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?

[manchmal]

Oh man, we had to do the McDonalds drive thru style flu clinic, too -- the whole school did it, with first semester students drawing up vaccines, and students who have taken pharm and passed skills tests in pharm giving injections.

I totally agree that students need to learn to pass meds. I have the same theory about that as I have of prisoners who have 2 year sentences: they're not gonna be students or prisoners forever, so it is wise to teach them how to function once they get out. :)

Edit: we precept over 130 hours our last quarter, too, and the expectation is that we will take 80% of the RN's patient assignments and do everything the RN would do, so long as it is in the scope of what we have been trained to do. They mostly expect by that time we should be trained to do almost everything for basic patient care. This is, of course, supervised precepting but students are supposed to delegate to UAPs, do assessments, meds, etc.

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

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?

You are stilling going through the whole process of administering meds with a nurse in the room. When I am working as a nurse on my own I will give meds the same exact way I did when in school. I did the whole thing in school, but with someone overseeing. As it should be IMO. The Nurse is the one responsible for the patients, they took over report and took responsibility of that student. When you are working in the hospital under your own lic. and take report you are then solely responsible for that patient. I will not allow a student to go and give meds to one of my patients that I am responsible for without me overseeing. I don't have to be 2 feet next to them holding their hand to over see.

If you mess something up what is the nurse going to say, "Oh I felt the unlicensed student was perfectly ok going alone to give meds to my patients." Mistakes with drugs kill people.

It was NEVER a problem in my program with there being too many students. Our co-nurses we able to oversee things we did and they had the patient load already. Our instructor wasn't the one that had to be there. Just a registered nurse.

I never sent pleading looks to the nurse of my NI, I was perfectly competent in doing it. Maybe it might feel different when the students who object to it actually get their license and are working and it's their license they need to protect.

[OhioCCRN, MSN, NP]

You are stilling going through the whole process of administering meds with a nurse in the room. When I am working as a nurse on my own I will give meds the same exact way I did when in school. I did the whole thing in school, but with someone overseeing. As it should be IMO. The Nurse is the one responsible for the patients, they took over report and took responsibility of that student. When you are working in the hospital under your own lic. and take report you are then solely responsible for that patient. I will not allow a student to go and give meds to one of my patients that I am responsible for without me overseeing. I don't have to be 2 feet next to them holding their hand to over see.

If you mess something up what is the nurse going to say, "Oh I felt the unlicensed student was perfectly ok going alone to give meds to my patients." Mistakes with drugs kill people.

It was NEVER a problem in my program with there being too many students. Our co-nurses we able to oversee things we did and they had the patient load already. Our instructor wasn't the one that had to be there. Just a registered nurse.

I never sent pleading looks to the nurse of my NI, I was perfectly competent in doing it. Maybe it might feel different when the students who object to it actually get their license and are working and it's their license they need to protect.

I believe you misunderstood my post.

1. Medications should be verified by the RN/ CI

2. It is understood that the Pt is still under the primary care of the RN

3. From a personal experience of being in a very high acuity Cardio-thoracic Step down unit, it was simply impossible for the CI to be in the room with each and every NS as they pass each and every medication. We would sign out the medications together in the med room, verify them with the CI and off we went to the PT room to administer these medications.

4. In a teaching hospital, the staff/ administration is well aware that NS's will be passing medications to PTs. Now im not a licensed RN yet, but not once in my 2 years (ASN) of clinical, did the RN come into the room and watch me pass medication. They were simply too busy and considering that we had checked off on various routes of med administration in school, we were allowed to pass the medication. as some posters noted, once the CI watched you pass meds once or twice and you proved competent, they would not hover around you each and every time you had to do the medications.

5. Mistakes with drugs do kill people. Licensed individuals make the same mistakes that kill people too. That is why the CI double/triple/quadruple checks the medications with the NS before they are administered.

I hope that clarified my previous statement.

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

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.

I gave a lot more then just PO meds. I was giving Morphine Push, Diluadid push, PCA's, Heparin, Lovenox, Digoxin just to name a few. It was school policy and hospital system (2 different health systems) that a licensed nurse needed to be present. It did not effect my schooling at all and I did not miss out on anything.

