Students, RNs and medication admin - Is this crossing boundaries?

  1. 0 I am a first year first semester nursing student. I have been in clinical for 11 weeks. We started passing meds 3 weeks ago. Our clinical group has 8 students an our instructor has been dividing the group in half for passing meds - as in 4 students get to pass this week and 4 the next. I completely understand this, as she does not have time to supervise all 8 of us in the act of scanning wristbands, verifying barcodes and dosages, etc. for all 8 pts before 9am for 8am meds. My question is, as I have (I believe) proven myself to be a reliable student so far (I understand and can explain my patient's diagnosis, the classification, action, side effects, etc of all drugs,) would it be presumptuous of me to either my instructor or, more importantly, the assigned nurse, to ask if the nurse could supervise me giving meds? Rather than my instructor? If you are a nurse, would this make you uncomfortable since I am only first semester? If you are an instructor would this worry you because you are "responsible" for me? Thanks for the input, don't know the politics and don't want to step on anyone's toes...
  2. Visit  Apples&Oranges profile page

    About Apples&Oranges

    Joined Oct '13; Posts: 35; Likes: 43.

    23 Comments so far...

  3. Visit  Esme12 profile page
    0
    thread moved for best response
  4. Visit  JustBeachyNurse profile page
    5
    Not in my school or any of the clinical facilities we rotated through. Students were only permitted to perform invasive procedures ( at least the first few times ) and pass medications under the direct supervision of a clinical instructors

    If the option of passing meds under the supervision of a staff nurse was not offered, it is likely not a possibility especially as a first semester student.

    As a nurse I would not want the responsibility of a first semester student on their first med passes.
  5. Visit  loriangel14 profile page
    2
    It wouldn't likely be allowed because the instructor is responsible for supervising medication passes. If they are going to be held responsible they will have to be the ones doing the supervising. They wouldn't likely "pass on" the responsibility to a staff member.
    Carrie RN and SoldierNurse22 like this.
  6. Visit  Rose_Queen profile page
    1
    Depends on the policies of the school and the host facility. Remember, the instructor is responsible for you; the nurse is responsible for her patients. The nurse may have 6 or 7 patients to give medications to, and taking the time to supervise you may make his/her other patients' medications late. There is a reason your instructor/school limits the number of students passing meds to only 4.

    As you are a first semester nursing student, I can understand your desire to do more. However, stay within what your school policies/ instructor directions tell you to do. It's only been 3 weeks; give it time. We weren't allowed to pass oral meds solo until 3rd semester of clinicals. IV meds weren't even introduced until 2nd semester, and until the last semester required instructor presence. In the last semester, we had to be signed off by that instructor before being allowed to do solo IV meds.
    Apples&Oranges likes this.
  7. Visit  akulahawkRN profile page
    1
    I'm a current student... just not 1st semester. In 1st, you pretty much work entirely under the direct supervision of the clinical instructor. After 1st Semester, we're checked off on PO med pass with our clinical instructors and can usually do PO meds on our own. Certainly this is the case with 3rd Semester students. As long as I'm familiar with the meds, I can give them. We still have to have an RN or Instructor with us when we do anything except rate verification of IV lines or inject a medication. Next Semester, we'll do IV push meds and the like, and toward the end, we'll do pretty much everything.

    Don't worry, there's lots to learn and a reason why your school does what it does. (Med error prevention!!!!!)
    Apples&Oranges likes this.
  8. Visit  MunoRN profile page
    1
    I've never worked in any place where the majority of med administration by a student wasn't done with the staff Nurse as the one supervising the student. Although first semester/quarter Nursing students rarely if ever have a Hospital rotation, but at least after that it's actually pretty rare in my experience for students to pass meds with their instructor instead of the RN they are paired with.
    KelRN215 likes this.
  9. Visit  Meriwhen profile page
    1
    Quote from JustBeachyNurse
    As a nurse I would not want the responsibility of a first semester student on their first med passes.
    Agreed. It doesn't matter if you are the class' top student: unless you were a prior LVN (and to be honest, even if you were a prior LVN), I'd rather that you have been judged competent by your instructor first...and that's not going to happen after just one med pass in the first semester.

    Patience, young padawan. Your time will soon come.
    diver117 likes this.
  10. Visit  dudette10 profile page
    2
    As MunoRN's statement attests, it depends on the facility policy, school policy, and unit culture to determine if a nurse can be responsible for an SNs med pass on a regular rotation. I think you could ask your clinical instructor if it's ok, but I would wait until the nurse offered to accompany you on med pass.

