#notmetoo or I am RaDonda
The #metoo movement is one of speaking up and out against silence associated with sexual violence, stopping those who perpetrate it, and holding systems accountable to develop strategies to eradicate it for all (Burke, 2022). Sadly, as nurses we find ourselves part of the #notmetoo movement. When we speak up and out we are finding that the response is not supportive but punitive. Every movement needs a “poster child” and RaDonda Vaught is ours, but not in a positive way (Kelman, 2022). Can we change that?
Nurses who power through obstacles and complete their tasks of care despite lack of tools and support are applauded as autonomous – until the unspeakable happens.
When a negative outcome occurs then they are held personally accountable for the very same actions that they previously were lauded for. The worse the outcome the greater the accountability. Take RaDonda’s situation. Nurses are delivering care to people who have very complex illnesses, assigned caseloads that are far above safe practice standards, floated from unit to unit to care for people they are not familiar with, and encouraged to “just do it”. They are required by their employers to deliver high quality and safe care despite hurdles, situations that are unmanageable, and multiple obstacles.
RaDonda faced distraction upon distraction taking her focus away from the task at hand. Her higher-level brain, identifying the risk of her behavior and choices, was overshadowed with the focus of getting her tasks completed. Every nurse who has ever administered medication using an electronic system knows that there are reasons that would require a nurse to override the system. I am not supporting the practice, but sharing the reality. These systems are reliant on WIFI service, mobile computers, and people who actually wear their bar-coded armband to name a few examples. What should have never happened did happen and now RaDonda will never be the same. Is prosecuting a human who admitted that she was distracted going to make our healthcare system safer? Will less people in care die?
In 1999, To Err is Human highlighted the impact of medical error by breaking the silence and encouraging organizations to create systems of reliability (Medicine, 2000). Since then organizations have struggled to create just environments that support reporting errors to learn from them. Since 2008, the Agency for Healthcare Research and Quality has surveyed healthcare employees regarding their perceptions of their organization’s response to human error. Since the Survey on Patient Safety Culture (SOPS) inception, more than half of employees responding each year are worried that mistakes were held against them and fear discipline, retaliation, and retribution. In 2021 more than 60% of employees responding held this concern (Famolaro T., 2021). Nurses have always been the largest profession participating in this survey.
Will any gains that healthcare organizations have made creating a culture of safety be swept away with this verdict? The Tennessee jury’s decision to hold RaDonda accountable for making a human error is the reality of every nurses’ nightmare. It demonstrates to me, regardless of how the complexity of the nursing profession was perceived during the COVID pandemic, that it still is far from understood. It also highlights that any organization that claims to have a culture of safety and encourages speaking up cannot protect you when you do. RaDonda is the offering as recompense for the failures.
The #notmetoo movement should focus on how nurses will change the perceptions of others to understand that the goal of care is not perfection but compassion. Nurses are humans who perform complex tasks in environments that do not have fail safe and redundant systems. I stand with RaDonda, I stand for her humanness and honesty. I also know that no one would want to be her. Not me too – because, surely, it could be me too.
Linda Paradiso is an Assistant Professor, CUNY School of Professional Studies.
Burke, T. (2022). me too. Retrieved April 19, 2022, from me too.: https://metoomvmt.org/get-to-know-us/history-inception/
Famolaro T., Hare R., Yount ND., Fan L., Liu H., & Sorra J. (2021). Surveys on Patient Safety CultureTM (SOPS ® ) Hospital Survey 2.0: 2021 User Database Report. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved April 19, 2022, from https://www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/2021-HSOPS2-Database-Report-Part-I-508.pdf
Kelman, B. (2022, March 25). Shots: Health News from NPR. Former nurse found guilty in accidental injection death of 75-year-old patient. New York, NY, USA: Kaiser Health News. Retrieved March 25, 2022, from npr.org: https://www.npr.org/sections/health-shots/2022/03/25/1088902487/former-nurse-found-guilty-in-accidental-injection-death-of-75-year-old-patient
Institute of Medicine (2000). To Err is Human: Building a Safer Health System. (Kohn, L., Corrigan, J., & Donaldson, M. Editors) Retrieved March 19, 2022, from The National Academies Press: https://nap.nationalacademies.org/catalog/9728/to-err-is-human-building-a-safer-health-system