After the Medication Error: Recent Nursing Graduates' Reflections on Adequacy of Education

Addressing Medication Administration Safety Through Simulation: A Quasi-Experimental Study Among Nursing Students

Healthcare institutions are dedicated to minimizing medication errors and promoting their reporting. This study investigates the impact of simulation on nursing students' attitudes toward and intention to report medication errors. A quasi-experimental one-group pre-post-test study was conducted. Third-year nursing students (N = 63) participated in a scenario-based simulation for medication administration. Participants' errors were documented. Participants self-reported attitudes toward medication administration safety and intention to report errors. The most reported error was "contraindicated in disease" (61%). The simulation increased attitudes of preparedness by the training program received (p < 0.01) and belief in the patient's involvement in preventing errors (p < 0.01), and decreased the belief that professional incompetence reveals errors (p = 0.015). Intention to report errors was influenced by medication error training received (p = 0.045), confidence in error reporting (p < 0.001), and a sense of responsibility to disclose errors (p = 0.001). Simulation effectively shapes attitudes and intentions regarding medication error reporting. Improving nursing students' awareness, skills, and clinical judgment can foster a safety culture and potentially reduce patient harm. Future research should examine the long-term effects of simulation and its impact on reducing medication errors.

Educational preparedness and perceived importance on confidence in new graduate registered nurses' medication administration

BACKGROUND

Medication errors are the most common type of error affecting patient safety and the most preventable cause of adverse medical events globally. Medication errors occur most frequently (33.3 %) during the administration phase. New nurses felt their education left them vulnerable to errors, suggesting that current curricula may be insufficient.

PURPOSE

The purpose of this study was to determine the relationship between new nurses' educational preparedness and perceived importance with confidence in medication administration. A secondary aim was to determine the difference in the variables based on demographic information.

METHODS

A descriptive, correlational design was employed using the Theory of Human Error. Ohio newly licensed nurses were surveyed for their educational preparedness, perceived importance, and confidence in nine medication competencies. Descriptive and inferential statistics were used.

RESULTS

N = 201. A significant, positive relationship was found between both educational preparedness and confidence, and perceived importance and confidence. Nurses reported high levels of educational preparedness, perceived importance, and confidence. All correlations and regressions were significant, indicating that as nurse educational preparedness and/or perceived importance increases, the odds of confidence increases. Demographic analysis demonstrated that practice area and years of experience significantly contributed to differences in the variables.

CONCLUSIONS

Understanding the educational preparedness and perceived importance of the medication competencies can help guide future research into creating educational and clinical interventions to ultimately decrease medication errors.

An Interruption Management Education Bundle: Feasibility Testing With Nursing Students

BACKGROUND

Interruptions and distractions are pervasive in health care settings, increase risks for errors, and decrease task efficiency. Researchers recommend the use of strategies to mitigate their negative effects.

PURPOSE

The purpose was to assess the feasibility and acceptability of (1) an education bundle that included an interruption management strategy and (2) simulated scenarios with embedded interruptions and distractions.

METHODS

Nineteen undergraduate nursing students participated in this repeated-measures, multimethods feasibility study. Data on interruption management behaviors were collected across 3 timepoints via direct observation of individual-simulated medication administration. Participants' perceptions of the education bundle were explored via semistructured interviews.

RESULTS

Participants described the simulated scenarios as realistic and interruption management strategy as easy to use and remember. Participants voiced increased confidence in handling interruptions after learning the strategy. The strategy averaged 4 seconds to apply.

CONCLUSIONS

Findings support the feasibility and acceptability of the bundle and need for studies to investigate the impact of the strategy on errors and task durations.

Final year nursing students' preparedness for medication administration during COVID-19: A multi-site survey study

AIM

To examine final-year undergraduate nursing students' characteristics and their perceived preparedness for medication administration across three universities during COVID-19.

BACKGROUND

Medication administration is a complex process and medication errors can cause harm to the patient. Nurses are at the frontline of medication administration; therefore, nursing students must be well-prepared to administer medicines safely before graduation. Little is known about final-year undergraduate nursing students' perceived medication administration preparedness during COVID-19.

DESIGN

A multi-site study using a cross-sectional survey of student demographics, the 'Preparedness for Medication Administration' (Revised) tool and an open-ended question.

METHODS

The questionnaire was distributed to nursing students in their final semester of the program in 2022 across two universities in Australia and one in New Zealand. Completed surveys n=214. Descriptive statistics were used to analyse the demographic data. Differences in demographic data and preparedness scores between the three universities were analysed using ranked means, correlation coefficient, Chi-Square, Mann- Whitney U and Kruskal- Wallace H. Directed content analysis was used to analyse the data from the open-ended question.

