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'I listened but I didn't HEAR'


One of the most commonly encountered situations we deal with as managers is when our junior nurses ‘make errors’. 

These can be drug errors, a failure to recognise a deteriorating patient, a documentation error or failing to attend for a shift, study day or meeting. 

I firmly believe that how we approach this can shape the nurse you are dealing with and with the right handling can turn this often difficult situation into a learning opportunity and give them the skills to develop and grow.

But, you still need to ensure they understand the gravity of the presumed ‘error’ without it becoming a warm cuddle and sending them off thinking that it’s all alright really.

An error is never alright. But it doesn’t have to be not alright. In fact, given the right approach and supporting reflection from the situation, it can form the basis of that nurse learning that being open, learning and sharing from it and using it as a tool to inform future practice will give you as an employer a nurse you know you can rely on and develop into a future leader.

“An error is never alright”

Let me give you an example: I was a junior nurse working in a busy Emergency Department (ED). I had been there for 6 months. I was now over the initial anxiety inducing period of thinking that every patient in my cubicle (be it an acute abdominal pain or a cut to the finger) would imminently arrest and die. In fact, I was working at the other end of the ED nurse spectrum: believing that they were mostly malingerers, no-one was THAT ill unless they were in Resus, haemorrhaging or brought in in cardiac arrest.

I had Band 5 ED’itis’. You know, that over confidence in yourself that you get after you’ve ‘been there, done that’. Only this night, I hadn’t ‘done that’. 

It was a busy Friday night. Ambulance after ambulance rolled into our ED bringing the borderline unwell in. The front door was looking like a January Harrords sale and no-one was really looking at the bigger picture. 

We reverted to form, queued all patients up in time order and worked hard to pick off the numbers, paying little attention to the small nuances in presentations. We were pace-setting to meet the targets imposed and tonight we were trying to win Game, Set and Match.

An ambulance arrived and I took the handover in the relative safety of the Majors area. I recognised this patient. Regularish attender (you ED nurses know who I’m referring too), alcohol excess with past episodes of ‘cry for help’ overdoses. It was busy. I listened but I didn’t HEAR. 

He had taken an overdose of his grandfather’s (who he lived with) Senna and Frusemide. Pay attention now: that’s right, I said Frusemide. His observations stacked up alright. He had been drinking. The ambulance crew knew him. I knew him. Are you seeing it? The human factors are already playing a part in this assessment. We were reverting to form again. 

I told the crew to place him on the chairs at the end of Majors. I did the cursory observations and carried on trying to play my serve: Game, Set, Lose.

At some point I became aware of a commotion on the Majors chairs. My patient had become doubly incontinent, not only that, he had also lost his blood pressure and was peri-arrest. Remember what I said about the Frusemide? He had taken about a blister pack amount. He spent the night being resuscitated and then went to ITU. Suffice to say, all the training we have about the dangers of diuretics, all the times I had administered them with caution in my patients, all the learning I had and I failed to LISTEN.

I failed my patient because of a range of factors that happened to be present at that time. 

“Making an error should not be an opportunity to deliver a punitive repose”

So, when I now, as a manager have to deal with my nurses and the ‘errors’ they have made; be it drugs, patients, attendance or personal I recount this story. 

I do it because I want them to see that I too, was once them. That junior nurse, who, because of circumstances and attitudes and systems failed to see the bigger picture. Because I want them to see that they are being managed by a person who has come through the system, learnt from it and used the errors they have made to positively influence my practice.

Making an error should not be an opportunity to deliver a punitive repose. Instead it should be about discovering why that nurse made it and how we as managers can support them to learn from it.

Most of the nurses that I have managed will have heard me recount this episode. It sits deep inside the archives of my PREP folder. There are many since. This isn’t because I am a bad nurse but because I have been taught the value in learning and evaluating my practice.

As a manager this is the message I try to give my staff and the culture the NHS needs to promote. Telling your story will encourage your nurses to tell theirs, as a leader you lead not only with the great but also with the not so great and this is how you earn the respect and admiration of your staff. And when they need to the most, they will knock on your door and remember you as the junior nurse they are now and will open up and share in a candid and honest way.

Surely leadership doesn’t get better than this?

And if you’re wandering, my gentleman survived his ITU admission but on the Sunday night his grandfather was admitted with overload due to missing his diuretics for 3 days. He couldn’t get an emergency GP appointment to get them prescribed. I believe they both spent a period of time in hospital together before being discharged home.


Gemma Davies is Lead Nurse for King George’s ED at Barking, Havering and Redbridge NHS Trust


Readers' comments (3)

  • Yes, as Managers relaying our experiences and how this has developed / benefited our practice can be a very useful strategy. I would caution however that staff do not always want to hear about our experiences and feelings - it is about them and managers should be careful to keep the focus on the person sitting with us. I talk from experience about a Manager who always had a bigger / more significant scenario to talk about rather than listen to her staff - her staff stopped listening to her.

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  • No matter how hard you listen to a patient everyone makes mistakes and in a&e I am sure more mistakes are made here more than anywhere due to the fast paced environment and stress. This is only an oversight which I would have done and lots of other nurses to.

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  • why just junior nurses. everybody makes errors from the very top down and that includes the most senior managers!

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