Think about your practicum project and the issue you identified in Module 3. What issue or problem did you identify? (Note: You may have also selected a prominent nursing practice issue that is of interest to you.)
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Analyze scholarly literature related to the issue/problem of and strategies for resolution. Review different nursing theories that could support a resolution to the practice issue or problem you have identified. NOTE: Many students may be inclined to choose Lewin’s Change Theory. This is not a nursing theory and would not apply to the required content for this assignment.
In a three-to-six-page scholarly paper, address the following elements. Include a minimum of three scholarly sources, current within 5 years, to support your work. See rubric for specific, required content
criteria within each section of the presentation:
o Introduction
o Description of Issue or Problem
o Nursing Theory
o Application of Theory
o Conclusion
Title page, pagination, subheadings, body of paper, citation of sources, and reference page must follow APA guidelines as found in the current edition of the manual.
NR520 Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum
Medication administration errors (MAEs) pose a significant threat to healthcare accountability, quality of care, and patient safety. Despite advances in safety protocols, barcode medication administration, and electronic prescribing, errors persist in clinical settings. Nursing practicums are particularly vulnerable to MAEs because nursing students are still developing confidence, clinical judgment, and technical skills. These practicums expose students to real-world challenges, including time pressures, frequent interruptions, high patient acuity, and difficulties with interdisciplinary teamwork. Together, these factors increase the mental workload nurses carry and may jeopardize safe medication practices. Simply emphasizing procedural compliance is insufficient. Instead, a theoretical framework is needed to understand how nurses develop judgment and competence over time. Medical and nursing theories offer valuable insights into the experiential, behavioral, and cognitive aspects of practice improvement. This paper reviews MAEs observed during practicums, analyzes current research, and applies Benner’s Novice-to-Expert Theory to propose evidence-based solutions.
Description of the Problem
During the nursing practicum, it became evident that nursing students and novice nurses are more susceptible to medication errors. Observations showed inconsistent safety checks, misunderstandings of drug mechanisms, delays in administering medication, and near misses. Workflow interruptions were common, often caused by conflicting clinical priorities, staff interactions or alarms, and disruptions during medication preparation. These problems reflect recent research suggesting that medication errors mainly result from individual factors—such as decreased situational awareness, anxiety about performance, limited pharmacology knowledge, and fatigue—as well as system factors like challenges with medication technology usability, communication barriers, staffing changes, and high workload (Naseralallah et al., 2023; Kellett et al., 2024).
Multitasking and interruptions can cause medication errors. Cognitive psychology research shows that interruptions interfere with working memory, increasing the risk of mistakes and slips during tasks such as dosage verification and calculations (Park et al., 2023). In addition, nursing students and novice nurses often adhere strictly to rules and protocols without fully considering the clinical context, increasing the risk of errors when faced with patient situations that differ significantly from standard scenarios. They tend to hesitate to report near misses because they fear the consequences or blame, which limits opportunities for organizational learning (Arkin et al., 2023).
Importantly, MAEs in practicum settings highlight systemic problems within clinical and educational environments rather than focusing solely on individual mistakes. Clinical areas crafted mainly for seasoned nursing practitioners can inadvertently overwhelm novice nurses and nursing students who are still honing automatic skills and pattern recognition. To minimize MAEs, there is a need to apply strategies that focus on creating a safe system, promoting cognitive growth, and enhancing skills. It is essential to choose the right nursing theory that allows the interventions to be customized according to learners’ developmental levels NR520 Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum.
Nursing Theory
Benner’s Novice-to-Expert Theory offers a valuable framework for comprehending the development of competence and its importance for safe medication practices. Based on Dreyfus’s Model of Skill Acquisition, five levels of nursing expertise can be outlined, including novice, advanced beginner, competent, proficient, and expert. Each of the five stages and the transitions between them involve notable changes in clinical abilities, decision-making, and perception. Novices rely on explicit features and rules. Advanced beginners begin to recognize meaningful, recurring patterns. Competent nurses improve their prioritization and planning skills. Proficient and expert nurses develop a holistic understanding and intuitive judgment (Lamichhane, 2025).
Recent research continues to affirm the significance of Benner’s theory in modern clinical education. The research indicates that novice nurses encounter greater cognitive challenges, are more prone to making errors, and tend to make slower decisions under time constraints (Pol-Castañeda et al., 2022). Benner’s theory focuses on experiential learning and mentorship, reinforcing evidence that patient safety and clinical skills benefit from guided practice and reflective feedback (Cunja et al., 2025). In addition, the theory highlights the importance of considering context when making decisions, which is especially relevant in medication administration, as patient-specific factors influence monitoring, timing, and dosing.
Benner’s framework is particularly focused on nursing, highlighting how practitioners integrate perception, experience, and knowledge. It treats medication safety not as a simple technical skill but as a developing interpretive and cognitive competence. Recognizing that learners progress through distinct developmental stages, Benner’s theory helps design tailored clinical and educational approaches. This approach is especially useful for managing MAEs identified during practicum.
