Unsafe Students and Dealing In Nursing Education
Who are Unsafe
Students
A
student labeled as unsafe, due to the presence of internal and/or external
conditions, is unable to uphold patient safety consistent with educational
expectation and professional standards. The presence of a singular or
combination of compromised physical, affective, cognitive, behavioral, social,
and ethical characteristics render students vulnerable to unsafe practice.
External conditions, whether associated with academic or health care contexts,
may exacerbate the risk for unsafe practice by individual students. Students
unable to self assess and communicate with competent educators struggled in
consolidating a professional identity composed of cognitive and performance
dimensions.
How Faculty Responsible for Safety
Safety
is a shared responsibility among educators, students, and clinicians. Despite
the best efforts of these individuals, the sanctity of safety is continually
threatened (Attree, Cooke, & Wakefield, 2008). Nurse educators, therefore,
must be mindful in the selection and provision of appropriate classroom, laboratory,
and clinical learning opportunities to facilitate student development
commensurate with safeguarding the public.
In addition, educators are obligated
to enact evidence-informed educational strategies; be vigilant for risks;
detect unsafe students and unsafe circumstances; accommodate and remediate, if Appropriate;
and remove unsafe students from practice.As
students advance through programs of study, the breadth and depth of the
responsibility for patient safety increases. Therefore, it is imperative that
leveled cognitive, effective, and practice expectations are explicitly detailed
and consistently upheld to avoid the progression of unsafe students.
Purposeful
dialogue among educators, students, and clinicians about patient safety is a
precursor to safe practice. A learning partnership, characterized by mutuality,
trust, and open communication (Gillespie, 2005), allows students to integrate
formative constructive feedback to support safety in practice. Despite
appropriate guided learning and timely evaluative appraisal, unsafe students
are unable to achieve minimal expectations for safe practice.
Impact of Unsafe Students On Working Environment
The
presence of unsafe practitioners involved in the care of individuals, families,
and communities is a global concern. As novices, students are susceptible to
compromising safety at many points during their learning processes. The
etiology of unsafe practice is a complex interplay of individual student
factors and system circumstances. In response, educational programs have been
developed with an overt focus on safety competencies (National Patient Safety
Foundation, 2014; Quality and Safety Education for Nurses Institute, 2014;
World Health Organization, 2011).
Shared focus across such programs include
evidence informed knowledge; patient contentedness; roles and responsibilities;
clinical reasoning; health informatics; and theories of communication, systems,
and risk management. Emergent programs, primarily created to generate safe
practitioners, emphasize the need for comprehensive safety curricula (Brady,
2011).From
the perspective of senior nursing students, the profile of an unsafe student
includes compromised professional accounting ability, uncritical knowledge
transfer, non-patient-contentedness, impaired interactions, unsatisfactory clinical
performance, and unsubstantiated clinical progression (Killam et al., 2012).
Educators are held accountable for their role in upholding the safety mandate
and protecting the public (American Association of Colleges of Nursing [AACN],
2013; Canadian Nurses Association, 2014). The evidence to date does not specify
a definitive educational approach to mitigate the presence of unsafe students
in their learning However, much of the available research has used
nonexperimental designs to investigate teaching and learning strategies to
facilitate student safety. Problem based learning, for example, has been
identified as a promising strategy to bridge the gap between theory and
practice, ultimately promoting safety (Khan, Ali, Vazir, Barolia, & Rehan,
2012; Larue, 2008).
Similarly, simulation assists educators to evaluate
application of safety competencies organizations may provide the structure to
allow for regular and recorded communication. Communication about patient
safety that meets learning needs, identifies risks for unsafe practice,
evaluates learning outcomes, and complies with professional and practice
setting policies will mitigate the presence of unsafe students in practice.