RESULTS

Overall, students reported high preparedness scores for medication. International students reported significantly higher preparedness scores (Md =119, n=29) compared with domestic students (Md=112.00, n=164), U=1759.50, z=-2.231, p=02, r=.16. Mean ranked scores for each item were above average across the three universities. The impact of COVID-19 on curriculum and students' opportunity to practice may be one explanation for the difference in preparedness scores between universities. International participants reported significantly higher scores on the Preparedness for Medication Administration (Revised) tool than domestic participants. Older students were more confident in applying principles of pharmacology to practice. Students' comments generated three major categories and five subcategories indicating preparedness gaps.

CONCLUSION

This study provides insights into students' medication management preparedness during restrictions and before transitioning to the role of Registered Nurse. It highlights the need to provide integrated and comprehensive medication education and assessments throughout the curriculum and the need for additional support for newly graduated nurses in medication management due to the restrictions.

Maintaining and Enhancing Nursing Students' Pharmacology Knowledge to Improve Patient Safety

BACKGROUND

Nurses play a vital role in the medication administration process and are frequently involved in adverse drug events (ADEs). One identified cause of ADEs is lack of pharmacology knowledge received during their training and/or failure to maintain this core information: the latter cause has been described as skill decay.

PURPOSE

The purpose of this quality improvement project was to implement an online pharmacology review program to maintain and/or improve nursing students' pharmacology knowledge, thus decreasing skill decay over the school's summer break.

METHODS

Nursing students enrolled in a 4-year BSN program participated in a virtual pharmacology knowledge review program consisting of a pretest survey, learning modules, quizzes, and a final posttest survey.

RESULTS

Comparisons showed statistical significance in test score improvement from pretest to posttest.

CONCLUSIONS

This project demonstrates that a review program can enhance nursing students' pharmacology knowledge throughout their summer break. It adds to the limited data about the need for pharmacology programs to decrease skill decay.

Competency scale of quality and safety for greenhand nurses: instrument development and psychometric test

BACKGROUND

Guaranteeing nursing service safety and quality is a prioritized issue in the healthcare setting worldwide. However, there still lacks a valid scale to measure the quality and safety competencies of newly graduated nurses globally.

METHODS

This scale was developed in two phases. In Phase One, a literature review and three-round e-Delphi were conducted to generate the initial item pool; while in Phase Two, five experts tested the content validity of the scale. The construct validity was evaluated using confirmatory factor analysis (CFA), and the data were collected among 1,221 newly graduated nursing students between May, 2017 and August, 2017. Finally, the internal consistency reliability and test-retest reliability were tested.

RESULTS

The final version's Competency Scale of Quality and Safety (CSQS) was confirmed by the CFA involving 64 items in six dimensions, including patient-center care, safety, evidence-based practice, collaboration and teamwork, continuous quality improvement, and informatics. The results of data showed that the data supported the modified model of CSQS (Standardized Root Mean Square Residual = 0.03, p = 0.053, Adjusted Goodness of Normed Fit Index = 1.00, Root Mean Square Error of Approximation = 0.007, Fit Index = 0.95, Goodness of Fit Index = 0.97, χ2/df = 1.06), and the standardized factor loadings of items were from 0.59 to 0.74 (p < 0.05). The internal consistency reliability of the total scale was 0.98, and the test-retest reliability was 0.89.

CONCLUSIONS

CSQS was a valid and reliable instrument to measure the safety and quality abilities of greenhand nurses, and could be fully utilized by nursing students, greenhand nurses, nursing educators, as well as hospital nursing managers.

Faculty Development on the Use of a Clinical Judgment Model in the Pre-licensure Nursing Curriculum

Clinical judgment is an essential component of safe nursing practice that pre-licensure nursing students should develop by graduation from accredited nursing programs. For novice nurses, the consequences of underdeveloped clinical judgment skills that do not meet the demands of clinical practice are serious. This theory-practice gap correlates with increased numbers of errors occurring during care delivery, resulting in poorer patient outcomes. From a student perspective, this problem correlates with lower first-time pass rates on the NCLEX licensing exam. For nurse educators, there are uncertainties about how to resolve this complex and costly problem, but faculty development is one evidence-based solution to explore. The purpose of this article is to describe a three-pronged quality improvement project consisting of: 1) a faculty development session to teach faculty to implement the National Council State Boards of Nursing's Clinical Judgment Model (CJM) in their courses; 2) the use of the Clinical Judgment Tool; and 3) the implementation of a faculty champion to sustain and maintain ongoing faculty momentum to foster clinical judgment. This article focuses on how faculty can develop their own CJM faculty development session and use a CJM across the course curriculum.

Reproductive endocrinology and infertility nurse online orientation program evaluation: a quality improvement initiative

Objective

To evaluate the effectiveness of a novel online orientation program (Nurses in REI Communication, Knowledge, and Skills [NRCKS]) among new and early-career reproductive endocrinology nurses to make recommendations for program quality improvement.

Design

Quality improvement.

Subjects

Reproductive endocrinology nurses.

Exposure

Online orientation program featuring 8 micromodules.

Main Outcome Measures

Knowledge acquisition, confidence, user experience, skills, and abilities.

