Using Simulation to Teach Nurse Residents About Healthy Work Environments

According to The Leapfrog Group (2015) medical errors are the third leading cause of death in the United States. There are two victims when medical errors occur, the patient and the healthcare professional. After a medical error the healthcare professional is often traumatized, and experiences negative emotions. According to Harrison et al., (2015) current evidence shows effective coping strategies use errors constructively as a learning opportunity, and help build coping skills. According to Shin, Park and Kim (2014) simulation has shown a positive effect on knowledge, skills, and behavior of the participants. Simulation provides the nurse a safe environment to make an error. Joesten, Cipparrone, Okuno-Jones, DuBose, (2015) found in their survey only 10 to 30% of respondents were offered support after an adverse patient safety event. While simulation scenarios often train nursing clinical skills, they do not incorporate coping skills. The desired state would be the incorporation of coping skills training into simulation scenarios.

A series of simulation scenarios for high risk procedures were developed and implemented with registered nurse residents. If nurses did not follow the correct procedure and policy, then they could make an error, much like an error might happen in the practice setting Errors occurring during the simulation were recorded. After clinical simulations were completed, phase two of the simulation began. Nurse Residents were informed of the errors that occurred during the clinical portion of the simulation. The Chair of the Nurse Peer Review Committee then led the nurse residents in a simulation scenarios created to demonstrate what happens after a nurse makes a practice error.

The nurse residents were given copies of the organization’s just culture algorithm, and the Chair explained how the algorithm is used to determine the type of error. Three nurses were randomly selected from those who had made practice errors during the clinical simulations. The remaining nurses became the peer review committee.

The committee was provided with copies of the hospital’s Nurse Peer Review policy, the Texas board of nursing rules regarding minor incidents (217.16), standards of nursing practice (217.11) and unprofessional conduct (217.12). As per policy confidentiality agreements were distributed and explained to the committee and signed. Next the nurses under review came into the simulation room and were questioned by the committee. After questioning and much discussion between the nurses and the committee a determination regarding the nurses practice breakdown was made by the committee. During the debriefing the nurses were asked to write their emotions, reflect on how the nurses who made the errors felt, and how they felt judging a peer when they may have made the same error. The nurse residents were then given tools and resources to facilitate coping with practice errors.