Can student administer medication without RN supervision?

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Is it possible (legal) for a student nurse to administer medication without supervision of the preceptor nurse or the clinical instructor?

I know it happens all the time, and often if the student makes a mistake, she is severely penalized.

I am wondering whether it is possible for the hospital, preceptor nurse or clinical instructor to allow the student nurse to administer medication without providing supervision through every step of the way.

I was told by someone that it is illegal (against Nurse Practice Act in most states) for a student to administer medication even if it is P.O., and that an RN must be with the student through every step of the process.

Is this true? Is this law different from state to state? Or is this pretty much the same in all states?

As echoed by many, we must have an instructor present at bedside.

My understanding (as explained by professors) is that everything we do, especially medication related, is on their license. If they sign on a paper or electronic mar that a medication was administered, they want to follow us to the room and make sure just that.

How would having a instructor/RN quiz you on a med, and then let you go into the patient's room and administer it by yourself be any different than a nurse letting any other UAP administer their medications for them?

Sorry, but no they can't. Although it varies from state to state the best thing to do is check the hospital policy if you aren't sure. In my case @ UCLA the floor that I did my clinicals I worked there as a PCA and my instructor knew the charge nurse and the charge nurse knew me. One day a patient was c/o of severe pain r/t post-op TURP and he was IV push Morphine. He had been calling since 6 that morning and hasn't been able to receive it. Our clinicals started @ 0700, but by the time I met the patient it was 0800. My instructor was with other students on another floor and this patient was getting irate. I approach the charge nurse and asked her if I could give the patient his medicine, but before I could I had explain the whole process of what involve in doing so, Having know the proper method of my floor I told the charge nurse everything from checking the doctor order, right dose, route, time, etc. I even told told her this medication affect the body, what category/classification well you get the picture. I had to sign my name in tripilcate with her co-signing since it was a controlled substance and I had to put down my title/school. At no time was I left alone during the process. I'll say this I pass with flying colors and later doing clinicals I was able to pass meds, but there was always a staff R.N. nearby. Basically, it not what you know, but who you know. I was forunate since I was already working @ the hospital and had a wonderful group of nurses that I worked with. Bottom line remember you're on your clinicals under your instructor license and he/she is responsible for you as a student does. Good luck.

Specializes in Med/surg, Quality & Risk.
How would having a instructor/RN quiz you on a med, and then let you go into the patient's room and administer it by yourself be any different than a nurse letting any other UAP administer their medications for them?

Because they're not UAP? They're student nurses who have presumably been taught to give PO medications properly?

Specializes in Retired OR nurse/Tissue bank technician.

As a first year student, we had to be directly supervised the first three times we gave medications in each form (oral, IV, IM, sc). If all went well, we could give medications without direct supervision, but were always reminded to talk to our instructor or RN if we had questions.

At my hospital ... if we ever caught any instructor allowing his/her students to give any kind of medication without direct supervision ... that instructor would be barred from our facility. If the school condoned it, we would cancel all of that school's rotations. Meds can only be given by nurses -- and student's aren't nurses.

If you have a question about the laws in your state, I recommend checking the Nurse Practice Act.[/quote

I beg to differ, students are nurses, we are just not registered yet. Whe we are doing clinical rounds, we are doing nursing duties under a RN. We have to give proper documentation to our school to function as a nurse even take out insurance.

To answer the lady question, you should not administer any meds by any routes without yr clinical instructor, yr putting his/her license on the line and yr nursing education out the window

Specializes in Radiation Oncology.

Wow this is eye opening to me! I just finished level 1 in an ADN program and as many have said before, our instructor had to be present with us the first few times then after that we could do it by ourselves. We had our main clinical instructor on the floor and also a med assistant who was also a nurse and employed at our school there during peak med times. At the beginning of each clinical day we had to give either instructor "report" on our patients and which meds we were giving (we had to take the meds to her so she could see the dosage and compare it to the MARS), why our patient was receiving the med, side effects, and contraindications.

There were some students our instructors never felt confident in and they would be present for their med passes. I just assumed it was like this everywhere but I was really wrong. I guess in Texas it is allowed because I have not only seen our students do it but also Texas Tech, UT, and Texas State students do it.

Wow. I can't believe that any student nurse is so capable of administering medications by themselves. Just because "it happens all the time" does not mean that it is okay. Giving medications is serious, and wanting to do it all by yourself is pretty dangerous. When a new nurse is being precepted, sh/he can't give it wothout a preceptor present, and this is for someone who actually has an RN, giving medications is that serious. As for the person who posted doing minor procedures by yourself, just be careful, it is fun to do new things, especially while in school, but you are still learning and it is not something that you should be so comfortable with as a student. Acting overconfindet can cost you in the end, and you might miss out more on the big picture of what is happening with the pt.

It makes me mad that student nurses, of course I was one once too, act overconfident. I sometimes here "I got this" those three worde are perhaps the most dangerouse because really you don't and are not proceding with caution and actually thinking about what you are doing, only doing a task without thinking.

