Student Errors in the Clinical Setting: Time for Transparency

Mistakes happen.

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.

Undocumented errors.

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.

Editor-in-chief, AJN

One Comment

  1. Wendie Howland October 4, 2017 at 10:14 am

    I had the great pleasure of teaching clinical for multicultural students from all over the world when I lived in Seattle. Some had challenges with idiomatic English, though in fairness they did much better working in their third language than I would have done in either French or Vietnamese. The Chinese woman who had been an obstetrician in Mandarin had great (and sadly for both of us, ultimately insurmountable) difficulty communicating with her patients or staff, and was unable to learn or teach how to use an inhaler, for example. [A student from another region] whose easygoing laissez-faire attitude made her a delight personally was also unreliable about treatments and meds or anything that would make her patient uncomfortable, like postop coughing and deep breathing. I know this is peripheral to the topic, and certainly not as humorous as an intranasal suppository, but thinking about watching these students made me lose sleep at night sometimes.

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