NEW YORK- April 25, 2017-A national survey from Columbia University School of Nursing finds that almost 40 percent of nursing students say they feel they need more instruction on preventing and controlling infection, especially in busy healthcare environments, despite believing that their nursing program emphasizes the importance of infection prevention. More than half of respondents also report observing breaches in prevention practices during clinical placements, yet have trouble addressing them because they feel unqualified or fear retaliation from others.
“Student nurses overwhelmingly reported that they knew when and how to use various infection prevention precautions, but acknowledged that it was often difficult to perform these practices when busy, which speaks to the complexity of the healthcare environment,” said Columbia Nursing Assistant Professor Eileen J. Carter, PhD, lead author of the study, which appeared in the June 2017 issue of Nurse Education Today. “Education is important but education alone is not sufficient.”
Carter, along with Columbia Nursing colleagues Amanda Hessels, PhD, associate research scientist; Ana Kelly, PhD, postdoctoral research fellow; Elaine Larson, PhD, associate dean of research; and Diane J. Mancino, executive director, National Student Nurses’ Association (NSNA), interviewed a national sample of student nurses about their programs’ overall approach to infection prevention and control. Students assessed the amount of time devoted to infection prevention, the quality of instruction, and the settings (lecture, simulation lab, clinical rotations) where they received instruction. They rated the difficulty of adhering to infection-prevention practices when they were busy. They also described the difficulty they often felt addressing breaches in prevention protocol that they observed during clinical rotations.
Of the 3,678 respondents, 91 percent were female, 67 percent were working toward a bachelor’s of nursing degree, and 66 percent were age 29 or younger. Despite students’ believing that their program emphasizes infection prevention, nearly 40 percent said additional education was needed. The survey found a significant association between the self-reported amount of instruction students received in handwashing, wearing personal protective equipment such as gowns and gloves, following isolation precautions, and hygienically inserting and maintaining catheters and other invasive devices, and their ability to follow these procedures when they were busy. Those who received less than an hour of instruction––compared with those who received more––were significantly more likely to have trouble following prevention protocol when they were pressed for time. “Nearly 20 percent of respondents said they found it difficult to perform key prevention practices when they were busy,” Carter said.
The survey also found that 51 percent of respondents witnessed poor infection prevention and control practices during clinical rotations but often had difficulty addressing them. “A culture of safety depends on healthcare workers’ ability to express their concerns, she said, adding that “we need to empower nurses to speak up in order to improve patient care. That empowerment should start early in training, before nurses get their RN degree.”
The study’s findings are particularly important, given the critical role that nurses play in preventing nosocomial infections, which contribute substantially to patient morbidity and mortality, as well as healthcare costs, Carter said. “It will take collaboration across disciplines and institutions to have discussions about how to best support student nurses, which will ultimately improve the care they provide as students and professional nurses.”