Results

Nurses demonstrated a statistically significant increase in reproductive knowledge after completion of NRCKS. Most nurse users felt confident applying knowledge in the clinical settings after program completion. Nurse users had an overall positive experience with interactive components and quality of visuals. Most nurse users gained skills and abilities that they will implement into professional practice. Nurses suggested improving navigation, adding more visuals in content expert presentations, and teaching soft skills necessary for the role of reproductive endocrinology nurses.

Conclusions

Nurses in REI Communication, Knowledge, and Skills was well received by nurse participants and emphasized the receptivity and desire for reproductive health and fertility training among novice reproductive endocrinology nurses. Nurses in REI Communication, Knowledge, and Skills increased nursing knowledge, and nurses felt confident applying newly gained knowledge in the clinical setting on completion. Nurse participants provided invaluable feedback for quality improvement to inform the hard launch. The results emphasize the online orientation's strong potential to close the theory-practice gap.

Effects of Career Adaptability and Self-Efficacy on Transition Shock Among Newly Graduated Nurses During the COVID-19 Pandemic: A Survey Conducted in China

BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak has increased the work pressure of nurses worldwide, and managers must provide support and assistance for the transition period of newly graduated nurses.

METHOD

A cross-sectional design was adopted to collect a sample of 318 newly graduated nurses from six hospitals in China during the COVID-19 pandemic. Data were collected using a questionnaire that consisted of a demographic questionnaire, the Transition Shock Scale (2015), the Career Adapt-Ability Scale (2012), and the General Self-Efficacy Scale (2001).

RESULTS

The transition shock of newly graduated nurses was 3.77 ± 0.48 in China. Regression analysis showed that transition shock among newly graduated nurses was predicted by career adaptability, general self-efficacy, living with one's parents, and education level, which accounted for 37.7% of the variance in transition shock.

CONCLUSION

Newly graduated nurses experienced a relatively high level of transition shock in China during the COVID-19 pandemic. Managers may offer continuing education to reduce the transition shock of newly graduated nurses based on the factors that affect their transition shock. [J Contin Educ Nurs. 2023;54(11):524-532.].

Undergraduate nursing student experiences in American clinical learning environments: A descriptive study

BACKGROUND

Newly qualified nurses are often considered inadequately prepared for practice. During nursing students' educational preparation, clinical learning environments are intended to provide experiences for students to develop skills and clinical judgments needed for safe practice. Yet, a recent systematic review found no quantitative evidence that clinical education models facilitate student learning. In addition, little is known about the frequency and type of skills students perform when in clinical settings.

OBJECTIVE

To investigate undergraduate nursing student experiences with skills and the quality of supervision and feedback received when performing skills in clinical settings.

DESIGN

Retrospective descriptive.

SETTING

A mid-sized private university in the Midwestern part of the United States.

METHODS

Students completed an online survey after clinical days during one semester. Students self-reported their experiences with medication administration, psychomotor skills and physical assessments via multiple choice items. Descriptive statistics were calculated using Microsoft 365 Excel. Content analysis was performed of one open-response survey item.

RESULTS

A total of 496 surveys were completed. On average, during one clinical day, 13.5 % of students administered medication, 20.5 % performed a psychomotor skill, and 64 % completed a physical assessment. Students were most frequently supervised by bedside nurses and reported the quality of their supervision and feedback as "very good" or "good". Some students reported being restricted from administering medication and performing other skills due to a clinical site policy.

CONCLUSIONS

In this study, students performed few skills and assessments when in clinical settings. Increased clinical experiences are needed for students to develop competencies to better prepare them for safe practice. The findings contribute to the dearth of knowledge related to the clinical learning experiences of undergraduate nursing students, and can guide strategies to improve new nurse preparedness.

Nurses and nursing students as second victims: A scoping review

BACKGROUND

Second victim describes the impact on health care professionals after an error causing preventable patient harm. However, to date, the impact of making errors in practice by nurses and/or nursing students is unclear.

PURPOSE

To describe and understand what is known about nurses and nursing students as second victims.

METHODS

A scoping review was completed using three databases: CINAHL, Medline, and Proquest for the period between 2010 and 2022. A total of 23 papers underwent thematic analysis.

DISCUSSION

Three themes were identified: (a) Psychological distress and symptomatology, (b) Coping-response/reactions to errors, and (c) Seeking support and understanding.

CONCLUSION

Nurses and nursing students' well-being and productivity levels can be negatively affected by inadequate team and organisational support. To improve team functioning, appropriate support mechanisms must be implemented to assist nurses who experience significant distress after making errors. Nursing leadership should prioritise improving support programs, assessing workload allocation, and increasing awareness amongst leaders of the potential benefits of providing support to second victims.

Next Generation NCLEX: Why Simulation Matters

BACKGROUND

The Next Generation NCLEX (NGN) is designed to specifically measure nursing clinical judgment. Schools of nursing are looking for ways to better integrate nursing clinical judgment into their curriculum. One effective strategy to promote nursing clinical judgment is simulation.

