Twenty-four to 29 percent . . . general nurses. Ibid.

Outpatient nurses Meredith Mealer et al., “The Prevalence and Impact . . .”

“intense fear, helplessness” See Darlene Welsh, “Predictors of Depressive Symptoms in Female Medical-Surgical Hospital Nurses,” Issues in Mental Health Nursing 30 (2009).

“Often, I feel it’s an impossible job” Interview.

In 2010, Kimberly Hiatt . . . 140-milligram dose. JoNel Aleccia, “Nurse’s Suicide Highlights Twin Tragedies of Medical Errors,” msnbc.com, June 27, 2011.

A ten-fold overdose . . . not necessarily be fatal. Interview with a neonatologist at another hospital.

hospital personnel escorted Hiatt See, for example, JoNel Aleccia. “Nurse’s Suicide Highlights . . .”

(who had heart problems) See, for example, Theresa Brown, “High Price of Mistakes Sits Heavily on Nurses,” The New York Times, The Virginian-Pilot Edition, July 17, 2011.

Hiatt, who told staff . . . careful in the future.” Ibid.

Hiatt was stunned . . . her entire career. JoNel Aleccia, “Nurse’s Suicide Highlights . . .”

Administrators had given her . . .“leading performer.” Ibid.

The state nursing board required . . . See, for example, “Too Many Abandon the ‘Second Victims’ of Medical Errors,” ISMP Medication Safety Alert, July 14, 2011.

Hiatt had difficulty finding . . . committed suicide. Ibid; Carol M. Ostrom, “Nurse’s Suicide Follows Tragedy,” Seattle Times, April 20, 2011.

Hiatt reportedly suffered . . . often be neglected.” See “Too Many Abandon . . .”

surgeons who thought they made . . . See, for example, JoNel Aleccia, “Nurse’s Suicide Highlights. . . .”

92 percent of doctors surveyed . . .” Ibid.

“If we fire every person . . .” F. Norman Hamilton, “Suicide of Nurse after Tragic Event,” Letters to the Editor, Seattle Times, April 22, 2011.

second victims usually require . . . “time of greatest need.” “Too Many Abandon . . .”

“Of course, we will also . . .” Tom Hansen, “Children’s Hospital CEO Responds to Infant Overdose,” kirotv.com, September 28, 2010.

half of nurse respondents believed . . . Thank you to Judy Huntington, the executive director of the Washington State Nursing Association, for providing the author with survey data.

After terminating Hiatt . . . “Patient Safety Day Strengthens Seattle Children’s Efforts to Improve Medication Safety,” Seattlechildrens.org, October 30, 2010.

In 2003 and 2009 . . . See, for example, “Death Was Third Fatal Medication Error At Children’s,” kirotv.com, September 28, 2010.

“This was not the fault . . .” See, for example, Q13 FOX News Web Reporter, on chicagotribune.com, October 1, 2009.

“If my mom got an insulin . . .” JoNel Aleccia, “Nurse’s Suicide Highlights. . .”

Ohio nurse Beth Jasper CNN Wire, “Lawsuit: Nurse Who Died in Car Wreck was ‘Worked to Death,’” KVDR.com, November 13, 2013.

The case was dismissed . . . Dismissal order, James Jasper vs. Jewish Hospital, Court of Common Pleas, Hamilton County, Ohio, entered April 10, 2014.

In Massachusetts, after a newborn . . . Scott Allen, “The ‘Second Victims’ of Medical Tragedies,” Boston Globe, November 30, 2004.

“have a little cry.” Interview.

even when their hospitals . . . Interviews.

if an average hospital RN salary . . . T. M. Dall, “The Economic Value of Professional Nursing,” Medical Care 47, no. 1 (2009).

staffing for hospitals is not . . . Interview, Peter McMenamin. The author is grateful to McMenamin for spending a significant amount of time explaining the economics of nursing.

