When I was working as an ED nurse, we often had nursing students assigned to the area. One day we had an elderly man with asthma in one of the treatment rooms. The physician ordered aminophylline suppositories. After reviewing the “5 rights”—right patient, right medication, right dose, right time, right route—I directed the student to administer the suppositories. All seemed well.
Imagine my surprise when the student proceeded to insert the suppository into the man’s nose! She explained that since it was a breathing problem, she naturally thought they would be inserted nasally. It never occurred to her that these were rectal suppositories and it never occurred to me to ask if she knew what to do with them. We all had a good laugh and that was that.
Another day, another patient, another faux pas: a physician said to “cut the IV,” which everyone knew (that is, we assumed everyone knew) meant to discontinue the patient’s IV. One of my colleagues intervened when she saw a determined-looking student, with bandage scissors in hand, approach the patient’s room, ready to “cut the IV.” We again marveled at the student’s interpretation of the phrasing, and that was that.
And that’s the problem—that was that. There was no documentation of these as “near-miss” errors, and while some of these seemed fairly harmless, suppose the line the student was going to cut had been a PICC line? That could have caused serious harm.
Students need to have real clinical experiences as part of their learning—and because they are executing just-learned skills, they will make errors. In addition, the students who follow them may make the same errors, if there’s no examination of the event or tracking to indicate which errors may be recurrent. Yet, according to this month’s original research article, “Exploring How Nursing Schools Handle Student Errors and Near Misses”:
55% of the responding schools had no tool for reporting student errors and 50% had no system of tracking student errors.
Time for schools to practice transparency.
The authors call for schools to move away from the “blame and shame” response that many seem to have around student errors and follow the trend that’s occurring in practice settings: recognizing that “that people sometimes make mistakes, system issues often contribute to errors, and a balance must be sought between individual accountability and system effectiveness.”
Next month, part 2 of this article will discuss strategies schools might implement towards achieving a fair and just culture of dealing with errors.