As faculty in a smaller-sized ADN program teaching the first semester of medical-surgical nursing, I wore many hats. In addition to classroom, nursing lab, and simulation teaching responsibilities, I also had a clinical group of eight students every semester that I brought to an acute care hospital for two eight-hour shifts per week. As anyone who has been a clinical adjunct or full-time faculty leading a clinical group will tell you, teaching in the clinical setting is fraught with anxiety-provoking moments. For me, one of the most challenging aspects of my role as clinical faculty was passing meds with my students on the unit.
I would select two students a day to pass meds, which doesn’t sound like a lot, but I can attest to the fact that I always breathed a huge sigh of relief when those meds passes were completed safely and (as often as possible), on time. Always in the back of my mind was the knowledge that nurses hold significant responsibility for administering medication to patients. My nursing students had to have the knowledge and abilities to safely carry out this essential intervention.
As is the case with many aspects of education, nursing not being exempt, things are taught a certain way more based on historical precedent than on empirical evidence that it is best practice…the famous “this is how we have always done it” mentality. Teaching nursing students how to safely administer medications was historically rooted in memorizing and reciting the right medication administration safety. However, what we know (and have known for quite some time) is that these teaching strategies don't fully address the complexities and uncertainties found in today’s healthcare settings. Change is needed, but this isn’t just my opinion based on anecdotal experiences – the research bears it out.
What the Research Shows About Medication Administration
A common theme that emerges in the literature is the role distraction and interruptions play in the rate of medication errors made by nurses. Nowell and colleagues (2023) found that students struggle to develop skills to manage these challenges and identified simulation followed by reflective learning as one way to develop these critical skills.
A study by Schroers, Ross and Moriarty (2022), in which senior nursing students were directly observed during med pass, found that about one-third of the participants made errors, with error rates being roughly the same in scenarios with interruptions (19.4%) and those without interruptions (16.7%). The most prevalent error types were related to documentation and dosage. Students pointed to interruptions and a lack of opportunities for practicing independent medication administration as the main causes of these errors.
Foss and Morandini (2023) came to the same conclusion, substantiated by clinical partner feedback: students had inadequate preparation and a limited grasp of the safe medication administration process. They went on to describe the use of (and success with) an Objective Structured Clinical Examination (OSCE) to evaluate student critical thinking and clinical judgment within the medication administration process, using a low fidelity simulation design.
What Do We Do About It?
I think as educators we can all agree: ensuring that our students are well-prepared to administer medications independently and safely in complex work environments is mission critical. It's crucial to incorporate systemic factors into educational approaches to achieve this goal effectively. One of the best and increasingly most researched methodologies we have to do this is through low and medium fidelity simulation.
That’s why we created Sim2Grow: students need the opportunity to practice medication administration as many times as needed to prepare for and overcome the challenges in our healthcare system. By providing a safe space for students to practice med pass with equipment that mimics what they’ll use in the real world, they gain the critical skill they need to keep all patients safe. When students use Sim2Grow to practice med pass again and again, I know that the patients we see those two days per week are in safer hands. And isn’t patient safety and health the goal?
Resources:
https://doi.org/10.1016/j.nedt.2022.105634
