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?
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.
This might be policy at a facility, but it certainly isn't law. Each facility--even each unit in a single facility--has different orientation lengths and expectations. Once the RN is earned, all bets are off at what can and can't be done by a "new nurse", by law. New nurses with 1 hour experience and those with 30 years experience are held to the same legal standard, and only policy would dictate if an orientee could or could not give meds with a preceptor present.
ETA: To clarify, the law does dictate "reasonable and prudent," which can correspond to "competence" for a new nurse, but no law says that a new RN can't give medications without a more experienced RN present.
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.
See, that scares me; I would never pass anything I did not pull, have been asked and politely declined and explained I could not, would not administer a med that I did not pull (and do all 3 checks myself with the MAR in hand); I now see howmed errors happen, other than just plain making a mistake; not just what you posted but others as well. Seems like there should be law, black and white, but that is where scope and ability come in.....
Specializes in ER - trauma/cardiac/burns. IV start spec.
By minor procedures I mean putting in foleys and startig IV's. Lol sorry.
I normally just read these threads as I am a disabled RN and post to the latex threads but this caught my eye. In our state students cannot pass any medications until they have completed specific courses and passed a dosages class showing proficency in all calculations. After that test then the schools policy along with the hospital's policy comes into play. In my shcool we could give PO meds without our CI in the room provided we stated the name, dose, why, side-effects, lab values (if req) and had given the meds at least once with the CI at the bedside. No IV meds coud be given under any conditions however we could titrate meds in CC rotation after taking and passing pharmacology. No students were allowed in the ER ever for rotations due to the fact that here nurses in the ER have more autonomy that in other units.
Now this brings me to the above. In our area foleys and IV starts are not considered "minor procedures". In fact while I was practicing only LPNs and RNs could place foleys, techs could straight cath only, and LPNs did not place IVs unless they had taken an additional training course in IV starts. Every state and school and hospital has policies that have to be followed and I am sure it differs according to the area. Here students from the BSN program graduate without having any real hands on experience while the ASNs graduate with plenty of experience.
I'm glad this thread was started as well. I'm surprised at the range of responses and it really shows how different we all are in regards to learned skills after graduating from school. In my first semester, I was also surprised at the autonomy students were given after proving competence in med passes, including giving shots. During my OB rotation, my instructor made sure that everyone had a chance to do at least one IV start and inserting foleys were done in both of my first semesters. It was only during the last few weeks that we were allowed (or at least had the opportunity) to push (non-narcotic) meds. I'm very glad I got the opportunity to do these things and get the nervousness and jitters out of the way as I would not want to be a new nurse on the job being nervous about putting in a foley or having to stick someone more than once to start an IV.
I didn't think I'd have much to say on this topic... guess that's not the case.
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.
This makes me a bit nervous- the fact that you used your position in order to gain permission (not from your clinical instructor!) that other students in your rotation didn't have. I work at a hospital as a tech as well, and I tried to keep my role as a student nurse completely different from my role as a tech. Even if you've proven yourself, I don't think that having an RN "nearby" is sufficient.
Because they're not UAP? They're student nurses who have presumably been taught to give PO medications properly?
Thank you! There is a HUGE difference between student nurses and UAP.
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.
I don't think your school is disjointed- every single clinical instructor that I've had has been different. A couple have gone with us for everything, some went with me until I'd done 3 successful passes and then just wanted to do the 1st and 2nd check with me, some let me pass with my RN, some wanted to be there for IV meds but let us give POs alone, etc. I think it's also important to remember that situations are different on different floors at different hospitals- you don't know what might have taken place last semester, or with a certain RN on the floor, etc.
However, an instructor or RN is ALWAYS aware of what med I am giving, what time, and to whom, and they've ALWAYS checked it against the MAR with me.
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..
How are you going to learn? Sounds like your school needs to find clinical sites that aren't out to use nursing students as scapegoats. What will you do all day during clinical?
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.
I'm all for EMRs and the electronic MARs that require you to scan barcodes before administering. My fear is that some RNs will become totally dependent upon them and stop using the computer inside their skull (brain) when giving care. Just like you said, you've caught mistakes in the record.
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.
Nursing services may be rendered by a student when these services are incidental to the course of study of one of the following:
(a) A student enrolled in a board-approved prelicensure program or school of nursing.
I am covered by my state's practice act to render nursing services. A few paragraphs up, medication administration is included in nursing services. I would never do anything that wasn't OK'd by my clinical instructor (now preceptor). But part of nursing school is building confidence and independence. I'm all for nursing students being properly supervised; how else will we know we need to improve in an area? But if your clinical instructor has seen you give 5 Arixtra injections, checking pt ID bands every time, and you are obviously competent, I don't see the harm in he/she standing outside the door during the actual administration. Hopefully clinical instructors have sufficient judgment to not place themselves AND their students in a compromising position by sending them into a patient's room to administer a medication without having proven competency and thorough knowledge of that medication.
I normally just read these threads as I am a disabled RN and post to the latex threads but this caught my eye. In our state students cannot pass any medications until they have completed specific courses and passed a dosages class showing proficency in all calculations. After that test then the schools policy along with the hospital's policy comes into play. In my shcool we could give PO meds without our CI in the room provided we stated the name, dose, why, side-effects, lab values (if req) and had given the meds at least once with the CI at the bedside. No IV meds coud be given under any conditions however we could titrate meds in CC rotation after taking and passing pharmacology. No students were allowed in the ER ever for rotations due to the fact that here nurses in the ER have more autonomy that in other units.
