Difference of Opinion...Opinions Needed!! *LONG*

[Crux1024]

Hello all,

Well, today went like this. There are 8 students in my clinical group. Half of us give meds on any given clinical day due to how long it takes.

Anywho, I was scheduled to give meds last. So, with the 3 other people in front of me, one of them being a peg tube so all had to be crushed, and the computer system being slow as heck..it was 10:50 until i was able to give 9am meds. (At my facility, 1 1/2 hrs earlier or later than scheduled time is permissable. I know that it was outside allotted time.)

So, that morning the Pt's assigned nurse, at around 0930 asks me when Im giving meds. I tell her honestly that I dont know. She tells me that she thinks he may need his meds now, b/c some of them are cardiac meds and he was getting "tachy". So I tell her, If you feel that you need to give him his meds now, please dont wait for me. I on the other hand have to wait for my instructor regardless.

She was very nice about it, and waited. She was a bit concerned b.c she was leaving at 11 and had wanted the meds in by then.

Ok, so fast forward. I give ONLY the PO meds, since I am first semester I cant do IV meds yet. She looks at the MAR, and asks why we didnt give the IV. My instructor tells her we cant since. Needless to say, she was quite upset b/c now she had to give my pt the IV meds and another pt down the hall since she had just figured out that he didnt recieve his 0800 IV med, and it was past 1100.

My CI and the nurse got in a bit of a argument, ended with the staff nurse crying.

I felt bad but there was nothing I could do.

So, to come to my actual questions:

Would you give the meds if you felt it was taking too long?? If so, how is the clinical instructor who is sure to be upset, dealt with??

Any opinions are welcome!!!

[Susan9608]

Personally, I think you should have reminded the nurse that you would only be giving PO meds on your patients. Nurses get too many students from too many schools who are all in varying levels of school to remember what each student from each school is supposed to do/allowed to do.

As the nurse who is ultimately responsible for the patient, I try to be understanding and accommodating with students, but if meds are going to be more than an hour late, I personally go ahead and give them. Some meds are timed the way they are for a reason (things like antibiotics, narcotic weans, lasix, etc.) and giving things too late can throw everything else off. I always offer to speak to the student's instructor myself and explain why I felt I needed to give the meds myself.

In the future, if you have that issue, I'd talk to your nurse about it and see how she/he feels about the meds being given so late (almost 2 hours late seems incredibly excessive to me); then I'd go to your instructor and report to her what the nurse said. At that point, I'd leave it up to your instructor on how to handle the staff nurse.

[leslie :-D]

the nurse should have immediately been told, that you could not give the iv's, and that she should give them.

she had a right to be upset.

if the ci had a problem, it should have been taken up with you.

it sounds like you neglected to tell the nurse you couldn't do iv's, until after the fact.

communication is everything.

leslie

[catlvr]

I would have told the staff nurse that as a student, I cannot give meds without my instructor, even POs, and that if she feels that the pt needs them, by all means she should give them. I would ALSO have made sure that she was aware that I was only able to give POs, not IVs, so that she could plan to give them (and I would have watched her do it if I could have!). That was, everyone knows what the plan for the patient is. It stinks for you, the student, if you don't get to give meds, but of course pt safety can't go by the wayside. We had this situation in our clinicals, and I learned from another student to be sure that the nurse knew exactly what I could and could not do - saves a lot of anguish.

As for your instructor, maybe if explain the situation to her and tell her that you'll be sure that it won't happen again, she'll be understanding.

Good luck to you in your studies,

e

[Dolce, RN]

That is a bad situation. The school should not be teaching students that it is acceptable to be giving meds that late. To me, that is classified as a med error, albeit a minor one perhaps. The nurse had every right in the world to be upset about the situation because that was her patient. I think your nursing instructor should have apologized to the nurse for her tardiness. Nursing is all about time management. If she wasn't able to help you give meds in a timely manner she should have notified you so that the nurse could have given them on time.

(BTW, if this happened to me I think I would be crying too).

[RN1989]

Big communication problem here. The pt's nurse should have come to you or your instructor and verified what you can/can't do - if you did not go to the nurse first with this info. If you think you are not going to be able to give meds on time - tell the nurse ASAP so that she can put them back on her schedule.

[santhony44, MSN, RN, NP]

The nurse should have been told in the beginning that you could not give IV meds.

It sounds like there are still too many students trying to give meds at once; maybed 1/3 should give them on any particular day.

Also, you could have asked the nurse if there were any meds that she didn't think the timing was so critical for that you could have given; then she could have given the ones she was most concerned about.

If I had been the nurse, I would have given the meds, and referred the instructor to my boss had she had a problem with it. The nurse is responsible for the patient. And I agree that the school should not be teaching you, even by example, that it's OK to be that far off with the med times. The clinical instructor has no right to be upset with the floor nurse for doing things correctly.

Sometimes it's unavoidable- the patient is down in x-ray or something- but an instructor having too many students to give meds in a timely manner is not unavoidable.

[EmmaG, RN]

I agree with all of the above. Bottom line, that staff nurse is responsible for those patients. And, although your training is important, the proper, timely care of the patient trumps it all.

My experience with students on our unit was exceptional. Their instructor actually worked our unit prn, knew the staff and the flow of the floor. She made certain that the staff knew what the students' responsibilities were for the time they were there--- and she made sure they knew this before the start of their shift. It was also up to the students to communicate this to the floor staff at the start of the shift, so that there was no misunderstanding.

I can very much empathize with the staff nurse's frustration as you describe what happened. Just from what you've posted about the incident, I think your instructor owes that nurse an apology.

[nyapa, RN]

Big communication problem here. The pt's nurse should have come to you or your instructor and verified what you can/can't do - if you did not go to the nurse first with this info. If you think you are not going to be able to give meds on time - tell the nurse ASAP so that she can put them back on her schedule.

Just as a nurse takes on patients and should be aware of their past history, she also takes on a student and should be aware of their abilities. BUT...you or the lecturer should have told her. We were actually given a folder listing all of our objectives and what we can/can't do. You did inform her that you needed the clinical lecturer to give the meds. In the long run, that educator does owe the nurse an apology...

[Susan9608]

she also takes on a student and should be aware of their abilities.

I have to say, I don't totally agree with this. Unless it's some kind of internship where a staff nurse has agreed to become a preceptor, then students are their instructor's responsibility during clinical time, *not* the staff nurse's.

I think it is the responsibility of the clinical instructor and the student to ensure that the staff RN knows what the student is allowed/not allowed to do during clinical time.

[canoehead, BSN, RN]

As a student you have to do what your instructor tells you. As a staff nurse I would have given the meds if I was concerned about the patient. I doubt that anyhing the instructor could have said to me would have made me cry if they were 2 hours late.

[MAISY, RN-ER, BSN, RN]

I agree the primary nurse should have been made aware that the students could not push iv meds, however, I have never heard of inability to hang iv antibiotics or piggy backs. In our nursing clinicals, a primary nurse could give medications with us to the patients. This way the instructor didn't have to be with everyone. This was especially true of students who proved to be responsible. Of course, everyone was fair game for the instructor as far as answering med questions about their patients.

I agree with the poster who mentioned that meds being that late might be a "right time" med error. There is no reason for meds to be that late!

If I was that RN your CI wouldn't get near my patients again! She/he sounds like a dope!

Maisy;)