METHOD

This article explains how to conduct simulations that follow the National Council of State Boards of Nursing Clinical Judgment Measurement Model (NCJMM). Focusing on layer three of the NCJMM, specific examples are provided that link each step of layer three to nursing clinical judgment using simulation.

RESULTS

Beginning with Recognizing Cues, the simulation focuses on each step of layer three ending with Evaluating Outcomes. The simulation concludes with a debriefing session to solidify relationships between the variables.

CONCLUSION

Simulation has the potential to improve nursing clinical judgment as well as pass rate on the NGN. [J Nurs Educ. 2023;62(5):285-289.].

Effect of Manikin and Virtual Simulation on Clinical Judgment

BACKGROUND

Evidence suggests competency in clinical judgment may be lacking in new graduate nurses. Graduates from accelerated baccalaureate nursing (ABSN) programs have even less time to develop clinical judgment competency. Various simulation modalities, including high-fidelity manikin and virtual reality, have been used to develop clinical judgment in prelicensure students. However, the outcomes of these simulation modalities on clinical judgment in ABSN students is not well understood.

METHOD

An integrative literature review was conducted using five databases with primary research that examined the effect of manikin or virtual simulation on clinical judgment in BSN students.

RESULTS

Fourteen studies were included in this review. The findings were organized using Tanner's Clinical Judgment Model.

CONCLUSION

Findings from this review were mixed, with a lack of evidence comparing the two modalities. Future research should include comparison studies aimed at examining the effects of these modalities with ABSN students. [J Nurs Educ. 2022;61(12):693-699.].

Toward Constructive Change After Making a Medical Error: Recovery From Situations of Error Theory as a Psychosocial Model for Clinician Recovery

BACKGROUND

Making a medical error is a uniquely challenging psychosocial experience for clinicians. Feelings of personal responsibility, coupled with distress regarding potential or actual patient harm resulting from a mistake, create a dual burden. Over the past 20 years, experiential accounts of making an error have provided evidence of the associated distress and impacts. However, theory-based psychosocial support interventions to improve both individual outcomes for the involved clinicians and system-level outcomes, such as patient safety and workforce retention, are lacking. There is a need for evidence-based ways to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts. Such interventions play a role within wider programs of health professional support. We sought to address this by developing a testable, psychosocial model of clinician recovery after error based on recent evidence.

METHODS

Systematic review methodology was used to identify studies published between January 2010 and June 2021 reporting experiences of direct involvement in medical errors and/or subsequent recovery. A narrative synthesis was produced from the resulting articles and used as the basis for a team-based qualitative approach to model building.

RESULTS

We identified 25 studies eligible for inclusion, reporting evidence primarily from experiences of doctors and nurses. The identified evidence indicates that coping approach, conversations (whether they occur and whether they are perceived to be helpful or unhelpful), and learning or development activities (helpful, unhelpful or absent) may influence the relationship between making an error and both individual clinician outcomes of emotional impact and resultant practice change. Our findings led to the development of the Recovery from Situations of Error Theory model, which provides a preliminary theoretical basis for intervention development and testing.

CONCLUSIONS

The Recovery from Situations of Error Theory model is the first testable psychosocial model of clinician recovery after making a medical error. Applying this model provides a basis to both structure and evaluate interventions to decrease the distress of making a medical error and its impacts and to support the replication of interventions that work across services and health systems toward constructive change. Such interventions may be embedded into the growing body of peer support and employee support programs internationally that address a diverse range of stressful workplace experiences.

Nursing Student Medication Administration Practice in the Clinical Setting: A Descriptive Study

BACKGROUND

Nurses are instrumental in preventing medication errors that cause patient harm. Increased practice and educational interventions are suggested to prepare nursing students to safely administer medications. However, a quantified account of the reality of nursing student medication administration practice in the clinical setting is unknown.

METHOD

This cross-sectional descriptive study assessed the frequency and quality of nursing student medication administration practice in the clinical setting. A convenience sample of prelicensure nursing students (n = 222) completed an electronic Nursing Student Medication Administration Survey after each clinical day for one semester.

RESULTS

Overall, participants on average had one medication administration experience, administered two drugs, and administered medications to one patient. Most medication administration experiences were supervised by bedside RNs.

CONCLUSION

Medication administration opportunities in the clinical setting are unpredictable and vary by facility and nursing program policy. Further investigation is necessary. [J Nurs Educ. 2022;61(3):137-142.].

Undergraduate Nursing Students and Management of Interruptions: Preparation of Students for Future Workplace Realities

AIM

The aim of this study was to investigate interruption management strategies and associative cues used by nursing students when interrupted during simulated medication administration.

BACKGROUND

Interruptions occur with high frequency in health care settings and are associated with increased medication errors and decreased task efficiency. The Altmann and Trafton memory for goals model, a cognitive-science model, proposes use of associative cues during an interruption to mitigate these negative effects.

METHOD

A mixed-methods, two-site study explored associative cues and other management strategies that nursing students used when interrupted during simulated medication administration. Data were collected via direct observation and semistructured interviews.

