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Date of Graduation
12-12-2025
Semester of Graduation
Fall
Degree Name
Doctor of Nursing Practice (DNP)
Department
School of Nursing
First Advisor
Jeannie Corey
Second Advisor
Patricia Todd
Third Advisor
Christine Argenbright
Abstract
Medical error is the third leading cause of death in the United States, following cardiovascular disease and cancer. Criminal punishment of nurses and other licensed healthcare providers for unintentional error negatively impacts patient safety and provider wellbeing. Millions of clinicians and patients in the United States remain vulnerable to harm, as Kentucky is the only state to have granted criminal immunity to nurses and other healthcare providers after unintentional error. The purpose of this project was to develop policy options promoting expansion of legislation to additional states. The Health Policy Triangle and Bardach’s Eightfold Path to Policy Analysis frameworks were used to conduct the policy analysis. Additional contextual information on nursing perspectives related to the issue was gathered through focused interviews of 18 registered nurses. Qualitative narrative thematic analysis of interview transcripts revealed overwhelming support for legislation and lack of awareness regarding criminal liability. All participants voiced concerns regarding the role of system level failures in nurse error and the importance of just culture practices in patient safety. Policy options were developed and evaluated for alignment with domains of the IHI Framework for Safe, Effective, and Reliable Care, which serves to guide healthcare organizations in systems level improvement of strategic, operational, and clinical elements. Based on intensive review of all evidence, it was determined that collaborative engagement of healthcare provider stakeholders, healthcare consumers, patient safety advocates, and legislators could increase national awareness of just culture practices and promote support for legislation to decriminalize unintentional error in other states. Partnerships with healthcare consumers and state legislators will be imperative for success. Robust analysis of qualitative and quantitative metrics will be needed to determine the true impact of legislation on patient safety culture and clinician wellbeing.
