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Can student administer medication without RN supervision?

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A Nursing Student cannot administer medication without RN supervision or Instructor supervision it is against the State Board of Nursing.

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~Mi Vida Loca~RN has 6 years experience as a ASN, RN and specializes in Emergency Dept. Trauma. Pediatrics.

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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.

It wasn't a personal choice in my program nor a case by case scenario and it didn't matter how much the CI trusted you. It was policy. It was the schools policy and the hospitals policy as it is many places. I was never insulted because I was aware of the policy from day one. If I didn't follow it I risked getting kicked out. Never did I say the CI was telling us what to do or when to give it. Rarely was it my CI instructor the one with me. The CO-Nurse was, the actual nurse assigned to the patients that I was paired up with. I gave plenty of narcotics. Most my patients were on them. I gave plenty of high risk medications. Most my patients were on them. Clinical was supposed to prepare us for real world. So we gave all medications.

The Co-Nurse simply observed, they didn't intervene, they didn't tell me when to hold medication or anything of the sort. At least they never needed to with me. I am not sure where there is confusion about this because apparently there is since I keep having to explain it repeatedly, yet the same assumptions keep being made. We worked independently without guidance as students when giving medication. (as long as it was within our semester, 2nd semester which is when we started hospital cliniclas was our only constraint. We couldn't give IVP work with central lines, give blood or tpn yet, we could third semester) We gave all medication. Whether a high risk medication, (I have also hung potassium) or protonix. The Co-Nurse (not the CI) was simply another body in the room.

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~Mi Vida Loca~RN has 6 years experience as a ASN, RN and specializes in Emergency Dept. Trauma. Pediatrics.

30,989 Visitors; 5,259 Posts

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

I don't believe I called you our specifically. But regardless, in the real world, the nurse, I do believe, would be passing out ALL meds. Not only PO meds.

Just throwing that out there since it keeps being brought up in this thread that the student needs to prepare for the real world. I was prepared for the real world, as I gave all medications and did all of my patient care and charting. Even if the policy stated a RN needed to be present for the administration of meds.

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redhead_NURSE98! is a ADN and specializes in Med/surg, Quality & Risk.

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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.

Welllll in that instance I wouldn't trust some student I hardly know to give my meds either. I'd hump their shoulder, personally, if I felt a student was "working under my license." However, at our facility, our clinical instructors are responsible for the students, not ten different RN's with varying degrees of education and experience, and the instructors are in ratios of 1:6 on the same unit in the same physical vicinity. So obviously, it's done differently in different places, and state law and facility policies hopefully accurately reflect that.

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~Mi Vida Loca~RN has 6 years experience as a ASN, RN and specializes in Emergency Dept. Trauma. Pediatrics.

30,989 Visitors; 5,259 Posts

A Nursing Student cannot administer medication without RN supervision or Instructor supervision it is against the State Board of Nursing.

Well apparently it doesn't matter what the State Board of Nursing says. Students know best :p LOL Ok I am really out. I haven't even packed yet.

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redhead_NURSE98! is a ADN and specializes in Med/surg, Quality & Risk.

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A Nursing Student cannot administer medication without RN supervision or Instructor supervision it is against the State Board of Nursing.

What state? Define "supervision."

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redhead_NURSE98! is a ADN and specializes in Med/surg, Quality & Risk.

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I don't believe I called you our specifically. But regardless, in the real world, the nurse, I do believe, would be passing out ALL meds. Not only PO meds.

Just throwing that out there since it keeps being brought up in this thread that the student needs to prepare for the real world. I was prepared for the real world, as I gave all medications and did all of my patient care and charting. Even if the policy stated a RN needed to be present for the administration of meds.

You responded to my post, therefore I considered you to be responding to me. I have much more to say about what we were allowed to do with pushes, injections, drips etc., however I don't care to.

