!Patient safety --- agk's diary 11 April 2022 @ 15:33 --- written on Pinebook Pro at kitchen table as excited roommate talks about negotiating a better contract with the hospital that's hiring her --- I wrote a discussion board post for school about medical errors. I swear the purpose of the class is to build a list of radicals to send to union- busting firms. I'm half-serious! We watched a video by the US Agency for Health- care Research and Quality. A woman's family was victimized by medical errors; it's her account of what happened. Our prompt: "Briefly discuss what happened to Sue's family. Discuss your thoughts and feelings." Sue's son sustained a preventable lifelong serious brain injury. Her husband died of treatable spinal cancer. Both tragedies were cascading system and practice failures, entirely preventable. Clinical observations weren't investigated with lab tests on multiple occasions. Sue's concerns were ignor- ed. She wasn't told information she needed to make decisions. Results weren't acknowledged or acted on by the attending physician. A test was interpreted wrong. Bad interpretations were un- challenged. Sue's clearly felt lots of anger. She holds it to- gether and channels anger into advocacy. Her story humanizes facts: medical error's a leading cause of death in the US and Canada. Probably a major cause of disability, too. My experience of nonfatal errors involves systems problems: understaffing, bad nurse-patient ratios, not enough resources at point of care, poor nurse morale related to the above and increasing nurse health insurance premiums, high student debt, cut COVID/FMLA sick-leave compelling nurses to work sick/exhausted. There's high turnover, increasing proportions of short-term H1B visa nurses and "traveler" agency nurses, providers outsourced to agencies, hospital chains consolidated by private equity firms (with policy changes, cost-cutting measures, record profits and executive compensation packages), etc. Shortages chosen by administrators produce short- term profit. Nurses and care techs ration care and attention at the bedside. At the point of care and management close to it, these issues are "bad weather" we work through. "Bad weather" boils down to money-making being institutionally and legislatively valued over human life and dignity. Good nurses develop safety cultures as "umbrellas," "shelter," "heat" for patients and floor staff to have the best outcomes and labor conditions possi- ble in routinely "inclement conditions," with "poor visibility" of patients' holistic circumstances, when what's in the moment and has to be charted takes priority. A few more issues I think make preventing medical errors in the US hard: RaDonda Vaught's prosecution with internal incid- ent report data reflects the problem of institut- ions displacing blame for failures onto scapegoats, substituting cheap interpersonal communication strategies and individual wellness/selfcare (on your own time/dime) for system change. RaDonda's scapegoating damages trust health workers place in incident reporting. Incident reports are neces- sary for performance improvement/risk management to build "shelter" for the safest care possible given "inclement weather." Like teacher unions, nursing unions advocate for patients in contract negotiations---especially safer nurse-patient ratios. Company negotiators threaten nurses' health insurance to force unions to drop safety demands. Who'd trade their child's insulin or husband's chemo for patient wellbeing? How bad does it feel to be put in this position? State and national nursing associations advocate legislative remedies. Our lobbying and campaign contribution budgets don't compare to the lobby for industries that employ us. The Kentucky Nurse Association bill to address the nursing shortage with scholarships was ignored in the state legisl- ature. Instead an industry bill to lower educat- ional standards and import more disposable H1B visa nurses was fast-tracked. KNA doesn't even try to fight for safe ratios or COVID sick-leave. Staff nurses complain about assertive patient fam- ily members---often current or past nurses or care techs. Patients with strong bedside advocates are often resented by nursing staff, maybe because (I'm using language I've heard from floor nurses) they "suck up too much of our time" or "pester us," disrupting the delicate balance of nurse time management. If visiting a room with an advocate takes twice as long, nurses put off going on the principle of justice (all patients should get nurse time rationed fairly). How do we, nurses with time limited by ratios and the task burden we're assigned, work with advocates instead of against them, not skimp on care of patients who don't have advocates and don't advocate for themselves, and avoid errors? When labs weren't ordered on an obviously, persi- stently jaundiced baby with increasing impair- ment, despite mom's expressed concern, if Sue's son was my patient, I hope I'd crossmonitor other health workers and SBAR the provider to request labs. If the provider tried to blow me off, no labs on that baby ain't concerning or uncomfort- able, but a safety risk! I'd name the risk twice to stop the line. If the provider wouldn't order labs, I'd ask my supervisor how to proceed. Maybe I could've saved Sue's starfish, but the beach is crowded with so many. My country's medical industry needs radical change.