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As many reports have noted, medical errors are frequent, costly, and a leading cause of death in the United States (Kohn, Corrigan, & Donaldson, 1999; Makary & Daniel, 2016). Unfortunately, their incidence has been vastly underestimated, making it impossible to quantify with any degree of accuracy (Makary & Daniel, 2016). Medication administration errors represent a significant percentage of all medical errors ranging from sentinel events (i.e., those that cause death) to those with less severe consequences (Anderson & Townsend, 2015; Aspden, Wolcott, Bootman, & Cronenwett, 2007; Keers, Williams, Cooke, & Ashcroft, 2013b). As the health care provider most likely to directly administer medications to patients, nurses are frequently involved in these events (Koehn, Ebright, & Draucker, 2016).
When an error occurs, blame is often assigned at the individual or personal level (Perrow, 1984; Reason, 2000). Medication errors are considered to be human errors, thought to arise from knowledge deficits, negligence, carelessness, or lack of concern (Mattox, 2012; Page, 2004). Indeed, some errors are caused by reckless behavior, but other errors are inadvertent or the result of failure to correctly assess the risks of the situation (Marx, 2001). Nurses often blame themselves for such failures, feeling guilty regardless of whether the error resulted in harm to the patient (Jones & Treiber, 2010). As a result, some may fail to report their errors, fearing punishment or disciplinary action (American Nurses Association Board of Directors, 2010; Unver, Tastan, & Akbayrak, 2012). Making an error can be devastating to any nurse, leading to questioning his or her own competence and skill (Scott, 2015; Scott et al., 2009). This is particularly salient when the nurse is new to the profession (Unver et al., 2012).
Despite the negative impact of making a medication error on one's nursing career, relatively little in the nursing curriculum prepares new graduates to cope with these events or their aftermath (Dolansky, Druschel, Helba, & Courtney, 2013). Although nursing education is mandated to instruct students in safe medication practices, questions of adequacy remain: Is it good enough? Is there more that can be done? The answers to such questions can best be obtained from recent nursing graduates.
System-level approaches acknowledge that errors result from the failure of safety systems designed to protect against them. Thus, errors can...