Now this brings me to the above. In our area foleys and IV starts are not considered "minor procedures". In fact while I was practicing only LPNs and RNs could place foleys, techs could straight cath only, and LPNs did not place IVs unless they had taken an additional training course in IV starts. Every state and school and hospital has policies that have to be followed and I am sure it differs according to the area. Here students from the BSN program graduate without having any real hands on experience while the ASNs graduate with plenty of experience.
Yes, this sounds like my school. We have dosage calculations on EVERY test, whether Pharmacology or Theory or Clinical; and that's after we were tested over and over in class as well. We also have a 2-day med calculation class before the semester even starts, before level 1; you cannot miss any on any test or you have to go to remediation/counseling; you have to do this on your own with your instructor at least once as well, to set a pump or whatever, but then you okay, if the instructor agrees, to do it on your own. We start IVs in level 3, never push or do blood products, but we can, as above, do those skills within our scope, been checked off, and instructor has seen or is confident you are okay on your own. We can pull with either the RN or the instructor as well; I do know, even if the RN is present, and something happens, it's on our instructor, not the RN, but we do not do anything we do not know how to do on our own; that's part of being an RN, too, know what to do on your own; if you don't know how to do something, even as an RN, you need to know what to do instead....so whether you are a student or an RN, you have to know not only what you are allowed to do, but also what you really know how to do and what is in your scope.
In my school you can. I do all the time. When I passed meds for the first time my instructor had to be with me. Once she knew that you were capable of doing it on your own, she only checked the meds in the hallway and she would send you to pass the meds alone.
I always make sure I'm understanding what I'm being told. If my teacher pulls meds from the Pyxis and tells me to go give them, I say something like, "Will you be joining me?" I almost always get a "No."
I gave lots of oral meds and IVP's this term by myself.
This rather scares me. I have taught LPN, ADN, and BSN clinicals numerous times. I have NEVER allowed a student without me or the graduate assistant or an RN I personally knew and trusted (approved beforehand) to give meds unless one of us were right there next to the student at every step of the way. To do otherwise was grounds for the student's immediate dismissal from clinical if not school. I have personally made med errors in my career (nothing serious) and I sure wouldn't want that hanging over the head of a student. This was not only my own policy but that of the two different states and the different institutions I taught in.
I fail to see the point of a Nursing program in which students are not able to administer medications...
i understand and completely agree with the RN OR CI verifying the medications before they are given... but it blows my mind that some schools do not let the NS give medication unattended (once the verification process is complete of course) How will you learn without the CI hand holding? what will you do when you are on your own and you have no idea what to do because you are used to sending pleading looks to the RN or CI during the process...
Lastly... how in the world does the process of watching the NS administer each med work with 6-8 NS's and copious amounts of medication?
This rather scares me. I have taught LPN, ADN, and BSN clinicals numerous times. I have NEVER allowed a student without me or the graduate assistant or an RN I personally knew and trusted (approved beforehand) to give meds unless one of us were right there next to the student at every step of the way. To do otherwise was grounds for the student's immediate dismissal from clinical if not school. I have personally made med errors in my career (nothing serious) and I sure wouldn't want that hanging over the head of a student. This was not only my own policy but that of the two different states and the different institutions I taught in.
Well I hope you continue to live in your non-scary states then, lol. Maybe I shouldn't tell you all about the drive-thru flu vaccine clinics we hold where the 2nd semester ASN students give the public their flu vax with teachers in the general vicinity of each car, 1:4. It rather scares me that the states you refer to have chosen this bizarre method of helicopter teaching. Seriously? It's Synthroid and Wellbutrin - what is the instructor supposed to be stopping from happening by standing next to a student while they hand a patient pills and water? And what would happen if you weren't there? If I couldn't trust someone to give po meds after they've given me the rundown on what the med is, what it is for, and any relevant information about the patient that the student needs to know in order to safely give the med, I wouldn't want those people to continue in nursing school.
Wow, I had no idea some states/schools were this strict. In my program, by the end of 1st semester we were giving PO meds and some injections independently. By our senior preceptorship, I was basically functioning as the nurse...my preceptor accompanied me for the initial assessment and beyond that was there for questions and planning, or if it was a procedure new to me, and of course when things got crazy we would tag-team everything. But by and large I was acting as the RN with my preceptor supporting me. It was a great experience.
I guess ultimately there are just different routes which hopefully all lead to the same outcome...a competent novice nurse.
dudette10, MSN, RN
3,530 Posts
This might be policy at a facility, but it certainly isn't law. Each facility--even each unit in a single facility--has different orientation lengths and expectations. Once the RN is earned, all bets are off at what can and can't be done by a "new nurse", by law. New nurses with 1 hour experience and those with 30 years experience are held to the same legal standard, and only policy would dictate if an orientee could or could not give meds with a preceptor present.
ETA: To clarify, the law does dictate "reasonable and prudent," which can correspond to "competence" for a new nurse, but no law says that a new RN can't give medications without a more experienced RN present.