By Carol Davis
Even before the COVID-19 pandemic began, critical care nurses (CCN) were experiencing alarmingly high levels of stress, anxiety, depression, and poor physical health—factors that correlated with an increase in self-reported medical errors, according to a new study by The Ohio State University College of Nursing.
Nearly two-thirds (60.9%) of the CCNs reported having made medical errors in the past five years, according to the study. Occurrence of medical errors was significantly higher among nurses in worse health than those in the better health categories. For example, 67% of the nurses with higher stress scores versus 56.5% of the nurses with no or little stress reported having made medical errors in the past five years.
However, critical care nurses whose organizations put strong emphasis on their well-being are more likely to be fully engaged in patient care and make fewer medical errors, according to lead author Bernadette Melnyk, chief wellness officer and dean of Ohio State’s College of Nursing.
Accurate estimates of deaths from preventable medical errors in U.S. hospitals vary widely because of inconsistent reporting methods:
- A 2020 Yale School of Medicine study estimates the number to be 7,150.
- A Journal of General Internal Medicine study published in January 2020 puts the number at slightly more than 22,000.
- A frequently cited 1999 landmark Institute of Medicine study estimates 44,000-98,000 annually.
- Johns Hopkins Medicine research in 2016 placed the number as high as 250,000, making medical error the third leading cause of death, behind heart disease and cancer.
Notwithstanding the numbers, errors occur more frequently in critical care units because of complex patient cases and multiple-system illnesses, which introduce more opportunity for human error, the new study says.
“These errors are made by very dedicated, caring, committed nurses who are experiencing their own symptoms of depression, anxiety, or poor physical health,” Melnyk says. “It’s important that hospitals fix systems issues and offer evidence-based programs and support to equip their clinicians with resilience, because we know that’s a protective factor for their own mental and physical health, as well as their ability to provide optimal care to their patients.”
The study surveyed nearly 800 members of the American Association of Critical-Care Nurses from August 2018 through August 2019. Findings, which were published in the May 2021 issue of American Journal of Critical Care include:
- About 61% reported suboptimal physical health. Nurses tend to like working three days per week, but that requires 12-hour shifts with limited breaks to rest properly, often resulting in sleep disruption, headaches, cardiovascular disease, gastrointestinal symptoms, and musculoskeletal disorders.
- About 40% screened positive for depressive symptoms and more than 50% screened positive for anxiety.
- Those who reported worse health and wellbeing had between a 31% to 62% higher likelihood of making medical errors.
- Nurses who reported working in places that provided greater support for wellness were more than twice as likely to have better personal health and professional quality of life compared with those whose workplace provided little or no support.
Stress, anxiety, and depression are likely even higher in the current environment than before the pandemic, when the study was conducted, the authors say.
The ‘hard evidence’ of wellness
An engaged, dynamic wellness program will enhance nearly every corner of a hospital or health system, according to the study.
“The major implication of this study’s findings for hospital leaders and policymakers is that critical care nurses whose well-being is supported by their organizations are more likely to be fully engaged in patient care and make fewer medical errors, resulting in better patient outcomes and more lives saved,” researchers wrote.
Wellness also contributes to higher productivity levels, less absenteeism, and less turnover—all of which translate into the hospital or health system’s bottom line, Melnyk says.
“Wellness is not a warm and fuzzy thing to do,” Melnyk says. “We have such hard evidence [that] not to do it is not good for a population’s health and well-being, but it also adversely affects healthcare quality, safety, and cost.”
Building a wellness strategy
The solution, Melnyk says, is for hospitals and health systems to boldly promote the well-being of their critical care nurses—and all their employees—by appointing a chief wellness officer and giving that executive strong resources.
“This is an important component of an organization’s vision and strategic plan, so they’ve got to invest in a leader to spearhead their population’s health and well-being,” Melnyk says.
“A hospital’s investment in the well-being of their healthcare professionals will lead to better quality and safety of care and fewer preventable medical errors,” she says. “It’s critically important that we understand some of the root causes that lead to those errors and do everything we can to prevent them.”
Just having a wellness program isn’t enough, she says; some 90% of hospitals implement employee wellness programs, according to an American Hospital Association survey, but there’s great variance among programs.
“A lot of hospitals will run employee wellness through HR, so they may have an online web portal where they collect personal health assessments or do wellness challenges, but then there are other [organizations] like Ohio State that really invest in a comprehensive, multiple-component wellness strategy,” she says.
The Ohio State Wexner Medical Center has several programs to promote clinician well-being, including its Employee Assistance Program which offers confidential mental health resources and services such as counseling, mindfulness coaching, and its Stress, Trauma and Resilience (STAR) Program that offers the Buckeye Paws pet therapy program to promote coping and resiliency skills-building.
Nurse executives also can take the lead to guide their nurses away from burnout and toward wellness, Melnyk says.
“From a nursing perspective, I would give some leaders in my nursing organization FTE time to focus on wellness for my critical care nurses,” she says. “Somebody’s got to be looking at this—watching outcomes and providing programming specific to these critical care nurses because the care, as my study shows, can cause medical errors if your clinicians are not in good mental or physical health.”
Screening programs are essential
Previous research also has linked medical errors with clinician stress, quality of life, burnout, and physical and mental health, according to the study, which notes that critical care nurses are known to experience higher levels of stress than nurses in other specialties because of their taxing clinical environment. Indeed, research indicates a 24% prevalence rate of posttraumatic stress disorder in CCNs, compared with 15% in nurses working in other clinical areas.
Stress and unresolved depression can lead to suicidal ideation and action, which have been on the rise and occur at a higher rate in nurses than in the general population, another prior study shows.
For those reasons, healthcare leaders should implement screening programs that detect depression in their nurses and other clinicians, the new study advises.
One successful program, for example, is the HEAR (Healer Education Assessment and Referral) screening program, patterned after a program developed by the American Foundation for Suicide Prevention, which provides anonymous online depression screening and treatment referral. Since its inception, the program has successfully identified a substantial number of suicidal nurses and connected them with treatment options, the study says.
Such results point to the reality that focusing on critical care nurses’ well-being is critical.
“It’s clear that critical care nurses, like so many other clinicians, cannot continue to pour from an empty cup,” Melnyk says. “System problems that contribute to burnout and poor health need to be fixed. Nurses need support and investment in evidence-based programming and resources that enhance their well-being and equip them with resiliency so they can take optimal care of patients.”
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.