When researchers proposed the shocking statistic that medical errors were the third leading cause of death in the United States, the healthcare community reacted in a variety of ways. Instead of diligently looking within and embracing the findings as a driver for change, improvement, and reform, some healthcare professionals responded with skepticism, defensiveness, or apathy. Fast forward to earlier this year when a door flew off a plane while in midair. The airline industry, and the Federal Aviation Agency, quickly responded with new plans for quality standards and oversight to propel safety measures, assure consumer support, and make air travel a safer means of transportation. It is with this level of urgency that the healthcare world should respond to errors currently taking place within the industry!
Recent research revealed that adverse events occurred in one-in-four hospital admissions, of which a quarter were deemed as preventable. Systematic review of critical incidents identified medication errors as the largest percentage of safety hazards in acute care settings, with nurses most often involved in these errors. These errors directly relate to the practice of novice nurses, as studies spanning 20 years note that half of new nurses report being personally involved in medication errors.
Although these issues are complex, and appear insurmountable, we would like to suggest a “simple switch” that may serve as a springboard for safety initiatives — #SAFE50.
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A recommendation for change
With strong linkages of medication administration and clinical judgment, the time is now to aggressively seek out solutions to enhance healthcare safety and reduce errors. Evolving evidence demonstrates that virtual simulation provides an effective, accessible, and inexpensive strategy to foster clinical judgment. Virtual simulation places students into a realistic and challenging clinical environment while holding them personally accountable for decision-making and acting on behalf of the patients they care for in the virtual world. We propose, through the #SAFE50 initiative, that nursing students should encounter these clinical challenges for 50% of their educational journey.
Instead of passive listening, review of endless slides, and benign observation of clinical information, students should be actively engaged in learning and held accountable for building information throughout their course of study. Students participating in virtual simulations experience challenges similar to those they will see in the healthcare environment, and practice skills in a safe space that allows for deep thinking and growth.
Virtual simulations, along with live simulation and clinical experiences, provide experiences for students to think, make decisions, consider alternatives, and act based on patient data. Students function as independent practitioners and use clinical judgment to learn and build skills so important for new practicing nurses. Because errors are built into these simulations, students learn how to identify and respond to issues, or potential errors, in the workplace. Knowledge and skills accrued in school can be further honed, as novice nurses use increasingly complex virtual simulations to enhance their orientation and education.
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The time for change needs to be now!
The “tsunami” of challenges facing the nursing industry – including retirements, faculty shortages, the high turnover rate (especially with novice nurses), and economic factors – require changes in nursing education, both prior to licensure and during orientation, to enhance and ensure safety. A study by the National Council of State Boards of Nursing noted that about one-fifth of registered nurses plan to leave the profession by 2027. Turnover rates of more than 30% among first year nurses are not uncommon, while the rate of more experienced registered nurses is about 23%, with each turnover representing a cost of $50,000 or more.
Although nursing has an exam which has had the onerous role in determining a candidate’s knowledge and skill for entry into practice, the entire responsibility should not be on an exam. In fact, ongoing professional development is critical for novice nurses as they move into today’s complex, changing, and often chaotic environment. Again, #SAFE50 urges that new nurses participate in 30-45 minutes of virtual simulation per week to develop clinical judgment skills.
We suggest that a feasible alternative to reduce error rates, turnover, and workplace stress is to arm nursing students and new nurses with the skills to meet the demands of today’s healthcare environment. Participating in virtual simulations in nursing education and during orientation to the practice environment, as part of the #SAFE50 initiative, is a feasible, important, and effective means to reducing healthcare errors. We call for our partners in practice, education, and industry to join this effort as means to make our healthcare settings safer for all patients.
Although the cost of this investment may present a barrier, it is important to consider the high costs of nursing turnover, human error, breeches in clinical judgment, and human pain and suffering. Balanced against these costs, investing in virtual simulation is a nominal and viable alternative as we strive to make healthcare safer for all!
Photo Credit: David Castillo Dominici
Tim Bristol, PhD, RN, CNE, FAAN, FAADN, is a faculty development, NCLEX, and curriculum design specialist. He’s taught at all levels of nursing and is an expert in bringing the evidence base of nursing, healthcare, and education to students and faculty as a nurse educator and is a fellow in the American Academy of Nursing.
Judith Wheaton Herrman, PhD, RN, CNE, ANEF, FAAN, is a nurse, educator, and researcher across the lifespan, nursing education, and health promotion. As a Senior Clinical Content Specialist-Nursing with Wolters Kluwer, Judy works with nursing schools, exploring the biology of learning, active teaching strategies, and product development.
Vicki Moran, PhD, RN, MPH, CNE, CDE, PHNA-BC, TNS is the nursing education research manager at Wolters Kluwer and has been a nurse and educator for over 25 years. She’s published manuscripts, written books on nursing education, edited books on pharmacology, and engaged exam analysis in nursing education.
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