This isn't directed to you, but I just get a bit annoyed by someone who's "scared" because god forbid another state/facility doesn't do it THEIR way. I can easily say I'm "scared" of someone who refers to a student passing out someone's home med Synthroid and Zocor (after having checked it off with a skilled instructor) on a med/surg unit as if they could possibly kill someone with it, and acts as if a student is an untrained monkey, but magically they transform into a total genius who should be supervising other nursing students as soon as they get their license.

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ohioSICUrn is a BSN, RN and specializes in SICU.

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What state? Define "supervision."

I wanted to ask this question too... because I believe that " supervision" is being missinterpreted!!!

(To the poster who said that it is against the Boards regulations) I would also like to know what state board says this. Perhaps a link could be provided?

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redhead_NURSE98! is a ADN and specializes in Med/surg, Quality & Risk.

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The Co-Nurse (not the CI) was simply another body in the room.

Then what's the difference, if she's not going to stop someone from being killed by the all-powerful Lortab 5? They never showed you how to do any of it or assisted you in any way? Even when you hung blood? Make up your mind - you and the instructor two pages back who thinks we're wildly unsafe and unsupervised if we didn't do it your way. Are they warm bodies or are they highly necessary to keep patients from being killed?

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jelly221,RN has 3 years experience and specializes in Neurosciences, cardiac, critical care.

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A Nursing Student cannot administer medication without RN supervision or Instructor supervision it is against the State Board of Nursing.

Depends on your state. In CA, there is a provision in the Nurse Practice Act that allows nursing students currently enrolled in a program to perform "nursing duties"- including passing medications. I've quoted it in an earlier post.

Welllll in that instance I wouldn't trust some student I hardly know to give my meds either. I'd hump their shoulder, personally, if I felt a student was "working under my license." However, at our facility, our clinical instructors are responsible for the students, not ten different RN's with varying degrees of education and experience, and the instructors are in ratios of 1:6 on the same unit in the same physical vicinity. So obviously, it's done differently in different places, and state law and facility policies hopefully accurately reflect that.

No one works under anyone's license- we've addressed this above. However, as the RN assigned to that patient, you do retain responsibility for their care.

Mi Vida Loca- I'm not saying that the way your school did it was wrong or that you didn't get good experience, much to the contrary, sounds like you had excellent clinicals. But schools are different, and as long as we are safe in our practice and learn to become (hopefully) excellent nurses with high standards, I think that there are accounting for differences in permissiveness. Assuming, of course, that no regulations and/or policies are being violated. Have a great vacation!

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5,176 Visitors; 255 Posts

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.

In our state/program, as NS we pass meds under our instructors license. The RN gives us the MAR the day we pass meds; all students do not pass meds every day, 3-4 of 12 pass meds each day. If the RN asks us to pass a med, we are allowed as long as we pulled with RN and performed checks with them.

I must reiterate, in my ADN program, we do no pushes or blood products. And unless it's passing monkey meds, we as students have to be aware of anaphylactic possibilities, etc. When it's our med day, we look up each and every med before we pull them as well, so the NS knows what to do in such a case.

As an RN once told me, there needs to be an element of trust within the team. I had asked how they took the PCT's word for it what pt VS were in that case, as my patient had a pulse-ox of 88%, but someone had taken "normal" VS 20 min previously.

I must also note that not all NS are given equal autonomy by instructors or RNs.

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~Mi Vida Loca~RN has 6 years experience as a ASN, RN and specializes in Emergency Dept. Trauma. Pediatrics.

30,989 Visitors; 5,259 Posts

Then what's the difference, if she's not going to stop someone from being killed by the all-powerful Lortab 5? They never showed you how to do any of it or assisted you in any way? Even when you hung blood? Make up your mind - you and the instructor two pages back who thinks we're wildly unsafe and unsupervised if we didn't do it your way. Are they warm bodies or are they highly necessary to keep patients from being killed?

There seems to be a reading issue going on and a gross exaggeration of what I did in fact say. But if you need something clarified I would be more then happy to clarify it when the discussion can be communicated in an adult manner without all the twisting of words and added exaggeration that seems to be added to all of your replies to me.

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