When nursing students begin clinical internships, they are often told: “You’re here to learn, not to work.” On the surface, this sounds reasonable, but it masks a deeper institutional issue:
While this statement might seem reasonable at first, it conceals a deeper institutional issue: students assist in patient care, document records, prepare medications, monitor vital signs and work long shifts — without pay, protection from liability or a space where mistakes are allowed. What appears to be a learning process is, in reality, a systemic ambiguity in labor rights and ethical obligations.
A triple failure of this system is clear: Mistakes teach no learning when errors are hidden instead of analyzed; mistakes foster no accountability when no one takes responsibility for systemic gaps; and mistakes erode integrity when students are taught to conceal, conform and comply.
The first major failure of the internship system lies not in the presence of mistakes, but in the fact that mistakes are prevented from becoming moments of learning. When students make procedural errors or act out of confusion or inexperience, there is no institutionalized process for recognizing, analyzing and correcting those errors. The result: “A mistake was made, but nothing was learned” — the very definition of a failed learning experience.
Different types of mistakes require different educational response. For instance, a low-level mistake in blood drawing might involve failing to locate a vein, resulting in repeated punctures and unnecessary pain or bruising — issues of technical skill. A mid-level mistake could involve improper bleeding control or a needle slipping, which requires attention to protocol and heightened awareness. A severe error, such as causing excessive bleeding, demands emergency response training and calm composure.
In pediatric settings, emotional regulation and communication become even more critical; mistakes might escalate due to crying children, nervous reactions or rushed execution. These errors are not just technical lapses, but moments where empathy, judgment and ethics intersect.
Yet the current internship systems fail to categorize errors or provide tailored feedback mechanisms. Students make mistakes without ever being told: “Here’s how to fix that,” let alone: “This mistake is an opportunity to learn three strategies for recovery.” As a result, mistakes are never positioned as opportunities for growth, but as blemishes to be hidden.
The second failure lies in the breakdown of responsibility. In clinical settings, mistakes often fall into a gray area where no one is willing to speak up or take ownership. When an intern makes a clinical error — whether it is administering the wrong medication, making a documentation mistake or delaying a report — the university claims the student lacks a clinical license, the hospital asserts that the school is responsible, and mentors often lack the authority or institutional support to intervene. As a result, students do not know where the boundaries lie, are discouraged from admitting fault and lack insurance or liability protection.
This ambiguity breeds fear: “Mistakes lead to punishment — better stay silent.” Students learn not how to acknowledge or correct errors, but how to avoid, conceal, and deflect them. Over time, this culture becomes internalized.
The third systemic failure is ethical. This is not merely a pedagogical flaw, but a moral injury. When interns are not taught to admit their mistakes, when no safe reporting system exists and when institutions focus on distancing themselves rather than offering protection — how can we expect new professionals to face and learn from their failures? Making a mistake is not the problem. Pretending it did not happen is.
Medical ethics rely on confronting errors and striving for improvement. Yet current systems teach students to suppress emotions, follow orders and avoid confrontation. This creates what can be described as a “severely conditioned professionalism” — a mindset that is numb to mistakes, indifferent to responsibility and silent in the face of moral choices.
If we continue to excuse institutional errors and suppress the voices of those still learning, we risk not only raising undertrained workers, but also cultivating professionals who are incapable of honesty, self-correction, and, ultimately, earning public trust.
This is no longer just a pedagogical issue — it is a crisis of ethics. Behind the tuition-only internship model lies an ethical collapse: a failure to protect the future by failing to protect those still in the process of becoming.
Chu Jou-juo is a professor in the Department of Labor Relations at National Chung-cheng University.
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