We’ve already covered a number of types of medical errors that can be made by nurses and other medical staff on this blog, but one often overlooked but key demographic it is important not to forget are nursing students. When performing RN duties, student nurses are held to the same standard of care as registered nurses, and therefore are held liable for their actions.[1] Therefore, it is important to look into what kinds of errors nursing students make, why they happen, and how they can be reduced and prevented. This blog post will serve as an introduction to these topics.
Common types of errors
The sorts of mistakes many expect of student nurses are cases involving negligence or distraction. While this is true, and there are certainly many cases where students do not know or disregard proper procedure, many cases of error are similar to those made by seasoned healthcare professionals, especially when it comes to medicine administration.[2] Some of these include misinterpreting an abbreviation, misidentifying drugs due to similar packaging, and programming a pump improperly because of a design flaw.[3]
Why errors occur
Causes of student nurse errors include distraction, lack of immediate nursing supervision, and communication breakdowns when a patient is assigned both to a student and staff nurse.[4] Also, when regarding medication administration, error can be due to nonstandard scheduled time of administration, documentation issues, confusing drugs prepared for multiple patients, or unawareness of held or discontinued medication.[5]
It is also important to note that inadequate supervision is due not only to the student but to their nursing instructor as well. Error can occur if an instructor gives a task to a student they know is not capable of completing it, or if they do not delegate a qualified supervisor to advise the student during a particular task.[6] This can result in serious legal trouble not only for the student, but for the instructor as well.
The culture problem facing student error
The traditional response in nursing education is to respond to student error with some form of discipline, ranging from warnings to immediate dismissal.[7] Some researchers have noted that many faculty members continue to believe that “individual self-vigilance is what matters most,” meaning a student is completely at fault if they make an error.[8] This, along with the concern that public knowledge of student error could result in clinical organizations retracting partnerships with universities, has led to a culture of shame, blame, and fear in many nursing programs.[9] This, in turn, leads to a lack of error reporting, questions asked, and a lack of good communication and transparency.[10]
The formerly mentioned study also found that half of the schools responding to their survey had no policy for managing students following a clinical error or near miss and over half reported having no tool for reporting those errors.[11] In a climate of secrecy and fear, student errors are less likely to be addressed and fixed, creating worse results for patients, clinical settings, and the students themselves.
What can be improved?
Beyond cultivating a culture of openness and communication, there are many basic rules students and staff can be better at following. Here are some of the big ones:
- Students must be appropriately supervised at all times
- Students should verbally confirm actions of medication administration while in the presence of an instructor or preceptor
- Documentation is critical to make sure that the record is maintained and accurate
- Curriculum needs to reflect different types of medical errors and how best to prevent them
- Both students and faculty must be given a proper orientation to the hospital’s methods and electronic data system of administration.[12]
Nursing students need the practical experience of a clinical setting to become the best professionals they can be. They deserve to be trained properly in an environment that values their success as best it can. Through combined effort and diligence, better safety and professionalism can be improved for all.
[1] Shinn, Linda J., “Yes, You Can Be Sued,” NursingWorld.org, 2001, http://ana.nursingworld.org/mods/archive/mod310/cerm101.htm
[2] “Error-prone Conditions That Lead to Student Nurse-related Errors,” Institute for Safe Medication Practices, Oct. 18, 2007, https://www.ismp.org/newsletters/acutecare/articles/20071018.asp
[3] Ibid
[4] “Error-prone Conditions”
[5] Ibid
[6] Shinn, “Yes, You Can Be Sued”
[7] Disch, Joanne, Barnsteiner, Jane, Conner, Susan, & Brogren, Fabiana, “Exploring How Nursing Schools Handle Student Errors and Near Misses,” American Journal of Nursing, Oct. 2017, https://journals.lww.com/ajnonline/Fulltext/2017/10000/CE___Original_Research___Exploring_How_Nursing.20.aspx
[8] Ibid
[9] Ibid
[10] Ibid
[11] Ibid
[12] McNichol Rothenberger, Catherine A., “Medication Errors Involving Students in Hospitals,” Kolsby Gordon Attorneys, June 27, 2016, http://kolsbygordon.com/attorney-blogs/medication-errors-involving-students-hospitals/