Question about student nurses working at your facility

[karenbear]

I just started working with Information Services at my hospital. We've been using computer charting for most units and will be going live for the rest in a few weeks. We have just (in the past 6 months) moved to a scan medication/patient/nurse system for medication administration. So, I am on a group that is trying to figure out a good policy for nursing students (in light of our "new" computer systems)-should they be allowed full access to all charting (which is what they get right now-just have NS at the end of their name) and the medication administration system? What is your hospital policy on this subject? I remember when I was in nursing school I wasn't allowed to breathe in the same room as a patient unless my instructor or another RN was around but I'm old so maybe times have changed! Thanks!

[CVmursenary]

as a student, the more we are able to do on our own, the faster we learn. Students should have access to the charts of the pt.'s they are assigned. The more a student has to bother their nurse for info, the worse the learning experience.

[nicoleRN831]

I just graduated from nursing school in May and the way that one of the hospitals let us give meds was our teacher had her own username and password for the Pyxis and she would sign in and then we would get our meds out and then she would check them. When we had to go and give them, she would come in the room and scan her ID badge and then basically leave us alone to scan the pt's arm band and then each barcode on the meds that we gave to the pt.

In regards to the OmniCell, my whole group had the same code to take out supplies with.

Looking at the charts was a little harder since we didn't have username and password. Some nurses would sign us in there username and we would look up all the labs and notes. Other nurses didn't let us do that so the secretary would print off the recent labs for that day for us and we didn't get to look at the old notes.

[evolvingrn, BSN, RN]

Im not sure why they wouldn't? i did when i went through nursing school last year as did my classmates (we were in a one-on-one preceptorship...so all at different hospitals with a preceptor/ supervision rn-bsn)

At the facility im at now it just has sn in thier title when they document in the computer... . using computer systems is a huge part of nursing. I know that is one thing that has made me stand out in orientation ect...is that i came in pretty proficient in electronic documentation and maneuvering the systems.

(all of my charting in school was cosigned at the end of each shift by my preceptor but like pp i had my own name and password and i went to a mini training session in epic at the hospital before i started)

[llg, PhD, RN]

I'm involved with the same issue at my hospital. We will also be "going live" with a major increase in computerization within the next 9 months. The issue isn't about allowing the students to see the patient information in the chart -- it is in the amount of education/orientation people need to USE the new computer system effectively. Most schools/students cannot afford to invest that much time prior to clinical in order to be able to learn the system.

Also, security passwords, etc. all have to be pre-assigned before the first day of the clinical rotation and that is a HUGE hassle for the school and for the hospital's IT department. At my hospital, when all disciplines are considered, we have over 700 students per year. That's a lot of training, generation and activation of passwords, removing those passwords after the particular rotation is over, etc.

What we have decided to do is to design some screens that include some basic functions that students will be able to use (e.g. recording vital signs and I&O). By limitimg their ability to chart to only a few functions, we can reduce the amount of orientation they will need. Instructors will have to undergo the full training and be responsible for any additional charting they need to do (or a staff nurse can chart it). Some schools who come to the hospital for only a few days may choose not to invest in all that training. They will still be able to have some "read only" access after taking a very brief orientation course.

The orientation to the computer system training will be online.

We are hoping that will work.

Great question/thread. I am curious as to what other hospitals are doing.

[karenbear]

I understand the need to learn and want to facilitate that as much as possible, but I also want to make sure the hospital is protected from a legal stand-point. I've been doing some researching on the BON site but haven't found a lot of specifics yet.

We have a variety of ways we could allow student nurses to see the information in our system. Right now they have the same access as an RN and just have "NS" at the end of the name to designate they are students. They currently each get their own login for pyxis so they could pull out meds but we are trying to determine if they should each get a badge for scanning/documenting meds given or not.

If your instructor is scanning her badge and then leaving and allowing you to administer meds is she/he not in essence saying that they gave the medications? I'm not sure I'd want that on my license.

I agree that the setup and education of all students is A LOT of work that most people probably don't understand. At our facility the spreadsheet with names first goes to someone who creates unique id's for all of them and then goes to my team for access to online documentation. It can take quite a bit of time to set everyone up. We also have to set up residents, nurse aide students, pharmacy students, etc. The taking people OUT of our system is actually the bigger issue from a security stand-point.

We also see errors created in our system due to lack of training for the students.

Not sure what all the answers are but I appreciate all the comments and feedback!

[Mags_RN, BSN]

During my clinicals, at a particular hospital, we had read-only access to all information. We were able to chart only vitals, simple I/Os, Activity. If we wanted to chart assessment information, we had to do it with our nurse preceptor: she would sign in and we would chart with her sitting by our side checking everything over as we did it. When we did chart anything by ourselves (vitals, i/o etc), we were to let our nsg instructor know at the end of our shift so she can go back into the pt record and there was an option for her to check off that she had double checked the information we documented. Charting medications was also done with the RN. The Pyxis was accessed by the RN or the instructor and we were not left alone with the machine, ever.

[hotenok]

At the hospital that I work at and did my clinicals, nursing students don't have access to Pyxis, but they do have acess to charting. When administering meds students have to have a nurse co-sign for them. They can chart on everything else - assessment, baths, ambulations, etc. At the end of each shift co-assigned nurse needs to co-sign stating that he/she reviewed students charting.

The other hospital in the area allowes student only access to CNA type of charting and no Pyxis access as well. Nurses who trusts students allow students to chart under/for them.

I find it very helpful to have access to all charting.

[netglow, ASN, RN]

More access/responsibility as time went on for clinical for us.

Last semester full access/full responsibility. For me that meant hourly CCU assessing all areas documented. ID and fingerscan Pyxis with med scanning. Full med pass. RN precepting checked my documenting. If the preceptor saw something questionable I would need to explain or complete, but my documenting was permanent record (RN cosigned). I was responsible for formal interdisciplinary report for my patients.

[chloecatrn]

Our students had charting access, but the instructor had to scan her badge for med administration. She was there with them for every medication administration anyway, and they administer under her license, so it made sense. They did NOT HAVE access to Pyxis. The instructor was the only one with access to Pyxis for their group.

[ObtundedRN, BSN, RN]

While in nursing school, the hospital system that we did clinicals at had computer documentation and medication scanners. We had our own login info for the computers and scanners, but no access to a pyxsis/omnicell. We did all of our own documentation, and scanning of meds. In the computer, all of our charting and eMARs showed our name but no credentials (but we were listed in the computer as nursing students). It also always showed our documentation as "unverified" and our instructors had to co-sign our charting. It would then show both of our names and list it as "verified." The computer software is Cerner's PowerChart.

As for how much access, the hospital had policies about certain things we couldn't do. Such as blood and blood product administration, chemo drugs, and we couldn't complete any admission/discharge paperwork but could assist with it.

[LoveMyBugs, BSN, CNA, RN]

Another thing to consider is when you have students who are also employees, which happened to me.

Once I became a student my computer ID shows CNA/SN, and now whenever I click on a patient I have to click off if I am a student, CNA or faculty.