Can student administer medication without RN supervision?

[AnneN]

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?

[BabyLady, BSN, RN]

I imagine it depends on the way that meds are administered at the clinical site. MAK won't let me give meds to the wrong patient in the wrong dose, so long as you don't override the meds or the bracelet, and use JC requirements for patient identification, and overriding would be questioned the next week once the teacher got the override report.

We use the same system and I can assure you, depending on how things are set up in your unit, it is possible.

MAK tells you what dose...but as you know, some IV medications have to be drawn up by the nurse or administrated a certain way, or if you do not have a roving MAK cart that you can take into the room, you can MAK the drug at the computer, but a student can walk into the wrong room, check the vital signs incorrectly, etc.

MAK is also only as smart as the pharmacist that puts it in..I catch mistakes monthly that are significant. Also, students in our facility do not get access to MAK, nor any graduate that has not passed NCLEX.

[BabyLady, BSN, RN]

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..

I'll be honest....your school is taking a HIGHLY unusual approach. That is part of nursing school.

How are you supposed to learn how to administer medications? Instructors are required to be licensed RN's and if there is an RN right beside of you and if they are watching what you are doing and supervising, you should not make a mistake.

The most difficult part of administering meds, after you are licensed, is not calculating the medications....school usually teaches you to have that down pat...but it is gathering the supplies that you need, how to connect them, what you need for an IV start, etc.

[redhead_NURSE98!, ADN, BSN]

We use the same system and I can assure you, depending on how things are set up in your unit, it is possible.

MAK tells you what dose...but as you know, some IV medications have to be drawn up by the nurse or administrated a certain way, or if you do not have a roving MAK cart that you can take into the room, you can MAK the drug at the computer, but a student can walk into the wrong room, check the vital signs incorrectly, etc.

MAK is also only as smart as the pharmacist that puts it in..I catch mistakes monthly that are significant. Also, students in our facility do not get access to MAK, nor any graduate that has not passed NCLEX.

Then your students have no business giving medications. We got our own access to MAK and have computers in every room. For anyone to sit there and say no student should ever give meds without an RN in the room is short sighted and assuming that their experience is everyone else's. I guess some states trust their nursing programs as a whole better than others.

[shortnorthstudent]

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.

While a nursing license doesn't mean that someone should assume what a student does or doesn't know, the license is what says that they are allowed to perform within the scope of practice of a registered nurse - including passing medications. Students are not yet licensed and are not authorized by the Board of Nursing (at least in my State) to perform those duties. Everyone makes mistakes at times and catching a nurse in a mistake does not change the fact that the nurse is licensed and the student is not. We all must work within our scope of practice. Fortunately, most of the things I see nurses doing that are "mistakes" are really innocuous things that are the difference between skills lab and real life. Some things I file away to remind myself that that is not the kind of nurse I want to be.

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..

Are you early in your program? I would expect that this will change as you gain experience and skills. In my program we couldn't pass IV meds last term because those skills were part of this term's course materials. So, it was a progression in terms of what we could and could not pass.

[studentinnursing]

Yes, I understand I'm not working my own license but my instructor's, in my state, and if my instructor knows me, not all will, then they know I only perform within my scope of knowledge and ability, and I guess that is not always the case, but I have passed under that license overseeen by a different RN. Maybe they trusted me as part of team.

[JBMmom, MSN, NP]

Nobody practices "under" another person's license:

Nursing faculty frequently talk about students practicing under a nursing instructor's license. This is an inaccurate statement because the only person who works on a nurse's license is the person named on the license.

Nursing Practice Acts include statutory language that specifies what are called exemptions or exceptions to the requirement for a nursing license. Typically, practicing nursing as a student who is enrolled in an approved nursing program is one of the exempted (or excepted) practices. The nursing student is accountable of nursing actions and behaviors to patients, the instructor, the facility and the nursing program.

The accountability for nursing instructors is for their decisions and actions as an instructor. For example, the instructor is accountable for the selection of patients for the nursing students' assignments. The instructor is expected to support studies preparing for the clinical experience and to monitor students' clinical performance. Most critically, the instructor must intervene if necessary for ther protection of the patients when situations are beyond the abilities of the students. Instructors must identify "teaching moments" as well as assess and evaluate the students' clinical performance.

Edited to add: not my own statement, this was a well worded explanation I found. http://www.iowa.gov/nursing/faq/education.html

[valsalvamanuever2]

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

My point was that medication administration is something which requires licensure. (at least in my state and I would be willing to bet any other in the union.) Student nurses don't have licenses which allow them to function independently.

[studentinnursing]

Different state I guess; I dont want to post any test questions, but each of us should understand accountability and licensing in our own states, and whose going to take the heat legally if something goes wrong....make sure to have that reversal agent and/or crash cart, et cetera. All I can say, for me, I will do what is in my scope (no matter how much I'd love to learn, plenty of time for that--hopefully learn as long as I am a nurse). Learn as much as possible with the help that is available because one day no one will be watching and we need to know what to do, what will give the patient the best outcome. God bless and I wish everyone well, wherever you are and however your school and instructor do it :)

[redhead_NURSE98!, ADN, BSN]

My point was that medication administration is something which requires licensure. (at least in my state and I would be willing to bet any other in the union.)

Kentucky or Ohio (or both) have some kind of tech that passes PO's once a nurse has checked and dispensed them. It might just be in LTC, but they have that ability.

[SAMISA09]

In our school we are not allowed to give any meds without the RN's supervision. They made it a rule after a student gave the wrong meds to some patient.

[sandyfeet]

Kentucky or Ohio (or both) have some kind of tech that passes PO's once a nurse has checked and dispensed them. It might just be in LTC, but they have that ability.

I was wondering about this as well. In CA a Med Tech can pass meds in Assisted Living (this was my job before nursing school). For this job the only qualifications were to pass a company specific test to demonstrate competency regarding medications. This was only PO and topical meds: some of the residents were diabetic and I could only hand them their insulin needles for them to inject themselves.

On a related note, when I first heard that story about the mom giving her daughter Botox, I wondered how she could possibly be administering meds without a license. Maybe the first clue the story was fake!

[~Mi Vida Loca~RN, ASN, RN]

I was wondering about this as well. In CA a Med Tech can pass meds in Assisted Living (this was my job before nursing school). For this job the only qualifications were to pass a company specific test to demonstrate competency regarding medications. This was only PO and topical meds: some of the residents were diabetic and I could only hand them their insulin needles for them to inject themselves.

On a related note, when I first heard that story about the mom giving her daughter Botox, I wondered how she could possibly be administering meds without a license. Maybe the first clue the story was fake!

Family can administer meds under some situations without a license. My mom gives my dad his weekly infusions in his port in his chest. The stuff she gives is derived from human plasma and then at the end she has to flush the line with heparin. A company comes out and delivers all the supplies and the medications. A home health nurse had to go and do it first and show her how, then had to watch her administer it. My mom didn't have to go and get any kind of lic or administration.