How Prepared Are Medical and Nursing Students to Identify Common Hazards in the Intensive Care Unit?



Care in the hospital is hazardous. Harm in the hospital may prolong hospitalization, increase suffering, result in death, and increase costs of care. Although the interprofessional team is critical to eliminating hazards that may result in adverse events to patients, professional students' formal education may not prepare them adequately for this role.


To determine if medical and nursing students can identify hazards of hospitalization that could result in harm to patients and to detect differences between professions in the types of hazards identified.


Mixed-methods observational study of graduating nursing (n = 51) and medical (n = 93) students who completed two "Room of Horrors" simulations to identify patient safety hazards. Qualitative analysis was used to extract themes from students' written hazard descriptions. Fisher's exact test was used to determine differences in frequency of hazards identified between groups.


Identification of hazards by students was low: 66% did not identify missing personal protective equipment for a patient on contact isolation, and 58% did not identify a medication administration error (medication hanging for a patient with similar name). Interprofessional differences existed in how hazards were identified: medical students noted that restraints were not indicated (73 vs. 2%, P < 0.001), whereas nursing students noted that there was no order for the restraints (58.5 vs. 0%, P < 0.0001). Nursing students discovered more issues with malfunctioning or incorrectly used equipment than medical students. Teams performed better than individuals, especially for hazards in the second simulation that were similar to those in the first: need to replace a central line with erythema (73% teams identified) versus need to replace a peripheral intravenous line (10% individuals, P < 0.0001). Nevertheless, teams of students missed many intensive care unit-specific hazards: 54% failed to identify the presence of pressure ulcers; 85% did not notice high tidal volumes on the ventilator; and 90% did not identify the absence of missing spontaneous awakening/breathing trials and absent stress ulcer prophylaxis.


Graduating nursing and medical students missed several hazards of hospitalization, especially those related to the intensive care unit. Orientation for residents and new nurses should include education on hospitalization hazards. Ideally, this orientation should be interprofessional to allow appreciation for each other's roles and responsibilities.





Published Version (Please cite this version)


Publication Info

Clay, Alison S, Saumil M Chudgar, Kathleen M Turner, Jacqueline Vaughn, Nancy W Knudsen, Jeanne M Farnan, Vineet M Arora, Margory A Molloy, et al. (2017). How Prepared Are Medical and Nursing Students to Identify Common Hazards in the Intensive Care Unit?. Annals of the American Thoracic Society, 14(4). pp. 543–549. 10.1513/annalsats.201610-773oc Retrieved from

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Alison Suzanne Clay

Adjunct Associate Professor of the Practice of Medical Education

Saumil Mahendra Chudgar

Professor of Medicine

Medical Education
Assessment of Clinical Skills
Clinical Reasoning
Curriculum Development


Kathleen Marie Turner

Associate Clinical Professor in the School of Nursing

Dr. Turner earned her BSN from the University of Vermont, her MSN (Nursing Administration) and DNP at the Duke University School of Nursing. She has over thirty years of experience in adult health / critical care, administration and education. Kathy has held numerous managerial and leadership positions. She presently teaches across programs and is the Director of the Nursing and Healthcare Leadership MSN program.  She is a member of the American Association of Critical Care Nurses, American Nurses Association, North Carolina Nurses Association, American Organization of Nurse Leaders and Sigma Theta Tau International Honor Society of Nursing.  

Her areas of interest, scholarship and research include: Nursing Education, Leadership in Healthcare and Nursing, Ethics in Healthcare, Adult Health and Intensive Care Nursing, Patient Safety and Quality Care.

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