RESULTS

Students primarily multitasked (66.7 percent) during the interruption. Few students (5.5 percent) used associative cues. Students voiced the need for education and practice on how to manage interruptions.

CONCLUSION

Evidence-based strategies are required to prepare nursing students for workplace interruptions. Use of associative cues during interruptions warrants further investigation.

Medication administration behaviors in prelicensure nursing students: A longitudinal, cohort study

AIM

This longitudinal study identified changes in safe medication administration behaviors in a single cohort of students followed over four semesters of nursing school.

BACKGROUND

Over 40% of a nurse's shift is dedicated to the processes of medication administration, placing them in a position to interrupt costly medication errors. Yet, despite efforts to decrease medication errors, including electronic medical records, smart pumps, and standardized processes, 5% of hospitalized patients experience adverse drug events and the sequela costs billions of dollars annually. One cognitive aid first introduced in nursing school to help nurses administer medications safely is the rights method, including the foundational five (patient, medication, dose, route, and time). However, facility restrictions, complicated electronic health records, and high faculty-to-student ratios are limiting opportunities to apply these rights and develop safe medication administration competency. Although nursing faculty and clinical partners expect competency when initially licensed as professionals, graduating nursing students are not competent and new graduates feel ill prepared to deliver medications safely. Previous studies report findings on safe medication administration in different cohorts of nursing students, but none has followed the same cohort of students throughout nursing school.

DESIGN

Using a non-experimental design, the same cohort of nursing students was followed over four semesters and observed independently administering medications in simulation scenarios.

METHODS

Each semester, this cohort of students self-selected into 10-12 simulation groups. One student from each group was randomized to the role of primary nurse. Guided by the NLN/Jeffries simulation theory and the International Nursing Association for Clinical Simulation and Learning's Standards of Best Practice: Simulation^SM, students participated in four simulations that required the primary nurse to deliver medications as part of clinical care. A single investigator completed an observational checklist during the simulations on verification of the foundational five rights in these students.

RESULTS

Verification of most rights varied each semester, but students consistently did poorly verifying right dose. One hundred percent of students observed in the first semester did not verify all five rights. At the time of graduation, 80% of students observed did not verify all five rights prior to medication administration.

CONCLUSIONS

These concerning findings align with previous research showing that students are not safely administering medications in patient care settings. Educators, administrators, and healthcare systems need to ensure that students receive consistent, high-quality experiences vital to training future nurses for competency in safe medication administration.

Nonclinical Transition-to-Practice Courses: A Review of Course Content

BACKGROUND

Both clinical and nonclinical transition-to-practice courses have been offered to facilitate the transition from student to novice nurse.

PROBLEM

Nonclinical transition-to-practice courses are less widely discussed in the literature; thus, their content and effectiveness have not been examined.

APPROACH

Academic institutions with baccalaureate nursing programs were surveyed to determine if they offered a nonclinical transition-to-practice course and to identify the associated content.

OUTCOME

Of 19 responding institutions, 15 reported having a nonclinical transition-to-practice course. Eighty-seven percent of the courses address ethical dilemmas, and 80% include delegation, interview preparation, stress management, and work/life balance.

CONCLUSION

Although schools of nursing are urged to address students' transition to practice, there is considerable variation in the nonclinical topics addressed. Research is needed to provide guidance to maximize the impact of these nonclinical transition-to-practice courses on new nurses' transition experience.

Medication math dosage assessment anxiety in undergraduate nursing students: A systematic review

BACKGROUND

Medication calculation assessment is commonplace in undergraduate nursing programs. A test is routinely used to assist in the determination of safe medication administration practice in a clinical setting. Multiple factors negatively impact student performance.

AIM

The aim of this article is to analyze current literature related to medication calculation assessment and undergraduate nursing student anxiety.

METHOD

A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Articles included were peer-reviewed publications focused on undergraduate nursing student anxiety related to medication dosage calculation.

FINDINGS

Anxiety related to medication calculation assessments can stem from students' personal lives and previous math experiences. Interventions related to increasing self-efficacy can impact student performance on assessments.

CONCLUSION

A variety of interventions to assist undergraduate nursing students increase performance on assessments were indicated in the literature. Advances in educational technologies allow for more assessment options to facilitate safe medication practices.

Critical Thinking Medication Storytelling: A Teaching Strategy to Engage Thoughts, Emotions, and Creativity

ABSTRACT

Nursing students struggle to learn medications that their patients have been prescribed, often regurgitating information found in a drug book or on a drug card. Watching students do this led to the development of the Critical Thinking Medication Storytelling assignment. The assignment was designed to bring information to life in a creative and meaningful way, enabling students to see how specific medications interrelate with the patient's condition. Qualitative results from students revealed that students embraced this teaching strategy; the strategy was effective for acquiring drug knowledge.