Application of Theory
Applying Benner’s theory underscores the need for developmentally appropriate strategies that evolve with the learners’ skills to reduce medication errors. At the novice level, nursing students should receive clear guidance, have explicit rules and guidelines, and engage in repetitive practice. Resources such as close supervision, detailed medication protocols, and standardized checklists are essential for reducing cognitive load and uncertainty (Park et al., 2023). Simulation-based education proves highly effective at this stage; high-fidelity simulations enable nursing students to practice error detection, barcode medication administration, dosing calculations, and medication preparation in a safe setting (Pol-Castañeda et al., 2022). Moreover, simulated interruptions train learners to stay focused and recover swiftly from disruptions.
For advanced beginners, effective learning should foster understanding within context and support pattern recognition. Using guided reflections, clinical scenario discussions, and case-based learning helps learners interpret patient-specific factors impacting pharmacotherapy (Cunha et al., 2025). Clinical preceptors are critical because they demonstrate expert reasoning; techniques such as “thinking aloud” during medication administration reveal implicit clinical judgments and improve situational awareness. Providing constructive feedback encourages correct practice and turns mistakes into valuable learning opportunities rather than punishments (Arkin et al., 2023).
Environmental interventions improve educational strategies, as evidence indicates that reducing interruptions significantly lowers MAEs. Increasing staff awareness of medication safety times, using visual cues such as signs or vests, and establishing dedicated “no-interruption” zones help maintain cognitive function during essential tasks (Kellett et al., 2024). Additionally, streamlining workflows and effectively managing workloads can further reduce the risk of errors.
As nursing students and practitioners develop their professional skills, interventions should gradually shift from strict adherence to rules to a focus on clinical judgment, anticipation, and prioritization. Participating in interprofessional collaboration activities enhances communication clarity, thereby reducing errors stemming from misunderstandings or ambiguous instructions. Debriefing sessions and reflective journaling help cultivate the metacognitive skills essential for safe practice. Overall, Benner’s theory supports a variety of interventions that align system design, mentorship, and education with the learner’s evolving clinical competence.
Conclusion
MAEs remain a significant risk and challenge in healthcare, particularly in nursing practicum settings. The principal concern is the higher risk of MAEs among nursing students and novice nurses, driven by factors such as organizational culture, environmental complexity, and cognitive development. Recent studies indicate that inexperience, communication issues, workload stress, and interruptions are primary causes of MAEs NR520 Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum. Consequently, developing a framework that illustrates high nurses gain clinical judgment and competence over time is essential.
Benner’s Novice-to-Expert Theory provides a nursing-focused view on how decision-making, perception, and performance develop across different stages. By tailoring MAE-reduction strategies to each level of nursing expertise, clinical leaders and educators can implement targeted interventions that enhance patient safety and support professional growth. This is a theory-based solution that includes mentorship programs, reflective practices, structured supervision, simulation exercises, and methods to reduce interruptions. Incorporating nursing theory into practical improvements ensures that strategies go beyond targeting procedural adherence to the experiential and cognitive aspects of safe medication administration. This theory-based approach enhances clinical education while improving patient safety outcomes.
Reference
Arkin, L., Schuermann, A. A., Loerzel, V., & Penoyer, D. (2023). Original Research: Exploring Medication Safety Practices from the Nurse’s Perspective. The American journal of nursing, 123 (12), 18–28. https://doi.org/10.1097/01.NAJ.0000996552.02491.7d
Cunha, L. D. M., Ventura, F., Pestana-Santos, M., Mota, M., Lomba, L., & Santos, M. R. (2025). Decision support strategies for bedside nursing clinical reasoning: A scoping review. International journal of nursing studies advances, 9 , 100393. https://doi.org/10.1016/j.ijnsa.2025.100393
Kellett, P. L., Franklin, B. D., Pearce, S., & Benn, J. (2024). Resilience in nursing medication administration practice: a systematic review with narrative synthesis. BMJ open quality, 13 (4), e002711. https://doi.org/10.1136/bmjoq-2023-002711
Lamichhane, G. (2025). Shaping professional nursing practice using Benner’s novice to expert theory . British journal of nursing (Mark Allen Publishing), 34 (22), 1133–1137. https://doi.org/10.12968/bjon.2024.0387
Naseralallah, L., Stewart, D., Price, M., & Paudyal, V. (2023). Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review. International journal of clinical pharmacy, 45 (6), 1359–1377. https://doi.org/10.1007/s11096-023-01626-5
Park, O., Jeon, M., Kim, M., Kim, B., & Jeong, H. (2023). The Effects of a Simulation-Based Patient Safety Education Program on Compliance with Patient Safety, Perception of Patient Safety Culture, and Educational Satisfaction of Operating Room Nurses. Healthcare (Basel, Switzerland), 11 (21), 2824. https://doi.org/10.3390/healthcare11212824
Pol-Castañeda, S., Carrero-Planells, A., & Moreno-Mulet, C. (2022). Use of simulation to improve nursing students’ medication administration competence: a mixed-method study. BMC nursing, 21 (1), 117. https://doi.org/10.1186/s12912-022-00897-z NR520 Module 4: Theory-Guided Strategies to Reduce Medication Administration Errors During Nursing Practicum
