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Overconfidence and nursing malpractice

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Overconfidence and nursing malpractice

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Safeguard your ambulatory care nursing practiceA nurse can be too overconfident for his or her own good, or the good of the patients. Just as too little experience can result in errors, too much confidence in one’s own abilities and experience can increase the likelihood of error. Overconfidence can result in the incorrect use of the nursing process. For example, the overconfident nurse may not perform an adequate assessment by failing to gather enough information the patient’s status. Or the overconfident nurse may assume she knows how to do a procedure, and then ski or incorrectly perform steps. Factors that contribute to overconfidence include:

1. Large amounts of positive feedback from peers, other professionals, or the public
2. The reliance on unaided memory
3. The lack of awareness of environmental or treatment effects on outcomes (i.e., focusing on outcome feedback as opposed to process feedback)
4. The failure to search for disconfirming evidence
5. Enjoying a feeling of control and self-confidence

Components of overconfidence include:
1. The failure to consider alternative perspectives
2. The failure to distinguish inferences from assertions
3. Favoring positive over negative information
4. Unwarranted certainty in the individual’s accuracy of prediction

The Overconfident Nurse Case Example

I reviewed a case as an expert witness that involved a patient who was to have surgery for glaucoma. The same day surgery nurse was being sued for medications she gave the patient. This nurse was confident she knew what preoperative medications were required. Further, she thought the physician forgot to provide preoperative eye drop orders.

The nurse created an order sheet listing the medications she thought the doctor would order, and wrote up the orders as a telephone order from the eye surgeon, although she did not speak to the surgeon. The nurse administered the eye drops to the patient. Unfortunately, the medications the nurse administered were contraindicated for the type of glaucoma the patient had.

The surgeon tried to reverse the effects of the medications the preop nurse gave, and went ahead with the surgery. The patient had a poor outcome and lost vision. The case was settled; the physician’s and nurse’s insurance companies paid the claim.

The overconfident nurse administered medications without an order, and the patient suffered.

This example is from Safeguard Your Ambulatory Care Practice to help ambulatory care nurses and attorneys understand the legal issues of this type of nursing practice.

Need help to figure out how an error occurred? Our legal nurse consultants work with medical records and attorneys to create chronologies, develop questions for depositions of defendants and suggest items to obtain through discovery. Give us a call. We’re here to help.

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