Pronoun Case in an Incident Narrative Headed for Root-Cause Analysis
Six weeks after a wrong-time insulin dose on a 32-bed orthopedic unit, the safety committee has asked for the incident narrative to be rewritten before it goes into the root-cause analysis packet. You are the risk-management reviewer assigned to the revision. The narrative was drafted jointly by the two nurses involved, and its main weakness is pronouns: in several places a reader cannot tell whether "she" means the charge nurse, the patient's daughter, or the patient, and in others the case of the pronoun is simply wrong. Because the packet may be read aloud at a committee meeting and could be subpoenaed, every sentence has to say exactly who did what. Legal has asked you not to add or remove clinical facts - only to fix grammar, case, and reference. You have three sentences marked for correction and one 30-minute meeting with the authors to explain each change.
1. Sentence one: "The charge nurse and me reviewed the MAR at 14:15, and the patient's daughter later asked whom had administered the 0900 dose." Correct it and show the test you used for each pronoun.
Read the worked answer
Both pronouns are in the wrong case, for opposite reasons.
- "The charge nurse and me reviewed" → "The charge nurse and I reviewed." The pronoun is part of the compound subject of reviewed, so it takes subject case. Test: delete the other subject. "Me reviewed the MAR" fails immediately; "I reviewed the MAR" passes.
- "asked whom had administered" → "asked who had administered." The whole clause who had administered the 0900 dose is the object of asked, but case inside the clause is decided by the pronoun's own job. Here it is the subject of had administered, so who.
Revised: "The charge nurse and I reviewed the MAR at 14:15, and the patient's daughter later asked who had administered the 0900 dose."
Contrast worth pointing out to the authors: between you and me is correct because the pronoun follows a preposition. Subject case and object case are decided by function, not by where the pronoun sits in the sentence.
2. Sentence two: "The nurse who the family spoke with documented the error, and the patient's son asked that the note be sent to whomever is on call." Correct it and explain why the second pronoun is not object case even though it follows a preposition.
Read the worked answer
- "who the family spoke with" → "whom the family spoke with." The pronoun is the object of the preposition with, so it takes object case. Leaving the preposition stranded at the end does not change the analysis; with whom the family spoke is the same call, just more formal.
- "to whomever is on call" → "to whoever is on call." This is the trap. The entire clause whoever is on call is the object of to, but the pronoun inside the clause is its subject, and subject case governs.
The reliable procedure: bracket the clause, then ask what the pronoun does inside the bracket. If it is the subject of its own verb, use who/whoever, no matter what precedes the clause.
Revised: "The nurse whom the family spoke with documented the error, and the patient's son asked that the note be sent to whoever is on call."
3. Sentence three: "Both nurses stated that they had verified the dose theirselves and that the physician was upset about them questioning the order." Fix both problems and say why the second fix matters legally.
Read the worked answer
- "theirselves" → "themselves." Theirselves is not a word in standard English; the reflexive form of they is themselves. Reflexive pronouns also need a referent in the same sentence doing the action - here they verifies, so themselves is licensed (unlike "the nurse and myself reviewed," which is not).
- "about them questioning the order" → "about their questioning the order." A gerund (questioning) takes a possessive before it. Them questioning reads as a pronoun plus participle; their questioning names the act as a thing the physician was upset about.
Why it matters here: them questioning leaves open who did the questioning, which is exactly the fact the committee is trying to pin down. The possessive fixes the actor in place.
Revised: "Both nurses stated that they had verified the dose themselves and that the physician was upset about their questioning the order."