Question on med passing

In most facilities, meds can be given within a window of an hour before or after the scheduled time.

My instructors do a pretty good job of knowing who will need to give meds when, but I've had times when the instructor wasn't going to be able to get to me in time and I just asked the RN who was assigned to the patient to give the med (particularly on something like a pain medication).

I made sure to shadow the RN and observe the entire procedure, and when my instructor finally made it to me, I told her that I had asked the patient's RN to administer the med because it wasn't fair to make the patient suffer just because they had a student nurse assigned to them that day.

Then I also verbally "walked through" the procedure with my instructor, telling her that the med was obtained from the Pyxis, the drug and dose and expiration date was confirmed upon removal from the Pyxis, then upon entering the patient's room the name/DOB was confirmed, the ID band was scanned, the med was scanned, the pain prompts were completed (part of the eMAR at that facility involves telling where the pain is, what number on the scale it is, and what type of pain it is, etc.), and the medication was administered. I also say that I will perform a pain follow-up after 15 minutes (for IVP meds) or an hour (for PO meds), and that if this were in a situation where it would be applicable, I would explain to the patient that the pain medication could make them drowsy and affect their response time, so they should not drive or operate machinery while taking it, and also that they should not take any kind of sedative or drink alcohol while taking this medication.

This way, the instructor can see that I do know what to do, and that I was thinking of the best interests of my patient -- not just trying to get out of having to do something that I was supposed to do.

Our teacher gets upset if she's taking longer than expected on another pt and we ask if the Rn can give the med. I have had times where there is a hold up and the med has been more than the hour window of being late. I really like the approach of not making the pt wait for a pain med because your right it's not fair for them to suffer. Let me ask you another question my teacher will tell me to go and relay a message to the Rn and when I do I get an evaluation by the teacher at the end of the week that says I need to work on my communication skills simply because I did as she told me to do? What gives...

My instructor splits the group up so we are not all giving meds the same day. She says there's no way she could get all the meds on time if she had to be with all of us on the same day. So one day the first half gives meds and then the second the other half. It has worked really well so far and the patients do far have gotten their meds within an hour of when it's due.

Let me ask you another question my teacher will tell me to go and relay a message to the Rn and when I do I get an evaluation by the teacher at the end of the week that says I need to work on my communication skills simply because I did as she told me to do? What gives...

This would be a good time to ask the instructor what TYPE of improvement needs to be made.

I'm guessing that the nurse was asked about your message-delivery competence. Did you use SBAR or similar format to convey the information to the nurse? Did you interrupt the nurse while she was doing a medication administration (big no-no -- you never interrupt during meds, as it can result in a med error)? Did you mumble or say "um" or not maintain eye contact?

Only your instructor can tell you this, though, and that means that you need to take the initiative to email her or pull her aside before or after clinical (doesn't sound like there's time during clinical) to ask WHAT you need to improve so you can do better next time.

I asked my instructor to go get the pain med that my pt requested to have before he had to go to have his ct scan done (we don't have the code, only the instructor has it). I had to get him on a stretcher for the scan, as students we are not allowed to get the pt's up without the help of an Rn or aid. I asked the aid for help and she told me no and that she was behind on her work, so I politely waited for the Rn and asked her to which she told me I would have to wait a few minutes. When the teacher came back and asked me why he wasn't on a stretcher I simply told her that I was waiting for the correct help as per hospital policy. She then told me you go right now and tell one of them that they either help you or they're on their own. Of course I didn't approach them with the nastiness that she implied that I should do, I was professional and not demanding at all. The aid did help me however I still got communication problems on my eval. I have asked the instructor about this but she couldn't tell me how I was wrong. I'm just at a loss it seems like she has decided this is my flaw, the funny thing is my last 4 teachers never said I had this problem. Like clockwork everytime I have her that's the only thing negative she points out? I really like my instructor and have learned a great deal from her I can't fix it no matter how hard I seem to try...

Perhaps the instructor just wanted you to be more assertive with the aide or RN in the first place, thinking that you didn't properly convey the importance of moving the patient. After all, if they came to help with your "or else" statement, then they could probably have come to help without the "or else" statement as well.

She may be wanting you to be more authoritative for your own good -- when you're an RN on the floor, you're going to have to get stuff done on your own, without an instructor there giving you directions.

Thanks again, I'm sure she just want's me to be more in control. I have a problem with getting help from the Rn or aides all the time on that floor, they are often nasty to us students. Although it's tough when you approach staff in a professional and polite manner and they reply with a flat out rude/nasty reply. Heck I'm not there to argue or be demanding, if anyone of them ask for my help with their pt's (which they have in the past) I help out in any way that I possibly can. Oh the joys of nursing school lol.