As nurses and as midwives our main purpose is to provide the best most effective care we can, to promote health and well being, to help our patients to recover from their illnesses and if necessary to enable the best possible death to occur. What we should also do it to do no harm.  Working as a nurse or midwife in the world of hospitals and all things health care today in 2008 is tough. There are challenges we never even thought of 20 or 30 years ago; there are lower staffing levels, there are higher expectations by patients, there is more to do that was formally done by doctors, there is greater risk and knowledge of those risks. One thing has not changed. If we make a mistake we are meant to admit and acknowledge the concequences.

In 2004 Mayra Cabrera, a nurse herself went to hospital and gave birth to a healthy baby. However what should have been a joyful experience for her and her husband turned to tragedy just an hour later when she was given a drug by mistake. A midwife stands accused of administering an epidural drug peripherally instead of saline or some other fluid replacement. She denies that she was responsible. Her manager says she was always a competent midwife and had never made a mistake before.

I do not know if the midwife wrongly gave that drug, but on that day in 2004 a woman died unnecessarily and much as she was a nurse she did not administer it to herself.  I fail to understand how no one appears to know nor accept who actually carried out the task since all drugs should be signed for on the medication chart. I accept that there was a system failure, that procedures must have been at fault and that perhaps it was an accident waiting to happen. However one of those midwives did harm to that woman and as such someone should at least acknowledge that they carried out the mistake.

None of us are perfect. Most of us as nurses have made mistakes, given the wrong drug, at the wrong time perhaps to the wrong person. Generally those mistakes are not serious, not life threatening. In such cases at times people have been treated extremely harshly, punished for what might have been a failure of the system. Maybe that is why no one accepted responsibility and why Mayra’s husband still feels that justice has not been done. Somewhere out there a child of 4 has no mother, and never knew that mother and somewhere out there a midwife knows what happened.