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As a registered nurse, I am shocked as I read the increasingly available information about errors and near misses in health care.  The frequency and severity are overwhelming.  What kind of healthcare system do we have?  Check out the Institute for Healthcare Improvement  (http://www.ihi.org) for a greater appreciation of errors. 

I still remember how sick I felt when I made a medication error as a young nurse.  I wanted to throw up.  I gave a stronger dose of a narcotic than what was ordered.  Fortunately, no patient harm occurred.  But regardless, to this very day, I never want to feel that way again nor ever harm any of my patients because of errors. 

But that is where reality and what I want do not match.   Despite the best intentions, thousands of patients are harmed in US hospitals every day.  Hospital-acquired infections, adverse drug events, surgical errors, pressure sores, and other complications are commonplace. 

Reducing errors and near misses require significant changes as we all know the reasons go way beyond the human involvement.   Increasingly, organizations are creating position statements to support Just Culture Concept and environment that include processes and reporting systems to improve patient safety.  Check this out….. http://www.justculture.org.

So my question for discussion is what is the role of discipline in errors?  What is the role of punitive sanction? Can we as a profession endorse Just Culture Concept?