Clinical Site Rules for Your School? - page 2
I am wondering if your school is anything like mine. Different hospitals have different rules for the nursing students, and since I have been in nursing school the rules have changed so much, to the... Read More
Jan 15, '12We Do head to toe assessments, give meds, feed, clean, wipe ...you name it we do it..& we get to chart it all .hahah
but like someone said, where ever you go you'll learn their system. SO dont sweat it, charting isnt that exciting haha.
Jan 16, '12There are to many hospitals in this geographic area to actually even accurately choose an answer. Some hospitals do let students chart, yet it has to be signed off by the clinical instructor, or no charting at all. Some hospitals allow students to give medications and some didn't, yet due to state regulations no student could do an accu-check (retarded I know) or sub q /iv push medications.
Each semester I was placed at a different hospital, every semester I did less and less, and so I couldn't answer your question =V
Jan 16, '12My maternity clinical allowed us to chart everything except giving medications and doing the hospital's own fall risk assessment. Medication was given under our teacher's name even though we drew it up, calculated it, and passed it (with them present of course).
However my pediatric clinical we weren't allowed to document anything not even vitals (supposedly due to students getting very different numbers from staff although the PCA's ended up asking us what the vitals were that we took and documented them anyway).
My school however does make us visit a good majority of the hospitals in our area so we do learn the charting systems at different hospitals. It is beneficial since not all the students will be hired in one place and going to work there you have some idea of what's going on.
Jan 16, '12We chart everything we do under our names on the computer. It goes into sort of a "pending mode" until our instructor looks over what we charted and approves it. Then it becomes part of the electronic record. We don't have access to remove the meds from the machine, so our instructor has to sign them out for us and fi there's something that needs to be charted after it's given, she does that. The hospitals we use have the scanners for the med/id bracelet and pretty much all the info goes in automatically.
Jan 17, '12We can do whatever we've learned and checked off on and at the hospital if we did it, we charted it. That included meds, HoT assessments, IVs, Foleys, vitals, blood sugars, etc etc etc. If we noticed something off about a pt and alerted the nurse, we charged that we noticed and told the nurse. We also have our own PYXIS numbers and once we got checked off we could pull meds(no narcs or IVPs of course) and give them as long as the nurse knew about it. And this was all in my first semester.
My instructors are really big on the "If you didn't chart it, you didn't do it." idea.
Jan 19, '12We've charted everything and done just about everything over the course of two plus semesters. What you are and are not allowed to do and chart is generally a matter of facility policy and/or whatever the particular nurse manager of your assigned nursing unit desires, and not necessarily the way the school has it set up or wants it to be.
Jan 19, '12It was always hospital-specific. Some places that still used paper bedside charts, we could document head-to-toe assessments, vitals, I&Os, etc. Never meds though; our instructors always do the meds under their own name. Other hospitals, the tech department would only give our computer usernames access to input vitals. (no assessments, no i&o). It just depends on the facility and what their parameters are for students. The school has no set rules or policies regarding what we're allowed to document.
Skills are a little different.. once we went over a skill in lab we could do it in clinical. Some instructors would want to oversee you do some specific skills before letting you "fly solo"; meds are always given with the instructor (not the hospital's nurse assigned to that patient and you; just the instructor). As a rule, we are not allowed to do any IV push meds; and no inserting of IVs, no matter what the hospital policy says. And sometimes the hospitals will have certain rules too. At one facility, students could do blood sugars (as sophomores) but at my last hospital (as a 1st semester senior) we were not allowed to.. just hospital rule.
Jan 29, '12We were always allowed to chart head-to-toe assessments and chart meds on the MAR and either our clinical instructor or RN we were with that day would co-sign.