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.
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