Give meds without RN/CI?

[theantichick]

I found and read through an old post about this, and am just trying to figure out if I'm doing the right thing.

I'm in my second semester of an ASN program, Med-Surg. Clinicals have been going on for about 4 weeks now. I've passed meds with my CI on one shift, and she's alternating floors for giving meds each shift because she can't watch 8 students give 0900 meds in a shift. So 2 weeks later, I'm prepping my meds to give - all PO. I pull them with the RN for my pt, verify them against the MAR, and then went to my CI. I verified them against the MAR wit her, told her what each was for and what labs/VS needed checked before admin and what those values/VS were. She then told me to go in without her OR the RN to admin the meds, that she was comfortable with my admin.

I am very comfortable with my skills, but it had been my understanding that even after we're checked off, that med admin required a licensed person in the room. So I talked to my RN (since it's her pt after all) and told her my instructor had cleared me to give by myself, but wanted to give her (the RN) the opportunity to be there when I admin. She was appalled that my CI wasn't directly supervising all med admin, and definitely wanted to be there. BTW I don't consider that any kind of slam to my skills or safety, and am just trying to do the right thing.

So afterwards, I pulled up my state Nurse Practice Act, and all it says about students is that they have to be supervised by the CI when performing skills that are limited to licensed personnel. It doesn't define "supervision". An informal poll of my classmates showed about 1/2 thinking the CI or the RN had to be present for ALL meds ALWAYS, and 1/2 thinking once the CI checked us off we were good to do anything but IVP/IVPB without anyone present. There doesn't seem to be a consensus here on AN, either.

I don't know at this point if I should approach my theory instructor or someone else in the nursing program and try to get a copy of the actual school policy (it's not covered in the student handbook either), or if I should just continue doing what I did last - if the CI doesn't feel the need to be present, then give the RN the option. I just don't want to violate my scope of practice, but I also don't want to get in a conflict with my CI - that never ends well.

Input would be appreciated.

[HouTx, BSN, MSN, EdD]

You don't have a 'scope of practice' since you are not yet licensed. As a student, you are practicing under your CI's license.

If your CI has already validated your competency, you can perform the skill without his/her physical presence. However, responsiblity for the overall care/safety of the patient remains with the hospital, so you you need to make sure that this practice is OK with their policies. I am sure it is, or your CI would not have OK'd it. If the RN is not on board, then you need to work out a solution with your CI that will meet everyone's needs. It is likely that the RN doesn't really understand the process or has not had enough communication with your CI to realize that you are 'good to go'.

The goal of your education is for you to leave the nest and 'fly' on your own. When they 'check you off' your instructor or preceptor has expressed confidence that you are safe to perform the task/skill on your own. Trust their judgment. They are also confident that you will ask for help if you encounter anything unfamiliar or outside your frame of reference/competence. If you continue to seek reassurance and handholding - they won't be able to cut the apron strings and you are going to come across as excessively "needy" and fearful. This is guaranteed to drive your future preceptors absolutely nuts.

[anonymousstudent]

I am usually confused about this. It seems like every system we are in does it differently. I just do what my CI tells me. After all, like you and PP pointed out, it's the CI's license you are practicing under - it's their #$% if you screw up. The nurses on our floors also don't seem to know what the rules are for students administering meds. They frequently give different answers if asked.

Several quarters ago I routinely gave IVP dilauded among other heavy duty narcs by myself. My CI would pull the meds out of the Pyxis, hand them to me, and walk away. I'd combine them on my own into one syringe (volume needed was in 2 packages) go and push it. I was shocked she let me do all of that, but whatever. Like I said, I just do what I'm told. I almost always reiterate at a basic level, "So you want me to go and administer this now without you?" And get the response. Every.single.time. CYA

I should add - my current CI wants to be present in the room when I give Senna, so go figure. Same college.

[JBMmom, MSN, NP]

No one ever practices under another person's license, it only covers the person named on the license. I'm in my third semester and I would not administer anything without my CI present. Am I incapable of popping a PO med out of its container and giving it to a patient? Nope. Even IVP I feel confident in, however, I'm NOT a nurse, yet. And if anything happens and I don't pass my schooling, I don't want to have ever administered anything on my own. Just my own feeling about it.

While we're not practicing under our instructors' licenses, they do have a responsibility to the patient and facility above and beyond being our instructors. I have not come across an instructor in our program that will allow students to administer anything without them present. I don't think that it's unnecessary hand-holding, and yes, I think everyone's probably competent in med administration early on in clinicals, but I think it's the safest way to go.

[NurseLoveJoy88, ASN, RN]

I'm in my last semester and have given meds without my instructor or RN present. I do double check the meds with my CI and she asks me the normal 500 questions prior to administering.... its worked out for me so far. knock on wood