Significance: Since 2000, nursing literature and research have aimed at preventing mistakes rather than reconciling once mistakes have occurred.  Nurses may suffer from making a mistake and this suffering may contribute to nurses’ dissatisfaction with the profession and ultimately for leaving the profession.

Purpose of Study:  This study describes the process that nurses experience as they discover and respond to errors in professional practice.

Setting and Sample:  Representative samples of registered nurses were interviewed for this qualitative study.

Methods: A grounded theory approach was used to interview nurses who had direct involvement with mistakes in nursing practice. An interview of participants was conducted by the two investigators and was analyzed by constant comparisons within and between investigators.

Findings:  Four categories emerged upon review of the data:  shock, impact, weigh-in, and restitution.  The participants had similar reactions when an error was made or discovered.  Initially there was shock about the incident followed by emotions such as fear, anger towards self or others, and disbelief or denial. A decision of whether to disclose or not to disclose the error was made (weigh-in).  Restitution occurred once the mistake was disclosed, and if the nurse chose not to disclose the mistake, various processes of internal rationalizing occurred.

Conclusions: Nurses’ experience an identifiable process that reflects the continued perfectionistic model of nursing where the ‘good nurse’ does not make errors and error is equated with silence and blame.  Restitution often was incomplete either with little known of the resolution or a concern that the error had some impact or a negative outcome for the patient.

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