When you have students on the floor...

[NightOwl0624]

Quick question to some of you more experienced nurses...

Last week we had students on the floor. I work the 7pm-7am shift, so we usually don't still have students at this time. I was working with 3 different students that covered my 5 patients. They were going to pass 2100 meds.

I was told that I was to check off their medications and to just look over all documentation. These students were so quick that they passed the medication without checking with me or their instructor first (instructor was on another floor with other students the entire time). I caught one of them as she was starting to mix the concoction to put down the NG tube, and another one I saw because I had to get something out of the pyxis for her, but 3 of my patients got meds by a student that were not checked off by a registered nurse.

I have been a nurse for less than a year, and have not worked with students very often. As a student myself, I would have never, NEVER done this. This situation was upsetting to me. Some people I work with thought it was outrageous, and others didn't seem very surprised. I sent off an email to my manager, but have not heard back from her. I did learn a lesson to say up front what I expect when working with students.

My question to you ... does this happen on your floor? Am I overreacting? How would you have handled it?

[Katie5]

How dare they?How did they get the medications in the first place?I would walk them off my floor.

You don't do that...you just don't. Which is why you're still a student cos you're learning.

[luvmypatients]

When we have students on our floor it is the responsibility of the instructor to check all meds. The only time we are responsible is when we have a transition student with us which is a one on one learning experience. Students must always have all meds checked!! I know there have been students kicked out of their programs for not doing so. This is something that definitely needs reported!!!

[Nightingale11]

I would be expelled from my program had I have done this.....this is a no no where I go to school. But then again, our instructor stays on the floor with us the entire time. We are only allowed to do vitals, bedbaths and showers w/o having her in the room.....we can't do anything w/o her being there. I would not be confident enough to pass meds by myself yet......geeze. How rude for them to take over like that!!!

[iNurseUK, RN]

Well I would be in BIG trouble with the NMC if I failed to supervise a student nurse on the drug round.

I'm English so nursing school supervisors don't appear often on the ward. It is the job of the designated qualified nurse mentor to teach and supervise student nurses.

[Little Panda RN, ASN, RN]

I am an LPN and an RN student. While I have been working on the floor we were supervised by our instructor once and then we passed the meds on our own. Now if it was an IV push or hanging a bag our instructor was always present. She was also always present for any skills that needed to be performed.

Since all of us in our program were LPN's, which was a requirement into getting accepted into the program, I am sure this is why we were allowed to pass meds unsupervised.

[whichone'spink, BSN, RN]

Wow, where the heck is the instructor. Mine always checks off on PO meds and I give them independently. Injections I'm still not giving independently.

[SkiingCait, BSN, RN]

I agree with the others that you most certainly are not out of line in being upset at this. I am graduating next week, and the way it worked in my program is that our instructor was the one to sign off on our meds, unless we had arranged something different (ie - she was busy with another student and I had already arranged that the primary RN would sign off for me). In that case, I would make sure that the RN had seen all the meds I was about to administer before doing it. These students are working under YOUR license when you sign off on something that they do, and it sounds like this needs to be addressed before a problem occurs.

Good luck and good for you for contacting your manager. I hope this gets resolved!!

[angelp71]

same here. i just finished clinicals for the semester. we had to check with our instructor before hand, show her the meds we were about to give, then give them. we cant do IV push at all, we would make a minibag and hang it (after showing the instructor the bag). if it was NG tube, she would want to be there. injections she monitored until she was comfortable with our technique, then she let you give it on your own, but still had to check in with the med before hand.

we would get at least a 'clinical deficiency' if we passed meds without checking, and likely dropped out of the clinical for the semester.

risky for that instructor to let students operate like that under her license. good thing its the minority. hope it gets resolved and no pts got hurt.

[CranberryMuffin]

I agree that they should have had them checked off with you prior to administering anything. However, perhaps the day shift preceptor or clinical instructor had given them a lot of leeway. I'm guessing they had been given a lot of freedom in prior clinicals or on other shifts and so they went ahead and did what they usually do. When coming on shift, it's your responsibility as the nurse to establish expectations. I've had nursing instructors and preceptors who all had a completely different take on how to pass meds, getting checked off (or not) and the level of independence given to students.

[llg, PhD, RN]

Unless they are licensed nurses, it is probably illegal in your state for them to give meds without having them checked by a real nurse first.

Clarify this before going any further ... but assuming that they they are not nurses, then you are not over-reacting at all. That situation needs significant follow-up, with both your manager and the school.

Even if they are nurses and what they did was legal, it is still VERY wrong that they gave meds to YOUR patient without confirming them with you first. As you indicated in your OP, it is important that all expectations be clarified at the beginning.

You're not crazy. You are right to be concerned. As my hospital's liaison with the local schools of nursing, I'd be on the phone with the Dean of the School if that happened at my hospital (unless special arrangements had been made in advance, of course -- and the legalities were OK'd.)

We had a paramedic student give a med unsupervised once ... and he was thrown out of his program. He figured that since he was allowed to give it in his job, he could give it at our hospital even though he had been told to wait. He learned the hard way to follow the rules and to always work WITH the nurse in charge of the patient.

[dudette10, MSN, RN]

I don't doubt there is some variance among instructors checking off students, based on skill/knowledge level and length of time in the program...

OP, I don't think it's out of line to give them a "talking to," if having a check off is what you want while you are supervising them. As you found while questioning your co-workers, even they have different attitudes toward it. That, to me, says that you should make it VERY CLEAR what YOU want done when you are held responsible for their actions.

One of the weird things about nursing school is that every instructor and every nurse we are learning from all have different opinions about the way things should be done. That said, the students you're supervising for meds shouldn't be at all surprised when you say you want it done a certain way. Yeah, yeah...they'll say, "But so-and-so never made that a requirement!" (After all, why do they think it's ok to do that?) So, making it clear that you aren't so-and-so should do the trick.