Negligence From A Nursing Student

[mariesexiest]

I am writing in response to an article that was posted on your website regarding nursing students and conditions that can lead to medication errors. I am a nursing student myself, and I found the article to be interesting. Although I agree that these conditions can lead to student nurse medication errors these conditions also could apply to licensed nurses as well. Nurses learn that by practicing the Five Right of Medication Administration you can significantly reduce the possibility of medication error. It does not always prevent medication error because there are conditions that are susceptible to causing medication errors.

First, I would like to mention that it has been my clinical experience to be supervised at all times during the process of administering medications. My preceptor makes sure that we know what medications we are going to be giving the patient and the reason for giving the medication. We also communicate with the staff nurses so that he/she knows that we will be administering meds to the patient.

An important point that was stated in the article was that errors can occur from student nurses misinterpreting abbreviations or illegible handwriting. I have to strongly agree that this problem can lead to medication errors. I believe something needs to be done so that a prescription is not misinterpreted. Instead of using a system of the prescriber writing with pen and paper, a computer generated prescription will reduce the risk of any errors. We currently use a computer based program at my clinical site and it’s easier to read the prescriptions without the use of abbreviations.

Documentation is an integral part of the medication process. The motto is that if it is not documented the medication was not given. It was mentioned in the article that nurses and students can administer meds to the same patient and this can lead to dose omissions or overdose. This is due to poor documentation or failure to review prior documentation of drug administration. In a situation like this I don’t think poor documentation is necessarily the problem but poor communication between the nurse and student. Both the nurse and student should discuss which meds they will administer and then document it as soon as administer the meds to prevent any harm to the patient. Sometimes nurses are too busy or too rushed to actually document sometimes because they have to make sure all their patients get their medications at the scheduled time so I can see how documenting can be missed. From my experience, the nurse was always present when I administered medications to their patient because a student should not be administering meds without the presence of a registered nurse.

Another good point that was brought up was monitoring issues. Students might not be aware of vital signs/lab values that should be checked before administering meds. As nursing students we are there to integrate what we learn in the classroom to actual practice in the health care setting. We are still learning when we are at our clinical, so I don’t think nursing students should be given the full responsibility of giving meds because a minor mistake like this can hurt the patient. I think that the registered nurse is still responsible for the patient even while the nursing student is caring for the patient as well and that should not be overlooked. I can also see this being a problem with registered nurses as well. This is a skill that is learnt over time as the nurse becomes familiar with certain medications. I don’t think that all nurses who are usually assigned to five to eight patients will remember to check the patient lab values or vital signs before administering meds. They are just too busy and overworked.

Preparing drugs for multiple patients was another condition mentioned that causes medication errors. Student being assigned to multiple patients is a good way for the student to become familiar working with multiple patients and time management. I think that this can problem can be easily avoided. Preparing medication for one patient at a time is the solution. I don’t think that students should be preparing drugs for multiple patients at a time. I have seen nurses doing this but I think with times comes experience. The nurse I worked with was able to prepare meds for two patients at a time and remembered which med to give to each patient.

Nursing student medication errors can be prevented by alterations in the system for ordering, dispensing and administration of drugs. I also believe that communication between the nurse and student is vital in the care for the patient. People need to remember that nursing students are still students that are still learning while at their clinical. We are still learning and making mistakes makes us better and efficient while preparing for the nursing profession.

The article mentioned many conditions that increase medication errors which was helpful to me as a student. Nursing students can utilize this information to provide safe practice to patients while in their clinical.

[mariesexiest]

this is reality

[Joe V]

curious as to which article you are talking about ??

[EDERAU]

In my own observation and opinion the student nurses should be monitored by their clinical instructors and double checked by the nurses assigned in the clinical area to prevent unfortunate things that might endanger patient's lives and health.Critical care and medical administration especially in the preparation of dosages should be done by licensed nurses. Student nurses can only assist and observe to prevent mistakes that might be committed.