Wow. I dont do anything I can't handle, and to assume all student nurses don't is a little out of line. I take more care in my med checks than some RNs as well as my last instructor; I go one by one down the MAR, whereas most just grab them all and sign as they go (that's assuming that RN didn't initial BEFORE administering). When you kust grab and give a monkey med, well anybody can do that; hence the name. Not one person can assume what another can do or cannot do. Point is, if a student is good and has done it before and, for example has worked in the medical field already, knows the average doses, side effects, contraindications, and the reason the patient is taking it.....well that RN license does not give anyone the right (or license) to assume who knows what. I have not seen anything done by the book except on instructor and 2 RNs in a year of nursing school. I gaurantee, at some point, some student nurse is gonna catch a mistake done by a licensed nurse (by experience), so to say RNs never never do things wrong is "out there" and I see it more than I thought I ever would in my entire career, in just 2 semesters. I say what I have seen, and it's real as well as real scary.

RE: IV push morphine; my school does not allow us to ever push while a student, so as students we have to know our scope of practice.

Did anyone else's school not tell them anything about this sort of thing? I mean, I got a student handbook that told me that I was to do x, y, and z, and most of it was somewhere along the lines of "if you don't follow your instructor's instructions, you can get dismissed from the program. ask your instructor if you have any questions. this is subject to change at any time. be nice. don't mess up."

Maybe my school is disjointed, but in my experience, every clinical instructor is different and has different preferences and rules about what students can and can't do. And the guiding principle seems to be what the hospital system dictates is acceptable, which I assume is in accord with state nurse practice laws, else they'd probably be in trouble come JC certification time, right? Like if student nurses were systematically running around on every shift and every floor callously passing meds unsupervised, and with overconfident reckless abandon, in direct insubordination to what nurse practice laws say?

I think what a student can do varies by state, like several people have said. Nursing education programs have their own section in the state legal code, separate from what an RN can delegate to a UAP (at least in my state), so I think it's different. Personally/not from a legal point of view, I don't see any problem whatsoever with nursing students executing some independence as they are trained to do tasks. There's no magic *thing* that happens inside you once you are licensed as an RN, and since that is the case, I'd prefer nurses who are caring for me to have practiced (hands-on) skills they are performing. Part of being an RN is learning to make independent (informed) decisions, and so I feel comfortable with nursing students learning this as they go along (with practiced skills, such as reading a MAR and pulling meds, IV placement, or walking into a room to give an IM vaccine), rather than granting them 0 independence, and then thinking they should be magically totally independent once they have a piece of paper/license.

We have clinicals this weekend and we were told NOT to give any drugs to the patient even if the RN was with it. We are supposed to tell them we arent allowed to. We learned if something happens to the patient we will get blammed. Our teachers are also RNs and they said they will also refuse to during clinicals..its the nurses job to do that (the one caring for the patient) no one elses..

Part of being an RN is learning to make independent (informed) decisions, and so I feel comfortable with nursing students learning this as they go along (with practiced skills, such as reading a MAR and pulling meds, IV placement, or walking into a room to give an IM vaccine), rather than granting them 0 independence, and then thinking they should be magically totally independent once they have a piece of paper/license.

You said this so much better than I did...obviously! Exactly what I was trying to get across. The graduation date does not make us a better RN; our education and how we choose to accomplish/utilize it on a daily basis is what can make us an excellent RN.

Specializes in Emergency Dept. Trauma. Pediatrics.
Wow. I dont do anything I can't handle, and to assume all student nurses don't is a little out of line. I take more care in my med checks than some RNs as well as my last instructor; I go one by one down the MAR, whereas most just grab them all and sign as they go (that's assuming that RN didn't initial BEFORE administering). When you kust grab and give a monkey med, well anybody can do that; hence the name. Not one person can assume what another can do or cannot do. Point is, if a student is good and has done it before and, for example has worked in the medical field already, knows the average doses, side effects, contraindications, and the reason the patient is taking it.....well that RN license does not give anyone the right (or license) to assume who knows what. I have not seen anything done by the book except on instructor and 2 RNs in a year of nursing school. I gaurantee, at some point, some student nurse is gonna catch a mistake done by a licensed nurse (by experience), so to say RNs never never do things wrong is "out there" and I see it more than I thought I ever would in my entire career, in just 2 semesters. I say what I have seen, and it's real as well as real scary.

Yea I have to say, as students I think a lot of times you are so nervous you are more careful. I have seen a LOT of med errors made by nurses during my clinicals. Some pretty serious, saw a lot of things done that were not ok (leaving the meds at the bedside with family there none the less) and as far as verifying the patients? Yea saw that not done a lot as well. There were many things I observed and tucked away in my "do not do" list. That said, I do think all Meds students are giving should be supervised. We do not have our own lic. to work under so if we mess up, it's someone else that is going to be getting in trouble for it.

Regarding push meds, we were able to push medications our second year.

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