Concepts and Definitions

Concepts

• Focus on evaluating the behavioral choices made by an individual, not on the outcome of the event; 
• Require leadership commitment and modeling; 
• Distinguish among normal human error, unintentional risk-taking behavior, intentional risk-taking behavior, and reckless behavior; 
• Foster a learning environment that encourages reporting (including self-reports) of all near misses, mistakes, errors, adverse events, and system weaknesses; 
• Lends itself to continuous improvement of work processes and systems to ensure the highest level of client and staff safety; 
• Encourage the use of non-disciplinary actions whenever appropriate (including coaching, counseling, training, and education); 
• Hold individuals accountable for their own performance in accordance with their job responsibilities; and, 
• Does not expect individuals to assume accountability for system flaws over which they had no control.

Terms, Definitions and Examples

Human Error (Not reportable to Board of Nursing)

Definition:

• Nurse inadvertently, unintentionally did something other than intended or other than what should have been done; 
• A slip; 
• A lapse; or 
• An honest mistake. 
• Isolated event, not a pattern of behavior.

(Repetitive human error or pattern of behavior requires further evaluation)

Examples:

• Single medication event/error (wrong dose, wrong route, wrong patient, or wrong time) 
• Failure to implement a treatment order due to oversight 

Responses to Behavior:

• Consoling or Coaching

At-Risk Behavior

(Board of Nursing Practice Consultant to be contacted for consultation)

Definition:

• Behavioral choice that increases risk where risk may not be recognized or is mistakenly believed to be justified; 
• Nurse does not appreciate risk; 
• Unintentional risk taking; and 
• Nurse’s performance or conduct does not pose a continuing practice risk to clients or others. 

(Repetitive at-risk behavior or pattern of behavior requires further evaluation)

Examples:

• Exceeding scope of practice 
• Pre-documentation 
• Minor deviations from established procedure 
• Nurse knowingly deviates from a standard due to a lack of understanding of risk to client, organization, self, or others

Responses to Behavior:

Coaching or Counseling

• If behavior not a pattern of practice) to raise awareness of accepted procedures and potential risks for failure to comply 
• Remedial actions taken may include education, training, and assignment of activities appropriate to knowledge and skill 
• Nurse may be informed failure to change is not an option 
• If nurse does not accept coaching, may result in disciplinary action

Board Action:

• Non-disciplinary Remediation 
• Disciplinary Action if Indicated

Reckless Behavior

(Mandatory report to Board or Nursing required)

Definition:

• Nurse consciously disregards a substantial and unjustifiable risk; 
• Nurse's action or inaction is intentional and purposeful; or 
• Nurse puts own self/personal interest above that of client, organization or others

Examples:

• Nurse abandons patients by leaving workplace before reporting to another appropriately licensed nurse. Nurse leaves workplace before completing all assigned patient/client care (including documentation) for a non-urgent reason. 
• Nurse does not intervene to protect a patient because nurse is not assigned to patient 
• Nurse makes serious medication error, when realized tells no one, and when questioned denies any knowledge of reason for change in client condition 
• Nurse falsifies documentation to conceal an error

Response to Behavior:

• Report to Board for Investigation 
• Disciplinary Action by Board

Additional Definitions

Consoling – affording comfort or solace; restoring confidence and relieving anxiety.

Coaching – supportive discussion with an employee on the need to engage in safe behavioral choices.

Counseling – a first step in disciplinary action; putting an employee on notice that performance is unacceptable.