Letter to the Editor by Marilyn Smith to “Enhancing Patient Safety: Factors influencing Medical Error Recovery among Medical-Surgical Nurses”

Elimination of Barriers to RN Scope of Practice: Opportunities and Challenges

August 6, 2018

Response by Marilyn Smith to “Enhancing Patient Safety: Factors influencing Medical Error Recovery among Medical-Surgical Nurses” by Theresa A. Gaffney and colleagues (September 30, 2016).

With Reply from Author

Dear Editor,

I am writing in response to, “Enhancing Patient Safety: Factors Influencing Medical Error Recovery among Medical-Surgical Nurses” (Gaffney et al. 2016). As a nurse leader, who is an advocate for patients as well as nurses, the article was of much interest to me. I was delighted to read to know that medical-surgical nurses were regarded as an integral member of the team in which one of their responsibilities was to keep patients safe. I agree that one of the core duties of nurses is to keep patients safe, but this will depend on the ability of the nurses to fully use their education, expertise, and role to identify, interrupt and correct medical issues.

I would like to add support to your article that organizational factors such as prolonged shifts could influence nurses from being able to recover medical errors. Almost all nurses on the medical-surgical units work 12-hour shifts which can turn into 13 or 14 hours and this could affect the ability to identify and correct errors. Caruso (2012) stated that the length of the shift can influence performance with an increase incidents of 28% to compare to 8-hour shifts. In addition, fatigue also caused by working too many hours result in profound sleepiness that can deteriorate a nurse’s alertness and safe patient care.

Also on May 4, 2017, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (2017) was introduced as a bill in Congress to propose minimum nurse staffing requirements for registered nurses. Aiken et al. (2017), stated that low nurse to patient ratios resulted in decreased patient mortality rates, low rates of nurse burnouts, and low rates of nursing satisfaction rates.

I do believe that nurses can recover more medical errors if given the opportunity to work fewer hours, as well as having an adequate nurse-patient ratio.

Thank you,

Marilyn Smith, MSN, RN
Doctoral student at American Sentinel University


Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A.…Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904-909. doi:10.1111/j.1475-6773.2010.01114

Caruso, E. M. (2012). The evolution of nurse-to-nurse bedside report on a medical-surgical cardiology unit. MedSurg Nursing, 16(1), 17-22.

Gaffney, T. A., Hatcher, B. J., Milligan, R. & Trickey, A. (2016). Enhancing patient safety: Factors influencing medical error recovery among medical-surgical nurses. OJIN: The Online Journal of Issues in Nursing, 21(3), 1-13. doi:10.3912/OJIN.Vol21No03Man06

Nurse staffing standards for hospital patient safety and quality care act, S. 1065, 115th Congress. (2017). Retrieved from https://www.congress.gov/bill/115th-congress/senate-bill/1063