MedError/Dismissal...What2Do

fab4fan · Jun 21, 2005

I'm glad that the program was willing to work with you. Consider it a moment of grace, which we all need from time to time.

Now, the most important thing is to make sure that you apply what you've learned from all of this. Sometimes, lessons have to be learned the hard way.

Best wishes to you in your future as a nurse.

rach_nc_03 · Jun 21, 2005

I would think that this would bring about all kinds of liability issues for the hospital as you are (were) a student, not an employee of the hospital.
We ALWAYS had to have a co-signer when I was a student and now as a preceptor, I am sorry but I want to know that the student giving meds on MY patient knows what they are giving and the side effects of the med that they are giving. After all it is MY patient and their care is ultimately in MY hands, I am the one that will be held responsible if my preceptee makes a med error. The OP proves that not all SNs know how to correctly pass meds.

I wish all nurses felt the way you do. My last semester was spent on a floor where the vast majority of the staff nurses saw us as "taking" their patients- 100%. This was a surgical floor, and we often had fresh post-ops during our clinicals. By our third or fourth week there, the OR nurse would be calling the STUDENTS to try to give report; in fact, several of the MDs on the floor tried to give verbal orders to students. Obviously, we wouldn't take them, but the reason this happened is that the nurses were referring these people to the student nurses. at least 75% of the time, we were unable to get help from our coassigned nurses if we needed them; there was a whole gaggle that would go outside to smoke together *frequently* while we were there for our 8-hour clinical shift (I smoke, too, but how many times must you leave the floor in an 8-hour period?), and two of the nurses liked to sit in an empty room to watch american idol. no joke. if we found them, the majority (barring 2 or 3 who were extremely helpful, one of whom had gone through our program) would either tell us to call the MD ourselves (school policy forbade this), or say "i'll get to it" and never actually go check the patient. I'm not talking about people being busy...I mean people sitting in the day room, surfing the net and doing online shopping. The nurses would fight over how many students they "got" for a shift, since we each took 2 patients, and they felt cheated if they didn't have at least half of their patients covered by students. we tried to get help from our instructor, but she was never able to get these issues taken seriously by the nurse manager.

at the beginning of the semester, I asked my nurses for supervision for all IV meds. almost exactly the same nurses worked those shifts with us each week, so after a few weeks, they started saying, 'ok, rachel, you know how to hang a piggyback. you're on your own with these.' a few students asked the instructor to be present whenever they did anything involving an IV, including flushes, and they did this til the end of the semester, but those of us who had demonstrated competency were asked to do these things on our own. also, none of us were required to have an instructor present- it was a comfort level issue, so those who wanted to were able to get her in there. another thing to consider is that 99% of the time, the meds were almost identical from patient to patient, so it wasn't unrealistic for our instructor and the nurses to assume, after several weeks, we had a grip on these meds.

the hospital where we had our peds rotation was a totally different story. when we started the semester, we had to have the instructor present for any IV push. After she'd seen you do it correctly about 20 times, she let you do it on your own. the difference was that she spent the whole shift going from student to student, making sure we were comfortable and knew what we were doing. she was also our pharm instructor, so she was a stickler on knowing meds. also, the nurses on that floor were much more involved with us and with their patients- most would check the patients every 30 minutes, at a minimum, and were very open to helping if we had questions or concerns. anything really new to us, like setting up TPN, we were able to do alongside a nurse, everytime if we wanted to.

I'm sorry to go on and on...and I'm not directing this rant at you, austin heart. nor am I defending the OP's errors, as I don't know the whole story with him or the day this stuff happened. I just wanted to make a point: it's certainly ideal for both the nurse *and* the clinical instructor to know each and every thing the students are doing, I agree. but there are lazy nurses in this world who will offload all responsibility to a nursing student, even if it's dangerous. it's also possible for a competent student to administer meds without a nurse or instructor at the bedside with them, if there is adequate communication and ongoing assessment by the nurse and instructor. the onus is on all three people involved- the student, the instructor, and the assigned nurse- to make sure patient safety is ensured. personally, I never did anything alone until I was 100% sure I knew how to do it, and I got my fair share of exasperated sighs from my instructor and co-assigned nurses when I wanted them to watch me do something they'd seen me do before. I didn't care, because if *I* wasn't comfortable doing it, I didn't feel safe doing it alone.

austin heart, BSN, RN · Jun 21, 2005

I just guess that nursing school has changed alot in the last 10 years. We were never aloud to do any type of procedure or to pass meds without the preceptor and or the instructor. And I think that we all turned out as pretty good nurses because the majority of my small class has ended up in Trauma and Critical Care nursing. The supervision did not bother me, after all I was there to learn.

I am all for letting students take charge and do procedures but I want to watch so that I may offer suggestions if needed. As I said, I am ultimately responsible for the patient's care. I love to teach and usually start the shift by asking the preceptee what skills that they have not had the opportunity to do or ones that they feel they need more work on. That is what nursing school is for, to learn. But, I think supervision is key. I do not care how knowledgeable they are these people are still STUDENTS, they are not licensed nurses working on our patients.

I would also like to say that I have learned a thing or two from some of the fine students that I have had the privilege to work alongside.