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!!!

[BluntForceTrauma]

It seems to be a communication error on both sides here......

However, in the student's defense, if the nurse knew that the 0900 PO meds hadn't been given, why would she assume that the IV meds had been given??

[APBT mom, LPN, RN]

We have to give meds with our instructor also. We tell the nurse that we can give 2100 meds but no IV pushes/piggybacks. Sometimes the nurses remembers not to give the meds sometimes they give them. The students/instructor never get upset that the nurse gives them just that we weren't able to. It happened to me tonight my patient wanted her pain med at 2000 and I told the nurse that I was going to give her 2100 meds but the patient requested her pain med now. The nurse went to look up the meds and it said that they were all due so out of habit she pulled and administered them all. She realized after that I was supposed to give them and apologized. I told my instructor when it was my turn and she apologized to her also because she knew it was a check off and counted towards our grade. My instructor told her that even when we are assigned a patient as a student, the nurse that is assigned to that patient is ultimately responsible for the patients care because they are employeed by the facilty so if she does something that we need/want to do we shouldn't be upset about it.

I agree with everone else about the nurse doing what she thought she should have regardless of what you needed to do for school. Two hours late on meds is a med error your instructor should have told you to have the nurse administer the meds and should apologize for yelling at her let alone upsetting her enough to make her cry. It was uncalled for.

[BBFRN, BSN, PhD]

I was a CI, and I personally told every nurse what my students could and could not do. I also posted a list of what student would be with what patients, and who they were giving meds to. I would write a big NO IV MEDS on the sheet, and post it by the med pyxis. If the nurse was really busy, I would give the IV meds myself, and let the nurse know that I was doing so. That helped to alleviate any confusion.

[Crux1024]

Thanks for everyones responses.

A list of what we can do, is hung in the staff breakroom along with our room assignments. I think that nurse may have been a floater to the floor, since Ive never seen her before and Ive been on the unit for a few weeks now.

It was my very FIRST time ever giving meds, so I can take the blame for not telling her about the IV meds. I was slightly nervous and all, and it completely slipped my mind. I guess we all ASSumed she knew.

Thanks all..:)

[Indy, LPN, LVN]

Really it takes too long on a student's first med pass, considering all the stuff you have to tell your instructor, to demonstrate knowledge and safety. It just takes all friggin' day. Or that's how it felt to me. In reality it took about an hour to do a simple med pass on one patient.

Eek. And so with 4-6 students in a group, not everyone was giving meds on any given day. Still I was nervous about being late with AM meds, and I know the nurses probably were too.

You can't help the past, let that clinical day go. When you see the nurse in question again, and you will, apologize for the misunderstanding. Next time you're in that boat, make sure the nurse knows what you can and can't do, and if she has a concern, say something like "Well I don't mind if you give the cardiac meds, and I'll give the other P.O. meds with my instructor, and that'll keep the patient and myself out of trouble, okay?"

Then you can explain the clinical signs to your instructor and why the patient needed his/her cardiac meds, and get off on the right foot with the instructor. You may not have given those meds but you know something about why the patient got them. Also, keep in mind, if the med order says "daily" not "once every 24 hours" then it's daily. Even if the pharmacy has scheduled it for 0900, if you give it once that day, you've still abided by the order. It's called "retiming" the med. When a a patient is admitted in the afternoon and was too sick to take all his meds that morning, it's not an error that the patient got 'em at dinnertime, that's just when he was able to first get them. Make sense?

Also, if you are not keeping the MAR in your possession throughout the day, but just grabbing it sometimes to give meds, sticky notes help the nurse know who you are and what you intend to give to the patient. They don't replace verbal communication but they are a good reminder.

[deeDawntee, RN]

This breakdown in communication and the way the instructor handled it is at the heart of why nurses can be so "nasty" to nursing students. Obviously this system isn't working in a lot of different areas.

First of all, the staff nurses have not REALLY been set up adequately to take on students, especially if a floating nurse was given a student without any kind of "orientation" about what is expected of her. For her to approach the OP at 1050 is entirely insufficient. She is one of the responsible parties in this situation and should have checked about the meds at 0850 to see if they would be done in time (including IVP).

On the other hand, the CI is also responsible in not making certain that each of her "precepting" nurses were clear on her responsibility. She knows that nurses float and may not know the specifics. Also, to take that long to try to do 4 med passes is ridiculous...she should have chosen patients for whom waiting that long would not endanger them or set up a different way to do the pass.

Hospitals and nursing schools are notorious for not doing enough to make having nursing students on the floor work for everyone involved. If it worked like it should, it could be a really exciting and empowering experience for everyone, including the patients.

The person with the least responsibility here is the nursing student. How can she have known how poorly things were set-up for her? I would have expected that there was more forethought in this process and I should not have to make sure the education that needed to be done was done before I got there. Undoubtedly, the OP was observing procedures or helping with bed bathes etc. and thought that everything had been arranged for her med pass to happen when it worked for the rest of her class. As a staff nurse, I know that things are rarely arranged that well, but how could she have known on her first med pass? Well, now she does, but she bares no responsibility for the conflict. The licensed "professionals" in the scenario do.....IMHO.

[SharonH, RN]

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!!!

The nurse is ultimately responsible for giving the meds and she should have clarified at the outset which meds were to be given by who. If I had anxiety about the meds being given late or I was concerned that the patient was having adverse effects due to the meds being given at a later date then I would have given them myself. As for dealing with the clinical instructor, then the CI would have just had to understand that and if she didn't, who cares? I guarantee you I wouldn't have been the one crying.

[pagandeva2000, LPN]

Based on what you were saying, it didn't seem that the clinical instructor was angry at you, unless I missed something. She had an argument with the staff nurse, correct? If so, there is nothing to be done. At this time, you are not practicing independently, you are practicing under the auspice of the CI, whose license may be in danger if you did something she did not tell you to do.

It would be best to communicate with the staff nurse by telling her what you are allowed to do for the day. Heck, she attended nursing school. She knows the deal, in my opinion. I had a few incidents with nurses during clinicals, also. But, I stood by my instructions from my CI. She dictates what I am allowed to do, not the staff nurse. You are trying to obtain your license; that staff nurse already has hers...bottom line.

[espritjolieRN]

Looks like you learned something here... communicate fully from the beginning! I don't blame you, first time passing meds and all, how were you to know how things went.

However, the nurse should have communicated fully with you from the beginning too, clarified exactly what you would be doing... she is partly to blame for the way the situation evolved.

As the patient's RN, I would have clarified with you from the outset what meds you would be passing with your instructor. I would have also asked you to let me know if you would not be able to complete the task within the allowed time. Should that occur, I would have given the meds that needed given with you by my side.