The transition from nursing student to practicing nurse: An integrative review of transition to practice programs

The transition from student to novice is a difficult time. Although the novice nurse is excited to start working, the nurse struggles with acclimating to a new role with new responsibilities and the need to reconcile disparities between what was taught in school and what is practiced in the real world. To lessen the impact of the transition experience, health care organizations have implemented transition-to-practice programs including orientations, preceptorships, and residencies. Despite these efforts, if the novice nurse does not find these programs helpful, there is still a risk that the transition experience will not conclude with successful results. This integrative review examined qualitative studies that explored the transition-to-practice experience of novice nurses who participated in a transition-to-practice program provided by their place of employment. Thirteen articles met the criteria for this integrative review; seven themes emerged from the commonalities in the studies: socialization, professional growth, feeling supported, transition challenges, reflections, transition shock, and feelings. Though the transition period includes unique experiences for each novice nurse, the common feelings and needs identified in these studies require nurse educators and the healthcare organizations to ensure that novice nurses are prepared and given the tools to successfully transition to professional nursing practice.

Managing Chemotherapy Extravasation Across Transitions of Care: A Clinical Nurse Specialist Initiative

Chemotherapy extravasation can lead to serious patient harm in patients with cancer. For nurses who administer vesicant chemotherapy, extravasation is a primary concern. Regardless of nurse experience level and despite prevention strategies, extravasations occur. Literature related to nurse management of chemotherapy extravasation beyond initial treatment is lacking, and no descriptors are available for a formalized process. Communication gaps and a lack of standardized follow-up within a 1400-bed, quaternary care academic medical institution contributes to challenges in care continuity when patients transition between hospital and ambulatory settings. With chemotherapy extravasation, the site does not immediately exhibit signs of tissue injury, leading to a false sense of security. As a result, tissue damage can be significant by the time the patient returns for his or her regular appointment. Two oncology clinical nurse specialists (CNSs) recognized an opportunity to bridge the gap and overcome the challenges by addressing patient needs postextravasation. Between 2015 and 2016, a formal consult process was designed, approved, and implemented to observe, manage, and make recommendations for timely care and follow-up. Since implementation of the process, the oncology CNSs have received multiple requests for consultations. Nursing staff report increased comfort levels with this process in place. A formalized process for managing chemotherapy extravasations increases patient safety and patient and nurse satisfaction.

Educating generation Z: Psychosocial dimensions of the clinical learning environment that predict student satisfaction

Generation Z (Gen Z) nursing students have characteristics that differentiate them from previous cohorts. They are entrenched in technology, prefer to work at their own pace, seek a great deal of feedback, and can be anxious. Because Gen Z is also entrepreneurial, it is important to identify strategies for promoting satisfaction among Gen Z nursing students to retain them in nursing. This study sought to identify the psychosocial dimensions of the clinical learning environment that best predict Gen Z nursing student satisfaction in the medical-surgical clinical learning environment. A secondary analysis was performed on data collected using the Revised Clinical Learning Environment Inventory-32. Maximum Likelihood regression analysis identified predictors of satisfaction. Three subscales of the CLEI-32, reflecting 3 psychosocial dimensions of the clinical learning environment, significantly predicted student satisfaction in the clinical learning environment, after controlling for clustering effects of students within hospitals. Findings were consistent with the literature on Gen Z learners and revealed that their satisfaction improves when they can make decisions, work at their own pace, and receive direction, feedback, and support. The effect of hospital environment on the clinical learning environment should be investigated further; other variables that predict satisfaction remain to be identified.

Nurses' Perceived Causes of Medication Administration Errors: A Qualitative Systematic Review

BACKGROUND

Medication administration errors (MAEs) are a critical patient safety issue. Nurses are often responsible for administering medication to patients, thus their perceptions of causes of errors can provide valuable guidance for the development of interventions aimed to mitigate errors. Quantitative research can overlook less overt causes; therefore, a qualitative systematic review was conducted to present a synthesis of qualitative evidence of nurses' perceived causes of MAEs.

METHODS

Publications from 2000 to February 2019 were searched using four electronic databases. Inclusion criteria were articles that (1) presented results from studies that used a qualitative or mixed methods design, (2) reported qualitative data on nurses' perceived causes of MAEs in health care settings, and (3) were published in the English language. Sixteen individual articles satisfied the inclusion criteria. Methodological quality of each article was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the data was performed. Perceived causes of errors were labeled as knowledge-based, personal, and contextual factors.

RESULTS

The primary knowledge-based factor was lack of medication knowledge. Personal factors included fatigue and complacency. Contextual factors included heavy workloads and interruptions. Contextual factors were reported in all the studies reviewed and were often interconnected with personal and knowledge-based factors.

CONCLUSION

Causes of MAEs are perceived by nurses to be multifactorial and interconnected and often stem from systems issues. Multifactorial interventions aimed at mitigating medication errors are required with an emphasis on systems changes. Findings in this review can be used to guide efforts aimed at identifying and modifying factors contributing to MAEs.

