THE BLOG
12/12/2012 09:45 am ET Updated Feb 11, 2013

When the Most Trusted Profession Falls Prey

Say what you will about whether there is more to British nurse Jacintha Saldana's alleged suicide than we know. The post-mortem report, and perhaps details of the newly revealed suicide note, will be released soon. But one thing, surely, is clear. Nurses are ranked as a "most trusted" profession, according to a new Gallup Poll. Nursing has topped the "most trusted" list for 13 out of the past 14 years (in 2001, the year of 9/11, firefighters were number one). This year, nursing received the highest ratings yet (since 1999 when nursing was included in the poll). When asked to rate the honesty and ethical standards of nursing, 85% reported that nursing is "very high/high." That is yet another reason why the death of Saldanha, who fell subject to a hoax last week by Australian 2DayFM radio DJs Mel Greig and Michael Christian, is such a tragedy. Nurses operate in an ecosystem based on trust.

The prank call inquiring about the Dutchess of Cambridge's status after being hospitalized for morning sickness, which led to Saldanha's apparent suicide, comes just as the Gallup poll came out. As a nurse and a professor of nursing, the timing of this poll and Saldanha's apparent suicide saddens me. I feel the senseless loss. I, too, have experienced helping someone even though it fell outside of the rules. Nurses everywhere can relate. They can also relate to the fallibility.

This is not the first time that a nurse committed suicide after making an error on the job; it's merely the latest. In April 2011, former critical care nurse at Seattle Children's Hospital, Kimberly Hiatt, age 50, hung herself after committing a medication error that may have contributed to an infant patient's death.

Nurses like Kimberly Hiatt and Jacintha Saldanha are "second victims." Recent studies published in Nursing Clinics of North America and the British Journal of Quality and Safety have shown that nurses are often traumatized when errors occur. The National Quality Forum Report for Safe Practices encourages hospitals and other health care organizations to care for the caregiver, but few do. Although hospital administrators would like to think they cultivate a "culture of safety," often it is a culture of blame. And the blame frequently falls on the individual nurses themselves, rather than the system in which they work.

Jacintha Saldanha was a second victim. Her error did not cause a patient to be hurt or to die. She was traumatized unnecessarily. The world of nursing lost another colleague. The world, however, has lost something more.

Saldanha's death reminds us that we are all vulnerable to being duped, fooled by someone who we have intended, merely, to serve.

Nurses, especially those of us who work in hospitals or other acute care settings, are given an almost impossible task -- to care for extremely ill people, with often not enough resources. Patients' needs are great, documentation and other regulatory requirements are overwhelming, and distractions and disruptions are constant. Yet we overcome these challenges. We do what it takes.

By all accounts Saldanha was a good nurse. She was described by the King Edward VII's Hospital chief executive as an "excellent nurse and well respected and popular with all of her colleagues." She was described as "much loved and valued." Lord Glenarthur, chairman of the hospital, said: "Jacintha was a first class nurse who cared diligently for hundreds of patients during her time with us. She will be greatly missed."

The fallout is far reaching. The DJs who committed the prank are "shattered" and "gutted," by all reports, crying as they spoke to Australia's Channel 9 last night in their first public interview following the suicide. "There's not a minute that goes by that we don't think about her family and the thought that we may have played a part in that is gut-wrenching," Greig said. The DJs have been taken off the air, and their radio station is banning prank phone calls altogether and suspending advertising. Southern Cross Austereo is reviewing the station's broadcast policies.

To be sure, the DJs are not the only ones to blame, as British radio host Martin Lewis and others are making clear. Organizations and health care systems need to examine, more fully and honestly, the aspects of the "environment of care" that make mistakes possible. Some hospitals do this. A recent article published in the Joint Commission Journal on Quality and Patient Safety provides a toolkit for hospitals and health care settings that explain how to set up a second victim support program. However, second victim programs are far from commonplace.

While we can laud policy reviews and prank call bans, none of these events -- the initial hoax and ensuing public humiliation, and then the public apologies, censor, and inquiry -- will make those who take the word of people they serve at face value feel any less vulnerable to deception by another human being. Yes, Saldanha made an error in her duties, but the public ridicule and humiliation promulgated by the radio DJs and social media, which undoubtedly contributed to her subsequent death, are unconscionable.

Saldanha was one of us. She represents the honest and ethical nurse on whom the public depends and relies. How sadly ironic that her death by duping epitomizes a violation of trust.

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