    Where I work, nurses can supervise med pass IF they want to. If I have time, I will accompany my student to first med pass for her co-assigned patient and supervise closely, otherwise, I leave it up to the instructor. If I have to hang IVPB or a new bag of fluids, I'll also talk them through it while they do the actual skill. Same with wound care.
    KelRN215 and Apples&Oranges like this.
  11. Visit  dudette10 profile page
    2
    Quote from akulahawk
    After 1st Semester, we're checked off on PO med pass with our clinical instructors and can usually do PO meds on our own. Certainly this is the case with 3rd Semester students. As long as I'm familiar with the meds, I can give them.
    When you say "PO meds on your own," do you mean give them after the instructor has reviewed them/labs/VS/NPO status/etc. with you, or do you mean that you check the MAR and just give whatever is scheduled on your own without any supervision?

    If it's the latter, hrm. I, as the nurse responsible for the patient, wouldn't like that. At all.
    KelRN215 and sapphire18 like this.
  12. Visit  ixchel profile page
    2
    In addition to working under the instructor's license (not the patient's nurse), your instructor will use this one on one time with you to help focus your thinking on what is important: what is the med? How does it benefit your patient? Can you do patient teaching? Do you know what to assess before and after med pass? Are you thinking critically about these specific meds and how they will interact with other meds and this person's complex medical needs?

    For example: if you are giving a beta blocker, will you remember to do BP and pulse first? What are you giving that beta blocker for? (They can be prescribed for reasons beyond high blood pressure.) Do you remember the patients rights every time? Is it possible this med is an error?

    Sure you have some knowledge by now, and chances are you did an awesome job thinking all of this stuff through after your preclinical. But...... Your instructor doesn't know that, and your instructor's responsibility is to make sure you did. This one on one time with you is a great time to assess your progress and for you to know if you're thinking about things in the right way. Second semester, things will be a little different. You will get to pass PO meds without as much hand holding, probably. But for now, appreciate the hand holding. It will give you time and opportunity to get better. And it will help your instructor protect his or her license while they get to know you and your abilities.
  13. Visit  T-Bird78 profile page
    5
    I'd let her know you're always interested in learning and doing more, but don't be so presumptuous as to say you're better than the other students and can do things without the instructor. You've been doing this one semester, you still have a long way to go. As others have posted, the facility may not permit it, the nurse probably won't want you to, and your instructor will go over the pt's chart/orders and verify everything and go into detail about the meds (dosing, reasons, side effects, etc). It's great that you're eager but don't put the cart before the horse. Good luck!!
    casi, SoldierNurse22, BuckyBadgerRN, and 2 others like this.
  14. Visit  akulahawkRN profile page
    0
    Quote from akulahawk
    I'm a current student... just not 1st semester. In 1st, you pretty much work entirely under the direct supervision of the clinical instructor. After 1st Semester, we're checked off on PO med pass with our clinical instructors and can usually do PO meds on our own. Certainly this is the case with 3rd Semester students. As long as I'm familiar with the meds, I can give them. We still have to have an RN or Instructor with us when we do anything except rate verification of IV lines or inject a medication. Next Semester, we'll do IV push meds and the like, and toward the end, we'll do pretty much everything.

    Don't worry, there's lots to learn and a reason why your school does what it does. (Med error prevention!!!!!)
    Quote from dudette10
    When you say "PO meds on your own," do you mean give them after the instructor has reviewed them/labs/VS/NPO status/etc. with you, or do you mean that you check the MAR and just give whatever is scheduled on your own without any supervision?

    If it's the latter, hrm. I, as the nurse responsible for the patient, wouldn't like that. At all.
    In 2nd and 3rd Semesters, we do review with our instructors those things for check-off. We're also required to write up every med that our patients have ordered as part of our prep. This is so we know what we're giving, why, and what to watch out for, including relevant labs. We do let our supervising nurses know what we're doing so they know what's going on, but we are not required to have someone observing each and every time we give PO meds. If the supervising RN wants to, that's perfectly fine. We actually do a lot of communicating with the nurses we're assigned to, so they're really not unaware. At one facility, we're the only program allowed to pass meds to patients. This includes the local BSN program.

    And yes, there have been many times that I've held a med because it was inappropriate to give. I notify the nurse I'm working with about it and why so that med isn't inadvertently given by someone else.

    We have access to the Pyxis systems and can pull most meds on our own. If we're not familiar with a med, we can't give it. We're expected to look up unfamiliar meds before we give them. While it is uncommon for us to give meds to a patient that we're not assigned to, we look up any unfamiliar meds, check any relevant labs for that patient, and notify our instructor what we're doing for approval to give those meds. We're not entirely unsupervised, however the level of supervision for 3rd Semester students to give PO meds is a lot different than it is for 1st Semester students. Even in our program, I would be VERY uncomfortable with 1st Semester students giving meds at the current level of supervision I have right now.

    And this also is what has been agreed to with all the hospitals we go to, and my program.


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