One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.
I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?
The instructor should write herself up. It's her failure if a student makes a supposed mistake like this. When I learned to fly, my instructor made it very clear- if I made a mistake or didn't pass a check ride, it was his fault/failure for being a poor teacher. We need a little more of this attitude in nursing.
the instructor should write herself up. it's her failure if a student makes a supposed mistake like this. when i learned to fly, my instructor made it very clear- if i made a mistake or didn't pass a check ride, it was his fault/failure for being a poor teacher. we need a little more of this attitude in nursing.
sooooo, it's entirely the instructor's responsibility to ensure that the student learns. that's funny. when i was a nursing student, i actually considered it my responsibility to study the material that was taught in order to learn it. i considered it my responsibility to research the patient's i was assigned as a student thoroughly. also the nursing instructor who taught me the fundamentals of nursing, i only had her once during a clinical rotation.
as a student i was also taught the components of a medication order:
1. client's full name.
2. date that the order is written.
3. drug name.
4. dosage.
5. route of administration.
6. time and frequency of administration.
7. signature of physician.
as a student i was also taught the "five rights of for the administration of medication":
1. right drug.
2. right dose.
3. right client.
4. right route.
5. right time.
anyone notice the correlation between the between the two?
i was also taught responsiblity and accountability as a student. meaning, my instructors could and would hold me responsible for my actions. that meant i should know policies and procedures. being a student does not relieve one of all accountability and responsibility.
in the original post, the student in question followed direction from staff nurses not her instructor.
a student gave the meds through the tube per the instruction of one of the staff rns.
although the staff should have had the doctor clarify the route when the initial orders were written, the subsequent staff also hold accountability for not clarifying the route. the student accepted instruction from staff that was wrong and there is not indication in the original post that she sought guidance from her instructor prior to administering medications through this person's ng. the op also didn't say that this student was lambasted, tared & feathered, etc. she said the instructor wrote the student up for a medication error. plain and simple. yes, i agree that the instructor could have used this opportunity as a teaching experience for all students in that class. obviously some of the staff nurses could have been included in a quick refresher about what constitutes a medication order and the 5 rights of medication administration.
btw, the op may not have known what the instructor said to the other student in private. she may very well have used this as a learning experience for that student. the instructor may have chose not to possibly subject the student to the ridicule/embarrassment of others by discussing the situation with the entire group. these are things the op may not be aware of.
how many students did your flight instructor have in the plane? my guess is your flight instruction was more one-on-one than any nursing program. i would agree that in that situation, your instructor would be a failure. i'm also willing to bet that if your flight instructor thought you were unsafe flying a plane, he wouldn't be up in the air with you allowing you control of that plane.
i've seen nursing instructors who have had groups of 10 students in clinicals and half will be on one unit and the other half on another (not necessarily the same floor). are you honestly saying that they should be able to oversee all 10 students at the same time? are you saying that the students bear no responsibility to learn the material they are taught in class so that they can apply what they've learned during their clinicals?
what i find disturbing in some posts is the slamming of the instructor. it bothers me that because the instructor wrote the student up for a med error that it should be considered "instructional error," or that the instructor "should be written up." nobody knows what went on between this instructor or the student involved. teaching responsiblity and accountability should always be ongoing.
I think the instructor failed in that her student didn't know to seek her out if she had a question.
Sorry, I disagree. As a student knowing when to seek guidance from an instructor is actually their responsibility. If she had a question I don't know why it wouldn't occur to her that the most appropriate person to go to would be her instructor to answer it.
The OP's original question was why it could be considered an error for this student to administer medications through the NG. Too many details about the situation were not included in her post, there may be alot more to the story that the OP doesn't know, including conversations between the instructor and the student in question. That is why it bothers me that other posters have thought the instructor's actions were inappropriate.
Instructor error indeed. Not to mention the floor nurse is the one ultimately responsible for that patient. If she says MY patient gets the med that route, that's the route the student should give it (as I recall, as a student I had to check all the orders before giving a med anyway, if you have a question, ask.). The instructor obviously wasn't there (and why not?) If you trust a floor nurse enough to turn your student over to her, then trust that she's knows what is best/routine for the patient. I made that error my first year of nursing, not checking up on what the students did to MY assigned patients - no long term harm but my responsibility nevertheless.