A strong nursing staff . . . P. Miller, “Nurses Drive Hospital Revenue Too,” HCPRO, Inc. (March 2009).

nurses could do a better . . . Interviews; also see, for example, B. Lombardo and C. Eyre, “Care for Caregiver to Avoid Low Morale and Burnout,” Hospice Management Advisor, August 1, 2009.

“People will just about kill . . .” Donna Gray, “Care Providers Get Compassion Fatigue: Burnout Common Among Healthcare Professionals,” Calgary Herald (Alberta), February 2, 2006.

nurses take self-care measures . . . their feelings. See, for example, Patrick Meadors, “Compassion Fatigue and Secondary Traumatization: Provider Self Care on Intensive Care Units for Children,” Journal of Pediatric Healthcare (January 2008); “Self-Care of Physicians: Strategies for Care,” Hospice Management Advisor, August 1, 2009; “Female Nurses Reduce Burnout in ICU Teams,” Nursing Times, August 30, 2011.

“permitting ourselves to seek support” Interview.

Some hospitals do have programs . . . Interviews.

Barnes-Jewish Hospital in St. Louis recently . . . staff retreats. Interview, Patricia Potter, director of research for patient-care services. See also Laura Landro, “When Nurses Catch . . .”

with experience . . . prepare themselves accordingly. Interview.

registered nurses younger than thirty . . . the profession’s demands. R. Erickson and W. Grove, “Why Emotions Matter: Age, Agitation, and Burnout Among Registered Nurses,” Online Journal of Issues in Nursing, October 29, 2007.

“The greatest common risk” Tara Parker-Pope, “A Doctor’s View of Medical Mistakes,” nytimes.com, March 26, 2008.

Burnout and compassion fatigue have been linked . . . See, for example, B. Lombardo and C. Eyre; Nadine Najjar et al.

correlated with higher patient mortality rates . . . See, for example, Lara Landro, “Informed Patient: Helping Nurses Cope . . .”; Patricia Potter et al.; D. Boyle.

prone to make mistakes. See, for example, Brittany Hoover, “Compassion Fatigue May Cripple Health Workers, Expert Says,” Lubbock Avalanche-Journal, March 30, 2012.

fatigue alone can cause . . . ISMP Medication Safety Alert, “Nurse Advise–ERR,” December 2005.

nurse burnout is linked to . . . $69 million a year. Jeannie P. Cimiotti et al., “Nurse Staffing, Burnout, and Healthcare Associated Infection.” American Journal of Infection Control (September 2012).

Michigan Health and Hospital Association implemented . . . See, for example, Tina Rosenberg, “Speaking Up for Patient Safety, and Survival,” The New York Times, Opinionator, April 28, 2011.

for every 10 percent . . . “Study: Nurse Safety, Patient Safety Linked,” United Press International, November 8, 2011.

a national emergency. See, for example, Meredith Mealer, “The prevalence and impact . . .”

99.9 percent of the nurses surveyed . . . R. Erickson and W. Grove.

“I work where kids die” Interview.

As Georgia nurse Brittney Wilson . . . Wilson gave the author permission to attribute the quote. Wilson posted this comment at: Kevin Pho, “Should nurses be fired for fatal medication errors?” KevinMD.com, May 2, 2011.

all but three circumstances . . . See, for example, R. T. Penson, “Laughter: The Best Medicine?” The Oncologist (September 2005). Globally, the use of humor in hospitals varies by the culture. In Taiwan, for example, nursing school professors teach therapeutic humor more than U.S. faculty, but use that humor less often in clinical settings because of a reverence for illness. See Lenny Chiang-Hanisko, Kathleen Adamle, and Ling-Chun Chiang, “Cultural Differences in Therapeutic Humor in Nursing Education,” Journal of Nursing Research 17, no. 1 (2009).

humor can help patients . . . their treatments. Ibid.

nurses use humor with patients . . . See, for example, Howard J. Bennett, “Humor in Medicine,” Southern Medical Journal (December 2003); R. T. Penson et al.