Transition shock and newly graduated nurses' job outcomes and select patient outcomes: A cross-sectional study

AIM

This study examined transition shock experiences in newly graduated nurses as well as its relative influence on job outcomes (job satisfaction, stress and burnout, and intent to leave their organisation) and select patient outcomes (missed care, adverse events and perceived quality of care).

BACKGROUND

Transition shock is a reality common among newly graduated nurses and has been considered an issue relevant to nursing administrators. To date, the mechanism by which transition shock perception is linked with nurse and patient outcomes remains unexplored.

METHODS

A descriptive, cross-sectional design was used. One hundred seventy-six newly graduated nurses (nurses with <1 year of work experience) were included in the study. Data were collected using seven standardized scales.

RESULTS

Hospital classification (e.g., being employed in a government-owned hospital) (β = 0.255; p = .001) predicted transition shock. Overall, newly graduated nurses reported greatest challenges with regard to their expectations of the actual work environment (mean = 2.60, standard deviation = 0.42) and in balancing their professional and personal lives (mean = 2.51, standard deviation = 0.35). Higher levels of reality shock were associated with adverse patient events (β = 0.821; p = .001).

CONCLUSION

New graduates experience great challenges in balancing their professional and personal lives. Ensuring work-life balance and work readiness in newly graduated nurses may potentially reduce the occurrence of missed nursing care and adverse events.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers can adequately support newly graduated nurses' transition through the implementation of empirically based transition programmes. By providing flexible work arrangement, reasonable workload, adequate nurse staffing, limited mandatory overtime and self-scheduling, nurse managers can effectively assist newly graduated nurses in attaining work-life balance.

Newly graduated registered nurses' self-assessed clinical competence and their need for further training

Aim

To explore and describe changes in self-assessed clinical competence and the need for further training among newly graduated Registered Nurses during their first 15 months of professional work in acute care hospital settings.

Design

Quantitative longitudinal design.

Methods

The 50-item Professional Nurse Self-Assessment Scale of clinical core competencies II was used. A total of 45 newly graduated Registered Nurses answered the questionnaire at four different occasions. Data were collected after 2, 5, 9 and 15 months of working experience.

Result

The components "ethical decision-making," "cooperation and consultation" and "clinical leadership" were rated highest in clinical competence and lowest in need for further training. The components "professional development" and "critical thinking" were rated lowest in clinical competence and "direct clinical practice" rated highest in need for further training. The clinical competence increased significant between 9-15 months, with the exception of "critical thinking" and need for further training decreased significantly between 9-15 months, with the exception of "critical thinking."

Nursing Students' Perceptions of Just Culture in Nursing Programs: A Multisite Study

BACKGROUND

While just culture is embraced in the clinical setting, just culture has not been systematically incorporated into nursing education.

PURPOSE

The purpose of this study was to assess prelicensure nursing student perceptions of just culture in academia.

METHODS

Following a quantitative, descriptive design, the Just Culture Assessment Tool for Nursing Education (JCAT-NE) was used to measure just culture across multiple (N = 15) nursing programs.

RESULTS

The majority of JCAT-NE respondents (78%) reported their program has a safety reporting system, 15.4% had involvement in a safety-related event, and 12% submitted an error report. The JCAT-NE mean total score was 127.4 (SD, 23.6), with a statistically significant total score decline as students progressed from the beginning (133.6 [SD, 20.52]) to the middle (129.77 [SD, 23.6]) and end (122.2 [SD, 25.43]) of their programs (χ[2] = 25.09, P < .001).

CONCLUSIONS

The results from this study are a call to action for nursing education to emphasize the tenets of just culture, error reporting, and quality improvement.

[Influencing Factors and Consequences of Near Miss Experience in Nurses' Medication Error]

PURPOSE

This study aimed to predict the influencing factors and the consequences of near miss in nurses' medication error based upon Salazar & Primomo's ecological system theory.

METHODS

A convenience sample of 198 nurses was recruited for the cross-sectional survey design. Data were collected from July to September 2016. Using the collected data, the developed model was verified by structural equation modeling analysis using SPSS and AMOS program.

RESULTS

For the fitness of the hypothetical model, the results showed that χ² (χ²=258.50, p<.001) was not fit, but standardized χ² (χ²/df=2.35) was a good fit for this model. Additionally, absolute fit index RMR=.06, RMSEA=.08, GFI=.86, AGFI=.81 reached the recommended level, but the Incremental fit index TLI=.82, CFI=.85 was not enough to reach to the recommended level. With the path diagram of the hypothetical model, caution (β=-.29 p<.001), patient safety culture (β=-.20, p=.041), and work load (β=.18, p=.037) had a significant effect on the near miss experiences in nurses' medication error, while fatigue (β=-.06, p=.575) did not affect it. Moreover, the near miss experience had a significant effect on work productivity (β=-.25, p=.001).

CONCLUSION

These results have shown that to decrease the near miss experience by nurses and increase their work productivity in hospital environments would require both personal and organizational effort.

Newly graduated nurses' clinical competencies and need for further training in acute care hospitals

AIM

To assess self-reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings.

