Factors Influencing Novice and Beginner Nurses’ Intention to Report Medication Errors and Near Misses

For nursing students

Study summary

Medication errors and near misses happen in every healthcare system, and research shows that newer nurses make more of these errors than experienced colleagues. At the same time, novice and beginner nurses are known to under-report these events. This study, published in the Canadian Journal of Nursing Research, asked a simple but important question: what actually influences whether a novice or beginner nurse intends to report a medication error or a near miss?

The researchers, Raouaa Braiki, Frédéric Douville, and Marie-Pierre Gagnon, surveyed 143 third-year nursing students at a Quebec university who were completing a critical care practicum in the fall of 2019. Almost all eligible students took part, giving a response rate of 95.3 percent. Most participants were female (92.3 percent), between 21 and 23 years old (83.2 percent), enrolled in a DEC-Bac program (a Quebec pathway that combines a college diploma with a university degree, 86 percent), and had one to two years of clinical experience (77.6 percent).

Students completed a 37-item self-reported questionnaire built around an adapted version of the Theory of Planned Behavior, a model widely used to study intention and behavior. The core constructs measured were attitude (how positively or negatively students viewed reporting), subjective norm (how much they felt other people expected them to report), perceived behavioral control (how easy or hard they believed reporting would be), and intention itself, along with the underlying behavioral and control beliefs that shape those constructs. The team also added three extra constructs that fit the topic of error reporting particularly well: anticipated regret (how much students expected to regret not reporting), moral norm (whether reporting matched their personal values), and professional norm (whether reporting matched their sense of professional duty). Sociodemographic information such as age, sex, education program, and years of experience was collected too.

Because the planned regression models ran into convergence problems, the researchers switched to descriptive statistics and a series of contingency table analyses using Chi-square and Fisher's exact tests, with a Bonferroni correction applied to keep the risk of false positives low across the many comparisons (using an adjusted alpha of 0.025).

Overall, 78 percent of the students expressed a high intention to report medication errors and near misses, a reassuring baseline number. More importantly, every single theoretical construct from the adapted Theory of Planned Behavior was significantly associated with intention to report. Attitude, subjective norm, perceived behavioral control, professional norm, moral norm, and anticipated regret all showed strong, statistically significant relationships with students' stated intention. In plain terms, students who felt reporting was the right thing to do, who believed the people around them supported reporting, who felt confident they could actually report without major obstacles, and who expected to feel regret if they stayed silent, were all more likely to say they intended to report errors and near misses.

Sociodemographic factors mattered too. Students aged 23 or older, those with two or more years of clinical experience, students in the DEC-Bac pathway (compared with the standard baccalaureate program), and female students were all significantly more likely to report a high intention to report. These findings suggest that reporting intention is not shaped only by attitudes and beliefs, but also by where a student is in their training and life stage.

The authors describe this as the first study to examine these factors specifically among novice and beginner nurses in the Quebec context, which matters because medication errors are the second most commonly reported adverse event in Quebec healthcare settings after falls. They are careful to note that intention is not the same as actual reporting behavior, and they call for further research to pin down which factors most strongly determine whether a nurse follows through. For nursing students and new graduates, the practical takeaway is that both the culture around you (how colleagues and supervisors react to reporting) and your own sense of professional and moral responsibility genuinely shape whether you speak up about an error. Nursing programs and clinical units that want to reduce underreporting should pay attention to both dimensions, not just to reporting procedures on paper.

For educators

Teaching and appraisal notes

This cross-sectional exploratory study by Braiki, Douville, and Gagnon (Canadian Journal of Nursing Research, 2024) addresses a persistent patient safety problem: under-reporting of medication errors and near misses by novice and beginner nurses, a population known to commit more medication errors than experienced staff. The study is framed as the first to examine determinants of reporting intention specifically among novice/beginner nurses within a Quebec setting, where medication errors are the second most commonly reported adverse event after falls.

The sample consisted of 143 third-year nursing students in a critical care practicum at a Quebec university (fall 2019), with a strong 95.3 percent response rate. The sample skewed heavily female (92.3 percent), young (83.2 percent aged 21-23), enrolled in the DEC-Bac pathway (86 percent), and relatively early-career (77.6 percent with one to two years of experience). Instructors should flag this composition explicitly in class: it is a convenience sample of students, not licensed practicing nurses, which constrains generalizability to the broader novice-nurse workforce.

The theoretical scaffold is an adapted Theory of Planned Behavior (TPB), a useful model to teach because it operationalizes intention through measurable constructs: attitude, subjective norm, perceived behavioral control, and the underlying behavioral and control beliefs, plus three constructs added for this topic: anticipated regret, moral norm, and professional norm. This is a good teaching moment for showing students how a well-established behavioral theory can be extended with topic-specific constructs rather than used off-the-shelf.

Methodologically, the study is instructive for a research methods seminar because the authors had to pivot: planned regression analyses failed to converge, so they substituted descriptive statistics with a series of Chi-square/Fisher's exact contingency analyses, applying a Bonferroni correction (adjusted alpha = 0.025) to control for multiple comparisons. This is worth discussing explicitly as an example of adapting analysis plans transparently when models do not behave as expected, and of the trade-off between contingency analyses (which show association) versus regression (which could show relative predictive strength while controlling for confounders).

Substantively, 78 percent of students reported high intention to report errors and near misses, and every TPB construct measured (attitude, subjective norm, perceived behavioral control, professional norm, moral norm, anticipated regret) was significantly associated with intention, with very small p-values throughout. Sociodemographic factors — age (23+), experience (2+ years), DEC-Bac program status, and female sex — were also significantly associated with higher intention. This pattern supports the TPB's general utility for this behavior domain while also flagging demographic and educational-pathway differences worth exploring qualitatively.

For appraisal exercises, key limitations to highlight are: a convenience sample restricted to nursing students (not yet practicing nurses) at a single institution; abandonment of the planned regression approach due to convergence problems, which limits the ability to assess which constructs are the strongest independent predictors; likely social desirability bias in self-reported intention measures; and the well-known intention-behavior gap, since measuring intention to report is not equivalent to measuring actual reporting behavior in practice. Discussion should press students to consider how these limitations affect the confidence we can place in translating these findings directly into curriculum or unit-level interventions, and to generate hypotheses about why sociodemographic differences (age, program, experience, sex) might operate through the TPB constructs rather than independently of them.