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

I believe you misunderstood my post.

1. Medications should be verified by the RN/ CI

2. It is understood that the Pt is still under the primary care of the RN

3. From a personal experience of being in a very high acuity Cardio-thoracic Step down unit, it was simply impossible for the CI to be in the room with each and every NS as they pass each and every medication. We would sign out the medications together in the med room, verify them with the CI and off we went to the PT room to administer these medications.

4. In a teaching hospital, the staff/ administration is well aware that NS's will be passing medications to PTs. Now im not a licensed RN yet, but not once in my 2 years (ASN) of clinical, did the RN come into the room and watch me pass medication. They were simply too busy and considering that we had checked off on various routes of med administration in school, we were allowed to pass the medication. as some posters noted, once the CI watched you pass meds once or twice and you proved competent, they would not hover around you each and every time you had to do the medications.

5. Mistakes with drugs do kill people. Licensed individuals make the same mistakes that kill people too. That is why the CI double/triple/quadruple checks the medications with the NS before they are administered.

I hope that clarified my previous statement.

Your second statement further verifies my point, they are still under care of the Registered Nurse, which is why the registered nurse, the one with the license, should be watching the medications their patient is taking. If the patient has a reaction, if something goes wrong, the nurse can't simply say "well I dunno, I didn't see the medication given, I let the student go do it because they knew what heparin was" and not be held liable. It's not safe. It doesn't matter that you were checked off on how to do it properly. Most of us are. You talked down about what a disadvantage students were that had to have someone present. I was never at any disadvantage. My school has an excellent program. The hospitals rave about how great the students from there are. We were at no disadvantage that our school and the hospital had the policy. The nurse wasn't holding our hand, they weren't hovering over our shoulder. They will witnessing the medications given to THEIR patients. The ones they are legally responsible for.

I am sure most students were in very high acuity units. That's why we didn't have to have our Clinical Instructor with us, we just had to have a registered nurse with us. If you were on such busy units I am surprised 1 instructor was able to be there for each student then to verify each medication before it was given and to check it out since you state that happened instead. I often had 4 patient and was pretty much giving meds every hour between them all, IV's, Push meds, PO meds. add to that numerous other students. There is no way the instructor could have signed out and verified before hand the meds each time. We passed out ALL meds for our patients each shift. As far as how busy and the acuity. I have been on just about every unit. Some of my regular patients and lower acuity units often had more medications.

My nurses weren't to busy. They weren't going to risk losing their license because they were to busy, not to mention had I not been there they would have had to find the time to give the medication regardless. It's not as if it takes 20 mins to give a patient their medication.

The last part sums it all up. They have a LICENSE and if something happens it is their license at risk. If you mess something up on their patient because they neglected to witness the medication given to the patient, it is their license at risk. Not to mention I can't imagine the lawsuits that would at least be attempted by the family members if there was mistake and there was no one licensed overseeing the medication given.

I feel it is a tremendous risk and unsafe. A lot of schools and facilities agree. It's simply my opinion and in a lot of cases the rules and perhaps the law.

[OhioCCRN, MSN, NP]

[ If you were on such busy units I am surprised 1 instructor was able to be there for each student then to verify each medication before it was given and to check it out since you state that happened instead. I often had 4 patient and was pretty much giving meds every hour between them all, IV's, Push meds, PO meds. add to that numerous other students. There is no way the instructor could have signed out and verified before hand the meds each time. We passed out ALL meds for our patients each shift. As far as how busy and the acuity. I have been on just about every unit. Some of my regular patients and lower acuity units often had more medications.]

Actually, it should come as no surprise that the one instructor was able to verify each medication for our 8 students. it happened every time too. I think its actually easier to verify each medication in the med room then let the student pass them than it is to follow each student into the room and watch them.

As a senior in a Nursing program, the RN's trusted us to pass the medications without having to be in the room.it was not such a huge breach of protocol that the RN's thought their licenses were in danger. Of course the RN's did their own assessments etc. Considering that 1 RN had different students taking care of their 5 pts. multiply that by 8 students with 4 PT's each it would be near impossible to have say the 9am meds passed in a timely manner if we all had to look for the respective RN and let her watch us do it...

