Fear-mongering in nursing school?

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Do you think that most nursing schools use a lot of fear tactics?

In the particular nursing school I went to there seemed to have been particular instructors who, while teaching skills in lab, would always say things like, "This nurse put the wrong thing in the wrong lumen and the patient died." "Oh, this and this happened and the patient died and the nurse didn't continue with their career." One year, my peers and I did a presentation on suicide and nurses. We talked about a nurse who made a fatal med error and ended up taking her own life as a result.

There is a lot of rhetoric on protecting your license. "Don't do this, you need to protect your license." Isn't protecting your patient more important? What about the value of human life? It can make you afraid to make a mistake. When you do make a mistake, it can make you afraid to tell anyone. A lot of times, you don't know if you'll be supported when you make a mistake.

Don't get me wrong at all! I know that we as nurses have to be super meticulous and careful, because we are caring for human lives. I get it. However, I don't think it should be motivated by fear of losing your license.

I'd be interested to hear what your thoughts are on this issue!

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

My school wasn't like this. We were encouraged to practice self care. My school was focused on positive nursing culture. I went to a very well respected, forward thinking university.

I don't think most people had an experience like mine.

It is up to us to change the culture for future nurses.

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Couldn't agree with you and FolksBtrippin more.

I hope I haven't just forgotten, but I don't remember too much emphasis on license on the line or losing your license in nursing school, (a million years ago).

But I also don't remember any talk about because you're human you will make mistakes....this is how you handle them.

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First- The whole license thing. Not sure where the myth came from, but it is a persistent them in nursing, and on this site.

You will see a lot of fear, but not a lot of first hand experience of losing a license for a medication error. And certainly nothing about people actually being disciplined for something done by somebody "working under my license"- another weird fear/myth.

Go to your state BON, and see why nurses get disciplined. Then, don't do what they did, which for the most part involves working impaired, committing felonies, diverting narcotics, that sort of thing. If at all possible, you should avoid being caught on video abusing patients, which can also cause problems with the BON.

As far as making mistakes and negative outcomes- That really is kind of a thing. Medical errors are a pretty significant source of patient harm in this country. And, while they are studied, it is highly likely that they are under-reported, and really hard to study. Many errors are known, but not reported for fear of discipline, and many errors are simply unknown. Mr smith and Mr Jones live in adjacent beds in LTC, and were accidentally given each others meds- all 20 of them. Mr Jones becomes lethargic and hypotensive, but nobody will ever know why.

I am guessing your instructors are trying to instill vigilance, rather than fear. Understanding the potential for the harm we, as nurses, can do is a good thing. So, if I am teaching you about epi, I am probably going to make sure you know that a misunderstanding in concentrations can, and has, caused deaths. If it makes you so scared it clouds your judgement, I have done a bad job, On the other hand, if you double check each time, and get another nurse to also check, I have done a good job. A tricky balance.

And, as mentioned, you will make errors. It is even likely that at some point, some harm will come from your error. In an ideal world, some of your early errors will be harmless, and will help shape your nursing practice and improve it. I know my errors have dome that for me. Or at least I hope so.

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I am guessing your instructors are trying to instill vigilance, rather than fear. Understanding the potential for the harm we, as nurses, can do is a good thing. So, if I am teaching you about epi, I am probably going to make sure you know that a misunderstanding in concentrations can, and has, caused deaths. If it makes you so scared it clouds your judgement, I have done a bad job, On the other hand, if you double check each time, and get another nurse to also check, I have done a good job. A tricky balance.

Just so. The tales of "one time this nurse did (insert med error causing a sentinel event)" shouldn't be meant to frighten, only highlight the need for vigilance. Once upon a time Charleefoxtrot was a button push away from giving a patient potassium IV that was meant for her roommate. Both little old ladies with dementia and had the same initials-in fact same first name. I was busy, mind already moving to other tasks when for some reason I stopped and checked again, remembering a horror tale told to me by a preceptor about potassium. I will never forget the ice-water running down my spine feeling. I had of course hooked the potassium up to the wrong patient but thankfully did not start it. I self reported, and after we both stopped shaking charge had one patient moved to another room.

Moral of the story? Pay attention to the horror stories and take away the true lesson.

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People come to nursing school with differing levels of maturity and responsibility, and sometimes an instructor needs students to realize the responsibility they carry. A lot of people get into nursing not realizing how much responsibility nurses carry. It is not like the TV shows where the doctor is always there and the nurses do only simple tasks and use no judgement.

Many of the things that the instructors talk about are true. They aren't scaremongering when they talk about what med errors can do to people.

The talk of losing the license might be over-hyped, but the possibility for patient harm is real.

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Do you think that most nursing schools use a lot of fear tactics?

In the particular nursing school I went to there seemed to have been particular instructors who, while teaching skills in lab, would always say things like, "This nurse put the wrong thing in the wrong lumen and the patient died." "Oh, this and this happened and the patient died and the nurse didn't continue with their career." One year, my peers and I did a presentation on suicide and nurses. We talked about a nurse who made a fatal med error and ended up taking her own life as a result.

There is a lot of rhetoric on protecting your license. "Don't do this, you need to protect your license." Isn't protecting your patient more important? What about the value of human life? It can make you afraid to make a mistake. When you do make a mistake, it can make you afraid to tell anyone. A lot of times, you don't know if you'll be supported when you make a mistake.

Don't get me wrong at all! I know that we as nurses have to be super meticulous and careful, because we are caring for human lives. I get it. However, I don't think it should be motivated by fear of losing your license.

I'd be interested to hear what your thoughts are on this issue!

My friend studied law enforcement in college. She said they spent one class just watching police get killed by people they pull over at traffic stops. Same sort of thing

In my ADN program we've spent a couple of classes reviewing case studies about how RNs have killed people. The really troubling ones are when the pharmacy mis-labels the med and the RN pushes it and kills the pt.

I didn't really take it as fear mongering. Just really driving home the gravity of the situation.

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Specializes in anesthesiology.

It's good to be vigilant, but honestly it's really hard to kill a patient. Even if you give the "whole vial" instead of the intended dose, the patient may experience some adverse effects, but it is unlikely you will actually be able to cause someone's death. The only med I can think of that has the possibility to instantly kill someone is potassium, and you hook it up to a pump, so even if you give it to someone that wasn't supposed to get it, you won't kill them as long as you don't hook it up outside of a pump and let it go wide open. There are so many safeguards now, I think it's pretty difficult to actually kill a patient as long as you stay reasonably within the confines of how med administration is done today.

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Specializes in MICU, Burn ICU.

Have you ever read about Just Culture?

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Excellent points, everyone! Thanks for your responses. I like hearing different perspectives.

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Have you ever read about Just Culture?

I've heard a bit about it, but I haven't done in-depth research on the subject.

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it is not a fear mongering, it is reality really. ever heard that you are accountable for everything that you do? Especially when you getting paid? I think the way they said it a bit off to your liking and a bit too crude, but let's be honest, if you are talking about mistake, especially as a nurse, are you so naive to the point that whatever your school was telling you about the punishment is incorrect? You already know what it takes and let them talk nonsense, or excuse yourself if you can't change the discussion into a more positive way in the school.

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