Understanding How Nurses Experience Their Responsibility for Administering Medications According to the 5 Rights -- Angela P. Stephan
Angela is the Human Capital Lead for the Veterans Affairs Account for Deloitte Consulting, LLP. She has spent the last 30+ years as a practitioner in corporate organizations, CIGNA and PECO/Exelon, a behavioral science consulting firm, her own management consulting firm, Booz Allen Hamilton, and now Deloitte. For the past 17 years she has focused primarily on healthcare, specifically hospitals addressing organizational and individual performance and behavior change.
The Institute of Medicine (IOM) released a report in 2000 entitled: To Err is Human: Building a Safer Health System (2000). Since that time, medication safety has improved, but progress has reportedly been slow (IOM, 2007). Serious concerns persist regarding the frequency of medication errors that occur when a medication is delivered to a patient and, as a result patients experience adverse drug events (ADEs) that are considered preventable (IOM). The July 2006 IOM report indicated there are more than 1.5 million preventable adverse drug events (ADEs) annually at United States facilities with total costs estimated at $17 to $29 billion per year (Sherwood, Thomas, Bennett, & Lewis, 2002).
Nurses have been given many responsibilities which continue to increase as new safety, technology, medical and process advances are made. It is important to understand from a nurse's perspective what it feels like to have the volume, variety, and criticality of all of these responsibilities at the same time that the environment contains a number of stressors-interruptions, fatigue, overwork, miscommunications, illegible drug orders, insufficient patient information, and malfunctioning infusion pumps and intravenous drug delivery systems ( Pape, 2001). In addition, nurses are asked to perform many non-direct care duties such as housekeeping, leading to their frustration with the role (Schimpff, 2009).
Felt responsibility focuses on the individuals' psychological linkage to the goals (or rules, protocols) of an event for which the individual's actions are then evaluated (Schlenker, 1997). Although nurses can be held accountable for these many responsibilities, it is suggested that their felt responsibility shapes their actions and behaviors (Cummings & Anton, 1990; Dose & Klimoski, 1995). The study's research question is as follows: How do nurses experience their responsibility for administering medications according to the 5 Rights standard? By answering this question, hospital managers and nursing executives will have new knowledge from a study of felt responsibility that has the potential to improve nurses' satisfaction with their role in administering medications safely, and could motivate them to want to continue their nursing careers.
Key words: Registered Nurses, Health, 5 Rights, Medication Administration, Patient Safety, Responsibility, Felt Responsibility, Accountability, Hospital Managers, Control