I am not arguing with the way your Nursing program chose to run things. I'm making a point that in some states and nursing programs, that is not done and it is a foreign concept that some of us are unfamiliar with.

Needless to say, throughout our 2 years of clinical,

-No student killed a patient

-No RN lost their license because they let a student pass medication unattended after the said student had verified it multiple times with the CI.

[jelly221,RN]

Your second statement further verifies my point, they are still under care of the Registered Nurse, which is why the registered nurse, the one with the license, should be watching the medications their patient is taking. If the patient has a reaction, if something goes wrong, the nurse can't simply say "well I dunno, I didn't see the medication given, I let the student go do it because they knew what heparin was" and not be held liable. It's not safe. It doesn't matter that you were checked off on how to do it properly. Most of us are. You talked down about what a disadvantage students were that had to have someone present. I was never at any disadvantage. My school has an excellent program. The hospitals rave about how great the students from there are. We were at no disadvantage that our school and the hospital had the policy. The nurse wasn't holding our hand, they weren't hovering over our shoulder. They will witnessing the medications given to THEIR patients. The ones they are legally responsible for.

I'm a bit confused about the monitoring for reactions- I don't stand in the room for 30 minutes to wait to see if my pt has a reaction to a PO med. If I'm giving a prn that needs to be followed-up on, I do it in the appropriate time frame. However, if a student has checked the pt's PTT or platelets and is giving SQ heparin that the patient has been receiving for 5 days, I fail to see how this medication could acutely adversely affect the patient. As long as it's given to the right patient and by the right route (hopefully as a 4th semester student you know that) and the instructor has verified the right med, right dosage, right purpose, etc, it seems perfectly safe to me. Maybe I'm missing something...

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

Yea it would have been impossible in our program so it does come as a surprise. We were on different units throughout the hospital. There is no way the CI could have done it. Not when 2 students are on different units on the 3rd floor, 2 on the 5th floor, 2 on the 4th and so on. Our CO-Nurses only had 1 student. Not multiple students. We took care of the same patient load they had. So I was giving meds for up to 4 patients a shift that had medications due regularly, as did the other 7 students in my group who were all over the hospital.

You implied we wouldn't be prepared for the real world. That the nurse was holding our hand and what would we do when we could not look at the nurse with pleading eyes I think was the phrase you used or something similar. That is not the case. Meds were always given in a timely manner as the nurse and I had the same exact patients, we prioritized the patients and started with patient A, the same exact way it's done in real life.

To use your same words, " I'm making a point that in some states and nursing programs, that is not done and it is a foreign concept that some of us are unfamiliar with" So it should be understood that just because a program is not ran the same way your program was run, doesn't make it any less and the students can still graduate as perfectly competent nurses that will know how to pass Meds in the real world without a nurse present. As was implied by your earlier statement.

[OhioCCRN, MSN, NP]

I'm a bit confused about the monitoring for reactions- I don't stand in the room for 30 minutes to wait to see if my pt has a reaction to a PO med. If I'm giving a prn that needs to be followed-up on, I do it in the appropriate time frame. However, if a student has checked the pt's PTT or platelets and is giving SQ heparin that the patient has been receiving for 5 days, I fail to see how this medication could acutely adversely affect the patient. As long as it's given to the right patient and by the right route (hopefully as a 4th semester student you know that) and the instructor has verified the right med, right dosage, right purpose, etc, it seems perfectly safe to me. Maybe I'm missing something...

I also think i may be missing something because the point you make is valid. I have never seen a Nurse stand in the room after administering a routine medication to watch for side effects...

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

I'm a bit confused about the monitoring for reactions- I don't stand in the room for 30 minutes to wait to see if my pt has a reaction to a PO med. If I'm giving a prn that needs to be followed-up on, I do it in the appropriate time frame. However, if a student has checked the pt's PTT or platelets and is giving SQ heparin that the patient has been receiving for 5 days, I fail to see how this medication could acutely adversely affect the patient. As long as it's given to the right patient and by the right route (hopefully as a 4th semester student you know that) and the instructor has verified the right med, right dosage, right purpose, etc, it seems perfectly safe to me. Maybe I'm missing something...