Not to mention some meds taste so horrible I'd almost rather have an NG put down just to avoid the taste. (almost ) :rotfl: :uhoh21: :rotfl:
People this is not a med error, the medication went to the stomach which is the purpose of the NGT. Giving a medication wether by swallowing or by NGT if present produces the same result....it's not like giving a medication iv when the order was IM....it's not as bad as giving a medication thru a dobhoff tube when the tip of the tube is in the duodenum as oppose to the stomach itself....this is a result of being over picky.
Specializes in Education, FP, LNC, Forensics, ED, OB.
People this is not a med error, the medication went to the stomach which is the purpose of the NGT. Giving a medication wether by swallowing or by NGT if present produces the same result....it's not like giving a medication iv when the order was IM....it's not as bad as giving a medication thru a dobhoff tube when the tip of the tube is in the duodenum as oppose to the stomach itself....this is a result of being over picky.
Yes, this could be a med error. The nurse should be sure the patient is not NPO. If suction is connected, the medication will be ineffective, lost .... so, yes, this could most definitely be a med error.
And, it can have detrimental outcomes. Never minimize this.
Hey siri, I do understand although we assume that it is not on suction because if it is on suction you would not give it to the patient to swalow it either because it will be suctioned back up.
Specializes in Education, FP, LNC, Forensics, ED, OB.
Hey siri, I do understand although we assume that it is not on suction because if it is on suction you would not give it to the patient to swalow it either because it will be suctioned back up.
Maybe I did not make my previous statements clear. Sorry, hrtprncss.
To clarify, if a patient has an NG tube and is on suction, ie, continuous, intermittent.......you can still give the med orally, IF ordered. You would clamp tube and leave tube clamped for 30 mins. after giving med.....
What I wanted to ensure is that this can be a very serious thing to give a med orally with an NG tube unless there are no contraindications.
I/we do not know the particulars of this scenerio...... :balloons:
When I saw the posting that the clinical instructor had written up this student I recalled a similar bright moment in a clinical instructor's career that my students related. It seems that their classmate had spent half of the night before clinicals writing the oh so popular care plan. Much to their dismay, the patient was discharged and gone by morning. During some lag time, the student elected to assist with passing out the meal trays. Apparently, this was not sanctioned activity. The instructor did not stop at writing up the student. The student was summoned by the course instructor back at the SON and severely repremanded.
When my students told me of this, I felt badly for the student, but of course, could not interfere. Imagine what a wonderful team player this nurse will become?
Specializes in Education, FP, LNC, Forensics, ED, OB.
When I saw the posting that the clinical instructor had written up this student I recalled a similar bright moment in a clinical instructor's career that my students related. It seems that their classmate had spent half of the night before clinicals writing the oh so popular care plan. Much to their dismay, the patient was discharged and gone by morning. During some lag time, the student elected to assist with passing out the meal trays. Apparently, this was not sanctioned activity. The instructor did not stop at writing up the student. The student was summoned by the course instructor back at the SON and severely repremanded.
When my students told me of this, I felt badly for the student, but of course, could not interfere. Imagine what a wonderful team player this nurse will become?
RodeoRN
Hello, RodeoRN,
I do not want to hijack this thread so I will be brief.
Please come into the Nurse Educator forum and introduce yourself. We look forward to seeing your posts and hear about some of your experiences/ideas.
The most important thing to remember during med administration is to read your phsician orders completely and if the med order is incomplete than the Doc must be notified for clarification. This said if there was not a route ordered than the MD should have been called before any meds were given regardless if the pt was NPO or not. That should have been one of the rationales given by the Clinical Instructor when righting this up as a med error.
Hey everyone:
One of the clinical instructors recently told a group abotu an experience with a student and giving meds to a patient with an NG tube. The patient had an NG tube in place, but the Dr.'s orders did NOT read "NPO." A student gave the meds through the tube per the instruction of one of the staff RNs. The clinical instructor wrote this student up for a med error, however. The rationale was that if the patient HAD been "NPO," the med could have been given through the tube. But because the pt was not NPO, the med should be given normally, via mouth.
I'm really confused on this. Isn't the whole point of an NG tube so you don't take things through the mouth? Can anyone please offer some insight and explain this to me?
rnpilot
77 Posts
The instructor should write herself up. It's her failure if a student makes a supposed mistake like this. When I learned to fly, my instructor made it very clear- if I made a mistake or didn't pass a check ride, it was his fault/failure for being a poor teacher. We need a little more of this attitude in nursing.