[psalm51]

our students in 2nd semester nursing course (med surg) give ALL meds (yes, even vasotec and dig IV) every clinical to their 2 assigned patients.

90% of our patients are between 80 - 100 and on at least 10 meds each. several dysphagia, many IV drugs, and a PEG or 2 in the mix.

i find that so much of my time is spent being a "technical advisor" that i have so little time to ask any substantive questions re: pathophys, etc. beyond meds.

i try to help them make connections between diagnosis, pathophys, labs, meds, interventions - but quite frankly, there's usually no time left over. in fact, 5 of 6 clinical days this semester, we were too busy even to do post conference.

could i please get a sense of what other schools / faculty are doing in terms of frequency of med pass, etc?

i would say that 5 years ago --it worked -- but several factors have changed, including the acuity of patients - that make our med pass about the only thing i have time for in our med surg clinicals.

what is everyone else doing? or, are you experiencing the same?

THANK YOU

[Alexk49]

How many students do you have? It sounds like un safe nursing practice. How about meds for one patient?

I teach in a LPN program with 8 students, we have 6 patients and one student does meds for 3 patients. I can understand why you feel you spend all your time doing meds.

Also what system do you use, I have to use my finger print to access the Pxysis machine.

[psalm51]

thank you for your response. i have on average 6 students -- so 12 patients and their meds -- so i'm trying to keep up with everything the students are doing, everything the patients are doing (a total of 18 people), new orders, etc.

i have a total of 8 students -- but b/c their rotation to other departments (stress test, interventional radiology, ambulatory surgery) i end up with 5 to 7 students each week.

[nurse educate]

Wow, you really have your hands full. A few questions (sorry my q-mark key doesn't work!!)

Is this what the school expects of their second semester students! Were you told you needed to have each student med both patients! What was their level of functioning coming into this semester (assuming it just started)! I cannot even imagine doing this with my second semester students. I know what it is like to have 3 or 4 of them pass meds in a clinical day, and that is a harrowing experience. They've had very little exposure to ed pass in fundamentals, and I am not comfortable having them give meds when they do not know what they are doing.

Another question: what are others in your school doing! I was talking to one of my colleagues who taught elsewhere, and this was the norm at this school as well. She said the other CIs would not even be watching them, or not being completely thorough with the process. I don't agree with that at all . During my first year (second semester students) my boss told me I was taking on too much and to only do as many as I was comfortable with. I know not all schools subscribe to that theory. I really believe on quality over quantity. They have 2 more semesters after me to build up their patient load. They need to know the basics, and to successfully medicate one patient before they can do 2. I don't tell them the answers, they need to tell me.

So FWIW, I agree that it is way too much to be doing with them.

[psalm51]

thank you for your response.

we (medsurg faculty) were told this semester that we must assign 2 patients for care, charting, and meds. this is not new -- however, in the past, we faculty (CIs) were being flexible in assigning only one patient when that patient's acuity / meds was particularly high. we can no longer consider acuity or # / type of meds in making assignments.

the nearest nursing programs are many miles away. while "student teaching" in graduate school, the other programs rotated the med pass experience. that is, a student would pass meds to their assigned patient one or two weeks during the semester. based upon what i have heard from transfer students, i believe that is still the practice.

med admin (including IV meds) is taught in their first semester (during November). Beginning the last 2 weeks of their 1st semester, the students are required to do all care, charting, and meds to 2 assigned patients. and this continues into their 2nd smester) it is a white knuckle ride! and it consumes most of our (CI) time. i go with the student for all PEG, IM, IV meds; wound care, procedures, assessment for / of pressure ulcers, IV site assessment, etc. etc. (the student also has a busy day tryiing to get their work done)

trying to get a sense of what other programs are doing. we (CIs) feel that this is a functional approach to nursing. that the COGNITIVE piece needs emphasis, that is, questioning to help students to make the necessary connections. we (CIs) had more time for this when we based student assignments on acuity / number and type of meds) i remember in my own basic nursing education (a very long time ago) how many of my CIs questioned and challenged me -- but then, they had the time.

other nurses would be AMAZED at what CIs see sometimes.

the local hospital wants graduates to 'hit the ground running' -- and this along with a few other factors, is influencing what we (CIs) do.

again, thank you.

[Penguin67]

I give a top medications quiz, covering 20 of the top meds that thye will mostl likely see in clinicals. I give them a chart with all material on it. THey just have to memorize it. (Generic and trade name, indication, why needed, action on body and top 3 side effects). They get a quiz on it at the beginning of the semester, and also see it on all 3 exams throughout the semester. It keeps meds fresh in their head, and on the ATI exam at the end of the semester, the class usually scores close to perfect on medications.

Another way for them to put it all together is to do a client database on one client for each clinical week. Documentation should include: past history, narrative physical exam findings per system, review of three patho conditions each week; No repeating),meds (and did they experience any SE's), lab values (and reasons for abnormal lab values focusing on patho), prioritization of a group of patients (that their assigned nurse was caring for), and top 5 nursing diagnoses with supportive data. I've seen students really dig into the assignment each week and be able to grasp more of the big picture.

Hope this helps a bit!

[psalm51]

thank you both penguin67 and nurse educate.

those are good suggestions penguin67 - and very helpful. sounds like their written assignment hits the key areas helping them to make connections and see the big picture.

going to discuss this with other CIs and maybe we can develop a similar approach.

i just feel like the way it is: there are some missing pieces and some students still get it but most don't.

thanks again. am going to give this a lot of thought.

[nurse educate]

I love your top 20 med idea, Penguin

[bookwormom]

I usually have about 7 or 8 students in the med surg setting and each has one patient. Until this year they gave all meds except IV. These patients have TONS of meds. Now there is a new scanning system which is difficult for everyone to use, so I am only having one or two students give meds each day. The nurse manager said something to me that really was food for thought. She said, "Eight patients is the maximum assignment we give our nurses. You can't expect to be able to supervise eight students giving meds safely [under this new system]."

So, my question is what is the staffing ratio on the floor? If your students are caring for 12 patients, that gives you the responsibility for 12 patients. Is the clinical facility okay with that?

[EEG1]

Overseeing passing meds to 12 people and being accountable for 6 students seems like unsafe practice. Even in my last semester of nursing school, we did not pass meds every week. We had 8 people in our clinical group and our instructor would pick 4 people to pass meds to their assigned patients that week. Each student would have 1 or 2 patients to care for. Then the next week, the other 4 would pass meds. This way, the instructor and students could safely pass all meds and still have time for discussions, teaching, etc. And for the students who were not passing meds that particular week, we were usually assigned one more patient to provide total care to (minus med admin).