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

BACKGROUND: The purpose of this study was to better understand individual- and system-level factors surrounding making a medication error from the perspective of recent Bachelor of Science in Nursing graduates. METHOD: Online survey mixed-methods items included perceptions of adequacy of preparatory nursing education, contributory variables, emotional responses, and treatment by employer following the error. RESULTS: Of the 168 respondents, 55% had made a medication error. Errors resulted from inexperience, rushing, technology, staffing, and patient acuity. Twenty-four percent did not report their errors. Key themes for improving education included more practice in varied clinical areas, intensive pharmacological preparation, practical instruction in functioning within the health care environment, and coping after making medication errors. CONCLUSION: Errors generally caused emotional distress in the error maker. Overall, perceived treatment after the error reflected supportive environments, where nurses were generally treated with respect, fair treatment, and understanding. Opportunities for nursing education include second victim awareness and reinforcing professional practice standards. [J Nurs Educ. 2018;57(5):275-280.].

Nurses' rights of medication administration: Including authority with accountability and responsibility.

Medication errors continue to occur too frequently in the United States. Although the five rights of medication administration have expanded to include several others, evidence that the number of errors has decreased is missing. This study suggests that medication rights for nurses as they administer medications are needed. The historical marginalization of the voice of nurses has been perpetuated with detrimental impacts to nurses and patients. In recent years, a focus on the creation of a just culture, with a balance of accountability and responsibility, has sought to bring a fairer and safer construct to the healthcare environment. This paper proposes that in order for a truly just culture to exist, the balance must also include nurses' authority. Only when a triumvirate of responsibility, accountability, and authority exists can an environment that supports reduced medication errors flourish. Through identification and implementation of Nurses Rights of Medication Administration, nurses' authority to control the administration process is both formalized and legitimized. Further study is needed to identify these rights and how to fully implement them.

Making an Infusion Error: The Second Victims of Infusion Therapy-Related Medication Errors.

Infusion therapy-related adverse events can result in distress and professional suffering for the nurse involved with the event, with long-lasting consequences. This article discusses the second victim syndrome and its impacts on nurses. Original research on 168 recent nursing graduates and their experiences with second victim syndrome after making an infusion-related error is also presented. The article concludes with strategies to help nurses cope with the aftermath of making an infusion therapy-related medication error.

More Than 1 Million Potential Second Victims: How Many Could Nursing Education Prevent?

Any error made in health care can cause the health care provider to become a second victim. There are many initiatives, tools, and instruments designed to support second victims after an error has been made. The role that nursing education can play in preventing nurses from becoming second victims has not been well explored. This article presents a study designed to investigate perceptions of recent BSN graduates about preparation for medication administration, medication error, and their personal experience with error making and second victimhood.

Workplace bullying, perceived job stressors, and psychological distress: Gender and race differences in the stress process.

A large body of empirical research documents the adverse mental health consequences of workplace bullying. However, less is known about gender and race differences in the processes that link workplace bullying and poor mental health. In the current study, we use structural equation modeling of survey data from the 2010 Health and Retirement Study (N = 2292) and draw on stress process theory to examine coworker support as a buffering mechanism against workplace bullying, and gender and race differences in the relationships between bullying and psychological distress. The results of the analysis indicate that coworker support serves as a protective buffer against workplace bullying, although the buffering effect is relatively small. We also find that the effects of workplace bullying more heavily impact women and persons of color. Specifically, women and African American individuals in our sample were less protected from the buffering mechanism of co-worker social support.

Dual, Yet Dueling Illnesses: Multiple Chronic Illness Experience at Midlife.

The prevalence of multiple chronic illnesses is increasing dramatically, especially among those in middle adulthood, yet much prior research has focused on the experience of multiple morbidity among older adults. We examined the online illness narratives (blogs) of 10 men and women aged 36 to 59 to better understand the experience of living with multiple chronic illnesses at midlife. Multiple morbidity presents distinct challenges to those at midlife: (a) diagnosis and management of multiple illnesses, (b) need for information, (c) identity dilemmas and threats to self-image, and (d) stigma and social rejection. Relinquishing the work identity was especially difficult for participants because it threatened to foreshorten middle adulthood and push them prematurely into late adulthood. Participants used their blogs to revise their identities, alleviate isolation, and inform and guide others.

When nurses become the "second" victim.

PURPOSE: Well-intentioned, conscientious nurses make medication errors. The subsequent feelings of guilt, remorse, and loss of personal and professional self-esteem these nurses experience are well documented. In this paper, we analyze the concept of "second victim" within the context of medication administration errors. We also examine factors that contribute to nurses becoming second victims after making an error. PRACTICE IMPLICATIONS: Implications for nurses and nursing practice include nurses being given a greater degree of authority in designing the nursing work environment. Implications for nurses and nursing practice are presented. CONCLUSION: Further study is needed to more fully understand this phenomenon and to discover appropriate support mechanisms and interventions to minimize the harm to nurses.

Medication errors, routines, and differences between perioperative and non-perioperative nurses.

Despite efforts to reduce the incidence of perioperative medication errors, these errors continue to be a problem. We examined written accounts from 16 nurses who discussed medication errors in the perioperative environment and 11 nurses who provided additional information about perioperative errors, nursing education, and the state of health care. Preoperative medication errors were the most frequently reported perioperative medication errors. Other reported errors involved intraoperative medication administration, IV sedation, and "close call" events. Reasons for errors included production pressure, complacency, and failure to follow established routines. We also identified evidence of self-blame and lack of understanding between nursing units and specialty areas. We compared attitudes and opinions of nurses working in perioperative settings with those of nurses working in non-perioperative areas and found both similarities and differences in the perceptions of medication errors and why they occur.

Devastatingly human: an analysis of registered nurses' medication error accounts.

Despite many safeguards, nurses make the majority of medication administration errors. The purpose of our research was to investigate the perceived causes for such errors and to better understand how nurses deal with them. We performed an interpretive analysis of 158 accounts by nurses who made self-identified medication errors. We found common themes among these accounts. First, although nurses admitted responsibility for errors, they simultaneously identified a variety of external contributing factors. Second, nurses' accounts were often framed in terms of "being new," with the underlying background expectancy of inexperience. Third, emotionally devastating visceral responses to errors were common and often incongruent with error severity. Fourth, nurses had to deal with fear. Fifth, nurses voiced frustrations with technologies and regulations. Sixth, embedded within many of the accounts was a "lessons learned" theme, through which nurses developed "personal rules" as a result of an error. We conclude with suggestions for additional research.