Medical Professional Publications

Appropriate Nursing Error Disclosure and Apology

(From the Spring 2013 issue of Everything Matters: In Patient Care)

Carol McGlone, RN, BS, Risk Manager, Department of Legal Services

The American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements 2001 explicitly states in Standard 3 that “The nurse promotes, advocates for and strives to protect the health, safety and the rights of patients.” The related interpretations state that nurses are required and expected to report nursing errors that are either committed or observed to the appropriate supervisory personnel and that nurses are expected to assure “responsible disclosure of errors to patients.”

Under this standard of the Code of Ethics, nurses are held accountable to disclose errors that they have made. Such transparency provides the patient with the information about an event that he or she has the right to know and, when done in an honest, empathetic manner, restores trust and respect to the patient-caregiver relationship.

Common examples of errors made by nurses include late or missed medications or treatments, failure to obtain ordered vital signs and failure to perform timely assessments. Because nurses have a duty to disclose an error that they have made, it is very important to understand how to disclose an error and how to apologize.

Ohio’s apology statute protects Ohio’s health care providers including physicians, nurse and allied health professionals from having any statement of apology for an error being admitted as evidence against them if there was a trial for malpractice. Specifically, Ohio’s apology statute applies to “all statements, affirmations, gestures, or conduct expressing apology, sympathy, commiseration, condolence, compassion or a general sense of benevolence that are made by a health care provider or an employee of a health care provider to alleged victim or a victim’s family. However, Ohio’s statute does not exclude any statements of responsibility or direct admission of fault from being admitted in court as evidence.

As a nurse or allied health professional, you need to understand what to say and what not to say when you disclose an event to the patient and/or the patient’s family. The following information can help you make an effective apology to a patient while protecting you from making poor word choices that indicate acceptance of responsibility.

Risk Management Interventions

  • Say that you are sorry for the situation and for the effects on the patient.
  • State only the facts of an event.
  • Do not attribute cause or blame to yourself and/or to others.
  • Say that you are going to investigate how this happened.
  • Be proactive with empathy and customer service measures but do not admit fault or state your hunch on why something occurred. In cases of a bad outcome, there will be time after an appropriate investigation to re-meet with the family and discuss findings.
  • Document the facts of an event in the medical record.
  • File an incident in Nationwide Children’s incident reporting system.
  • Educate yourself on how to make an apology before a bad outcome.

According to Grena Porto, RN, MS, CPHRM, a principle with QRS Healthcare Consulting, the following examples are words and phrases to avoid as you disclose and apologize:

  • I am responsible
  • I am at fault
  • My mistake
  • My fault
  • I made an error

Ms. Porto offers the following as examples of ways to apologize:

  • I am sorry that this happened to you.
  • I am sorry for the suffering that this caused you.
  • I am sorry that this means you will have to undergo additional treatment.
  • I am sorry that this did not go as we had hoped.

Appropriate disclosure and apology support Nationwide Children’s Zero Hero initiative to provide asafe day every day for our patients.

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