BACKGROUND

NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context, and professional nurses' clinical competence is critical in providing high-quality and safe nursing care.

DESIGN

A cross-sectional design.

METHODS

Data were collected using the 50-item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross-sectional reporting guidelines were used.

RESULTS

The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics.

CONCLUSION

The use of instruments to identify NGRNs' self-assessed clinical competence is of value when designing and evaluating introductory programmes for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves and patient safety.

RELEVANCE TO CLINICAL PRACTICE

An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organising nursing programmes and in making clinical policy decisions when designing introduction programmes in acute care settings.

New graduate nurses' clinical safety knowledge by the numbers

AIM

To explore new graduate registered nurses' knowledge and attitudes concerning medical error and patient safety, during their first 6 months of professional practice.

BACKGROUND

New graduate registered nurses demonstrate basic skills and levels of performance due to limited exposure and experience in actual situations. There is a concern held for their clinical reasoning skills required to recognize patient deterioration, posing a threat to patient safety.

METHODS

An online questionnaire was used to survey new graduate registered nurses at three time points during graduate nurse programmes between August 2016 and February 2018.

RESULTS

A decrease in self-reported knowledge and attitudes regarding medical errors was noted over the three time points. These results indicate initial confidence in theoretical knowledge and attitudes upon completion of undergraduate education, and prior to commencing professional practice.

CONCLUSION

Results suggest that a theory practice gap persists with respect to medical error for transitioning new nurses.

IMPACT FOR NURSING MANAGEMENT

New nurses lack confidence around compromised patient safety situations and a knowledge gap around actions related to medical error. Nurse managers and educators should be made aware of this gap to implement strategies to decrease risk during novice nurse transition.

Comparison of nursing aids and registered nurses mixed nursing staffing model with different ratios on the nursing outcomes and cost in Neurology and Neurosurgery Center

BACKGROUND

This study aimed to investigate the effect of nursing aids (NAs) and registered nurses (RNs) mixed nursing staffing model with different ratios on the nursing outcomes and cost in China.

METHODS

Five thousand and ninety-one patients treated at Neurology and Neurosurgery Center were consecutively recruited in this study and divided into three groups according to the proportion of NAs and RNs: 100% RN group (N = 1756), 90% RN group (N = 1654), and 75% RN group (N = 1681). Nursing outcomes including medication error, unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, urinary tract infection, pressure ulcer, ventilator weaning, morality, hospital stay, and nursing cost were recorded.

RESULTS

No difference of patients' characteristics or RNs' characteristics among three groups was observed. Three-group comparison disclosed that medication error, urinary tract infection, ventilator weaning, and nursing cost were different among three groups, while no difference of unplanned endotracheal tube extubation, bloodstream infection, respiratory tract infection, pressure ulcer, mortality, or hospital stay was found. Two-group comparison revealed that medication error and nursing cost were reduced in 75% RN group compared with 90% RN group and 100% RN group, but urinary tract infection was increased while ventilator weaning was decreased in 75% RN group and 90% RN group compared with 100% RN group. Multivariate logistic regression also validated 75% RNs independently correlated with decreased medication error, ventilator weaning, and increased urinary tract infection.

CONCLUSIONS

NAs and RNs mixed nursing staffing model with 75% RNs reduces medication error and nursing cost, while increasing urinary tract infection and decreasing ventilator weaning.

New graduate nurses' understanding and attitudes about patient safety upon transition to practice

AIMS

To explore the transition experiences of newly graduated registered nurses with particular attention to patient safety.

BACKGROUND

New graduate registered nurses' transition is accompanied by a degree of shock which may be in tune with the described theory-practice gap. The limited exposure to clinical settings and experiences leaves these nurses at risk of making errors and not recognising deterioration, prioritising time management and task completion over patient safety and care.

DESIGN

Qualitative descriptive approach using semi-structured interviews.

METHODS

Data were collected during 2017-18 from 11 participants consenting to face-to-face or telephone semi-structured interviews. Interviews were transcribed verbatim, and data were analysed using thematic analysis techniques assisted by Nvivo coding software. The study follows the COREQ guidelines for qualitative studies (see Supplementary File 1).

RESULTS

Key themes isolated from the interview transcripts were as follows: patient safety and insights; time management; making a mistake; experiential learning; and transition. Medication administration was a significant cause of stress that adds to time management anguish. Although the new graduate registered nurses' clinical acumen was improving, they still felt they were moving two steps forward, one step back with regards to their understanding of patient care and safety.

CONCLUSION

Transition shock leaves new graduate registered nurses' focused on time management and task completion over patient safety and holistic care. Encouragement and support needed to foster a safety culture that foster safe practices in our new nurses.

RELEVANCE TO PRACTICE

Having an understanding of the new graduate registered nurses' experiences and understanding of practice will assist Graduate Nurse Program coordinators, and senior nurses, to plan and provide the relevant information and education during these initial months of transition to help mitigate the risk of errors occurring during this time.