Passing Meds

[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

[sdprcrn]

I would see if you can 'team up' the students so that you have 2 students with the same 2 patients, ideally in the same room. They can share the information they get with each other. One day have one pass meds on the 2 patients while the other student does the assessment and documentation and then have them swap on the next day. They can compare notes and findings that way.

[BeenThereDoneThat74, MSN, RN]

I would see if you can 'team up' the students so that you have 2 students with the same 2 patients, ideally in the same room. They can share the information they get with each other. One day have one pass meds on the 2 patients while the other student does the assessment and documentation and then have them swap on the next day. They can compare notes and findings that way.

I did that a few times this past semester. It actually worked out very well. One saw things that other didn't and vice-versa. The "med nurse" would prepare his/her meds, then inevitably be waiting for me to pass meds, so he/she would help her team member with theb AM care and assessments.

I am more of a 'quality' over quantity person, when it comes to patients and meds for the students. IMO, I can't see them rushing through all having two patients each, just to say they can care for 2 or 3 patients, when they are not doing it competently. Fortunately, my school is in support of this (although some of my colleagues do not do this).

[ceecel.dee, MSN, RN]

You could save some of that really important quizing (pathophys, contraindications, etc.) for post-conference, and that way the whole group benefits. I have students pocket the med packages and the student quizes the others about their meds in post-conference. This is a great way to become very familiar with the most common meds given too, and can be kind of a fun group game.

I typically have 8 students (usually 2 of them with 2 patients), so responsible for around 10 patients. We don't do the IV meds yet, so that helps! Very busy, and impossible to do everyone's on time. They are indoctrinated into what it is I like to hear from them as they are being checked (name of med, what it's given for, is there anything you need to know about the pt. before you give it, i.e. AP prior to beta blocker). The rest I save for post-conference usually (can sometimes depend on the student).

[llb1228]

I am amazed at the number of students on one unit and having the ability for them to take a 2 patient assignment. I am also amazed at the need to do all patient medications including IVP. Having only been out of the clinical instructing field for 2 years now things have either changed or we in the northeast have some catching up to do. I was not taught 20 years ago to do IVP meds until I took an IV course at my place of employment. That is still the thinking in the staff development office I work in presently. I am not sure what others are thinking about students giving IVP meds with or without their instructor present but it raises a red flag for me. I hope I am not out dated on this. Your load does seem extreme and wonder what the medication error data shows with nursing students and their instructors giving meds with this kind of load. This is a great topic and glad you asked the question about your load and the expectations to provide the instruction you describe. WOW your nursing students must rock after they graduate.

[JoMom4]

I think students do need to learn to give IVP meds these days. Gone are the days of Demerol and Vistaril IM q4h. In our facility, pain meds are given IVP. Antiemetics are also given frequently. We give steroids and heparin bolus as well. There is no "IV course" per se at our facility. When the new grads hit the floor, they will be expected to have basic knowledge of IV meds. I would rather have them learn as a student.

I will be starting as an adjunt clinical instructor for advanced med/surg students at the facility where I work. I will have 10 students per clinical group, but some will be observing in various departments each clinical day. I appreciate the comments made in this thread, and will be more aware not to let myself become overwhelmed with med pass. I like the idea of having half the group give meds each week. There are other things students can focus on if they are not giving meds that week.