I never said you had to stand in and monitor for 30 mins. First, we were giving more then just PO meds, often times my patients were on more then just PO meds. My point was, if I go in and give some morphine push and 2 minutes later my patient has a reaction of any sort. The Nurse of the patient is going to have to answer for that patient. What are they going to say. "Well I never saw what the student gave or if they pushed it over the right time frame, no one saw, the student was in there alone." or even with PO meds, usually multiple PO meds "Well I am not sure what all the student gave, the CI verified something in the med room and then the student went in and handled it themselves, I never checked anything, well Doctor they weren't supervised so I guess we can't be positive of the exact events."

It doesn't seem safe nor legal to me because the student is not licensed and because of this it is of my opinion and the opinion of our local school and hospitals that someone licensed should be present during the administration of medication.

BTW Heparin was just an example of a medication that came to mind. It could be anything. I also don't recall people saying it was ONLY in their 4th semester they were giving meds alone. It went from being able to give meds alone during the 2 years of the program, to only PO meds, to only routine meds. I guess my hospital is different, my patients didn't only have PO meds, or only routine meds as they were usually in the hospital for a couple days for something acute. Often times they were on new meds and the students were doing all the patient care and meds (IVP once we got in third semester and TPN and Blood and so on then too) because it was supposed to resemble real world. The Co-Nurse would be a fly on the wall in the room to observe.

With that, I am leaving for vacation in 6 hrs so I am out. No one has to agree with my opinions (well actually it looks like a lot of places run the same way for the same reason) but regardless, that's OK. I have my lic. now and I will fully ensure I do everything to protect it. That includes watching any medication given by a student that is working with me in the future.

[jelly221,RN]

I never said you had to stand in and monitor for 30 mins. First, we were giving more then just PO meds, often times my patients were on more then just PO meds. My point was, if I go in and give some morphine push and 2 minutes later my patient has a reaction of any sort. The Nurse of the patient is going to have to answer for that patient. What are they going to say. "Well I never saw what the student gave or if they pushed it over the right time frame, no one saw, the student was in there alone." or even with PO meds, usually multiple PO meds "Well I am not sure what all the student gave, the CI verified something in the med room and then the student went in and handled it themselves, I never checked anything, well Doctor they weren't supervised so I guess we can't be positive of the exact events."

It doesn't seem safe nor legal to me because the student is not licensed and because of this it is of my opinion and the opinion of our local school and hospitals that someone licensed should be present during the administration of medication.

My instructors always asked me how long to push IV meds for, I wasn't allowed to give anything until I did that. As far as actually doing it, I guess it's a personal decision that the instructor bases on knowledge of the student and the trust that they decide to place in them. If we had students that were unsure about a certain med, or were giving something like 80mg Lasix IV, the instructor would go with, or ask that another (clinically strong) student went with them, unless the RN preferred to do it. In some of my rotations, we weren't allowed to give narcotics at all. Of course if it's a high risk medication, I can understand the nurse (or CI) wanting to observe. If we ever had vasoactive meds or a large dose of Lasix or pain meds and the pt's vitals were iffy (but no parameters), our instructor would tell us she wasn't comfortable with us giving the med just in case something happened, but it would be up to the RN if he/she wanted to give it.

I think it has to be a case by case decision. I would be kind of insulted if my instructor went with me my last semester to make sure that I passed morning meds correctly on every patient. Like I said, high-risk medications or those with the potential for harm (like your morphine example) I can understand. But there also needs to come a point where the instructor isn't telling you when to give/hold medications and is instead tests your clinical judgment to see that you can make sound decisions come graduation day, but still has the opportunity to intervene if you make the wrong decision. That, for us, occurred in the medication room in most instances.

[redhead_NURSE98!, ADN, BSN]

I gave a lot more then just PO meds. I was giving Morphine Push, Diluadid push, PCA's, Heparin, Lovenox, Digoxin just to name a few. It was school policy and hospital system (2 different health systems) that a licensed nurse needed to be present. It did not effect my schooling at all and I did not miss out on anything.

I was referring to po meds and have continued to do so throughout this post. I don't wish to compare apples to oranges.