as a difference in "clinical judgment" rather than an error.

Ann Freeman Cook and Helena Hoas, psychology professors at the University of Montana and members of the study research team, said they would like to see physicians, pharmacists, administrators, and nurses equally share the responsibility for patient safety. They admit that this is easier said than done, however.

"The real problem here is that by our selective looking, we may fail entirely to understand what it is going to take to increase patient safety, and that has an implication for all healthcare providers," says Hoas.

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