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Dealing with the emotional response to errors

Errors can be devastating for all involved, evoking feelings of guilt, self-blame and anxiety among staff. Learning how to cope with these emotions is essential in rebuilding self-esteem and confidence, says former nursing director Caroline Shuldham 
Support after error

Errors can be devastating for all involved, evoking feelings of guilt, self-blame and anxiety among staff. Learning how to cope with these emotions is essential in rebuilding self-esteem and confidence, says former nursing director Caroline Shuldham

Its a heart-sinking feeling when you realise an error has been made, either by yourself or a colleague.

Sometimes it is immediately apparent that a patient has been harmed, other times there is no injury or a problem only becomes obvious later on.

Duty of candour

When an error occurs, there are processes to follow, including remedial actions to treat the patient, a duty of candour to the patient and/or relatives, investigation and root cause analysis, and improvements in practice to prevent further

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Errors can be devastating for all involved, evoking feelings of guilt,
self-blame and anxiety among staff. Learning how to cope with these
emotions is essential in rebuilding self-esteem and confidence, says
former nursing director Caroline Shuldham 


Nurses have a role in creating a culture where all can admit
to errors and receive help rather than censure. Picture: iStock

It’s a heart-sinking feeling when you realise an error has been made, either by yourself or a colleague. 

Sometimes it is immediately apparent that a patient has been harmed, other times there is no injury or a problem only becomes obvious later on. 

Duty of candour

When an error occurs, there are processes to follow, including remedial actions to treat the patient, a duty of candour to the patient and/or relatives, investigation and root cause analysis, and improvements in practice to prevent further errors.  

But policies about serious incidents tend not to dwell on the reactions of staff to errors, and the emotions involved. As a nursing and governance director, I have seen staff of all disciplines become truly distressed by what has occurred.  

A ‘stiff upper lip’ does not denote absence of feelings, and there can be guilt, self-blame, anxiety and huge concern for the patient. In the aftermath of incidents, I too have felt these emotions, so how should we deal with them? 

It is useful to recognise that errors result from human factors – the issues affecting how people do their jobs – and system failures. 

Empathy for colleagues

Alongside practical matters to ensure patient safety and fulfil reporting requirements, we need to show empathy for colleagues; support them, listen and talk.  

Being at work may be helpful, but we need to recognise when it is not. As well as support from a manager and colleagues, services such as human resources and occupational health may be required.  

Debriefing sessions can also help people emotionally – and assist them in contributing to an investigation positively.  

The aim is to rebuild self-esteem and confidence to care for the next patient. In my experience, the least helpful things are recriminations and blame, and talk of disciplinary action or referral to the relevant professional body.   

Accidents happen. Everyone has a role in creating a culture where all can admit to errors in the certainty they will receive help rather than censure.  


About the author

Caroline Shuldham is chair of the RCNi editorial advisory board. A former nursing director, she is an independent adviser on research, teaching and mentoring

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