[Ksather222]

Nursing students need to learn from a nurse and standing on the sidelines is not a good way to teach the student. How do you learn to ride a bike if you were not put on the thing and pushed.

[chapril]

As a student nurse, I caught a would-be med error of the RN I was shadowing at the NICU; she pulled out the wrong (concentration) bag, and I am glad that I always copied the MAR entries for the day - thanks to the millions of CarePlans we had to submit in school- into that little notebook I carried around in my pocket. The nurse hinted that I maybe copied wrong, but I insisted it best that we go back together to the MAR to check. Lucky baby that was.

Point being, student nurses can do more than "assist and observe" .

April

[kadiddle]

With 12 or so student nurses under a clinical supervisor, she can't always be with the students every time they do a new procedure or give a med. That may work in a perfect world, but not in the real world. Also, if we could learn everything by watching someone else instead of doing, nursing school would be alot shorter and we would have no need for a lab!

[EDERAU]

I would like to comment on " negligence of student nurses" and thanks for the notes and appreciate so much in sharing our ideas as future nurses. We are still learning the proper nursing procedures and the safest thing for us to do is to "observe and assist" being done by professional nurses and our clinical instructors. I am fearful for student nurses who act as licensed nurses and perform beyond their scope of learning. When we assist we are in hands-on procedures but supervised by the professional nurses.I am not implying that we just watch and of course nursing is an applied science that needs actual procedures to perform. Remember that we are playing Russian roulette with our patients lives if we apply what we learn without proper supervision.One mistake and there are far-fetching consequences.

:redpinkhe also if we see nurse's mistakes and we believe that it might endanger the patient's health , i suggest we should refer ASAP to our clinical instructors and not to directly confront the erring nurse. Confronting directly might just bring out hostility towards us by the nurses on duty.

[kadiddle]

I am certainly not implying that we do any procedure without either our clinical instructor or the RN we are working with watch us. But once we have done the procedure effectively and with supervision, we are NOT outside of our scope to do it alone. For example, when giving meds, the RN gets the meds, checks them with me, I tell her what they're for and the route, but I go in the room and after doing the 5 R's, I can certainly give the medication to the patient without the RN in the room.

Surely you don't think that schools wish to take the risk and allow students to do procedures without having been trained and watched over like a hawk the first time or two? I don't believe my school wants to take that risk. And I have NEVER as a student, done anything outside what I was legally allowed to do. We have already been warned by the school that if we are found willfully going outside our boundaries, we will get kicked out of the program.

[valkyria, BSN, RN]

This is a fine line to walk. As a nurse who has precepted students I can only speak from what I have seen and what I did. First, I do not yet have bad habits and if I did, I was sure to be on my toes not to show my student. They will learn there share of "short cuts" later. Second, two patients at a time is nuts. Now, where I was at this time, we had a binder that we kept our MAR and notes and labs in and each patient had a divider separating him/her from thier neighbor. So, I pulled all the morning meds for each patient, put them in separate bags and each went in their individual divider. Of course, that would not apply if I had to crush the meds for NGT. THird, I set the example for organizing my day and my charting and report giving and taking style, just as a foundation. I told her that each nurse developed their own style and method that was easiest for them. Fourth, in nursing school they are very anal about the chart and what time you pull meds. I showed her by how our unit ran that each nurse had a predicta ble time that they would pull their meds and that was when both med rooms were full. Each unit has a flow and if you watch, you can schedule your day around it. Now you cannot account for CODES, and other emergencies that may come up. But, even the doctors had a usual time that they would all pour in and then the charts would disappear. Above all you have to be flexible. Have a strong foundation of good habits but be flexible enough to work around life. I miss my students.:heartbeat:heartbeat

[kitten0509]

did it say the original article anywhere? I'd like to read it

[Corsair41]

I wonder, how does one learn to do anything without practical experience?