Question: Weighing Conflicting Obligations You are the unit supervisor of a medical-surgical unit. Shauna, an RN on your unit, who graduated three years ago from nursing school, has made a number of small errors in the past few months, all of which she has voluntarily reported. These errors included things like missing medications, giving medications late, and on one occasion, giving medications to the wrong patient. No apparent harm has occurred to her patients as a result of these errors and on each occasion, Shauna has responded to your coaching efforts with an assertion that she will be more attentive and careful in the future. Today, however, Shauna came to your office to admit that she flushed a patient's IV line with 10,000 units of heparin rather than with the 100 units that was ordered. The vials looked similar and she failed to notice the dosing on the label. Shauna reported the error to the patient's physician and filled out the adverse incident report form required by the hospital on all medication errors. At this point, the patient is demonstrating no ill effects from the overdosing, but will need to be monitored closely for the next 24 hours. You recognize that Shauna's pattern of repetitive medication errors is placing patients at risk. You have some reservations, however, about dealing with Shauna in a punitive way since she openly reports the errors she makes and because none of her errors until today had really jeopardized patient safety. You are also aware, however, that you have an obligation to make sure that the staff caring for your patients are competent and that patients are protected from harm. You are also attempting to establish a unit culture that encourages open reporting, not "shame and blame," so you are aware that your staff are watching closely how you will respond to yet another error on Shauna's part.

ASSIGNMENT: What will you do to address this error as well as the errors Shauna has made in the past few months? What options are available to you? What obligations do you have to Shauna, to the organization, and to the patients on your unit? How will you create a culture that encourages the open reporting of errors and yet protects patients from potentially unsafe practitioners?