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!

[ObtundedRN, BSN, 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.

Those students had a seperate student login from their employee login. I now work for the hospital that I was a student at. So now I have a new login that shows me as an RN. They don't just update the old with new credentials.

[starmickey03, MSN, RN]

Im in NS now and we have full access to computer charting. But then again, my program is hospital based so this may have something to do with it. Im not sure about the access that the other nursing programs get when they do rotations at our hospital.

We also have badges so that we can enter the hospital facility after hours if we ever needed to. Obviously the other programs that do rotations there dont get that same benefit, so maybe the full access to charting is given to us because our program is directly linked to the hospital.

We also had to undergo a full orientation session on how to use the program (just as the staff did), along with completing some home training on our own.

[SierraMoon, ADN, BSN, RN]

We get everything but Pyxis access. The facility doesn't scan badges for meds, only the pts and drugs. We don't have to be co-signed by faculty for charting but we stick to PCA level for the most part. We attend training and hospital orientation similar to that of employees (I am also an employee so I know that it's pretty close, I do have separate IDs for extern and student).

[CMille14]

From a legal standpoint, I think it might be necessary to have the clinical instructor or a staff nurse co-sign with the student under most circumstances. If an issue ends up in court (God forbid), it would be a nightmare for a student to be the person ultimately responsible for medication errors, etc.

While it's great for a student to get the experience of passing medications and documenting, our work with patients and our documentation should be checked by someone who is licensed, in my opinion.

[whichone'spink, BSN, RN]

At the hospital I was at last semester as well as the one I am at this semester, I have full access to charting. I am required to do 2 assessments, 2 sets of vitals, all medications except IVP, and whatever interventions I do during the course of my day. At the hospital I was at last semester, I had my own Pyxis ID and I didn't need to have anyone with me to pull meds, except narcs. Over at the hospital I'm at now, I am given a new Pyxis ID every week. Our class decided to have 3 people do meds on Thursdays, and 4 people to do meds on Fridays. In addition, I have to have my instructor co-sign every med I administer, and Lord help us if my patient has tons of meds. Hence why we decided to split med days, so that my instructor is not running between two floors. I think the more we do, rather than just doing aide stuff, the more confidence we get in being a nurse. I understand there's liability issues for the school and for the hospitals, but it shouldn't come at a cost to students' learning experiences.

[amarilla, RN]

When I was a student, we had individual booklets each week outlining assessments and shift notes for our patients. We would complete them using the charts and bring them to post conference to discuss and hand in every week. We were only allowed to chart vitals, I&O, ADLs and the like on the computer while at the hospital. As for the pyxis, our instructor had a badge and would need to pull meds for us as needed. We did our med passes with our primary nurse or instructor; all meds had to be cosigned at the time of administration.

As a new nurse, I'm not sure I like the idea of students charting full assessments, admissions or discharges. Students may be charting what they see, but that may not agree with what actually is, and unfortunately it is already on the patient record. A student who had one of my patients charted numerous pressure ulcers without asking or discussing same...

which, if she had, I could have told her was a flare of psoriasis.

Knowing this didn't save me from chart audits and a flag for 'inaccurate documentation', however, even after I rectified the charting to reflect the nature of the lesions and added an explanatory shift note. At the end of the day, it does not fall on the shoulders of the student or the instructor; the patients always belong to the primary nurse and it all rolls downhill.

I would love to sit with students and go over their charting, but I have 7 patients and likely precious little time to be as thorough as need be.

JMO, of course.

[linearthinker, DNP, RN]

Let them have access to whatever NAs can chart, VS, I&O, etc. Assessments should only be done by a RN and should be 'read only' for students.

[karenbear]

According to what I've been able to decipher from the legal speak that is our nurse practice act, a student nurse is held to the same standards of care as any other licensed person. The critical part if the equation is in the delegation of tasks. The student is responsible for saying, "I'm not experienced enough to do this" and the nurse or instructor has to only delegate tasks that the student is competent to perform.

I agree that students need to learn, but not at the expense of the patient. My husband is an airline pilot and I was with him the first time he flew and landed his new airplane. I bet the other 75 passengers would have been a little nervous if they had known their captain had never flown the plane for real (just in the simulator).

My point is that everyone has to learn but we have to have some systems in place to ensure that our patients don't suffer because some nursing student (and this is the exception not the rule) isn't willing to say they don't know how to do something. I also think that our patients expect, when they are introduced to a student nurse, to see an instructor or preceptor. If you knew a new pilot was flying your plane I bet you'd want someone watching over what he's doing!!

I think that as students progress through their clinicals they should be allowed more responsibility but until you have your own license mine is the one responsible for the patient.

I know I'll offend someone with this statement...this is just my experience. I have worked with a lot of nursing students and new graduates who have a lot of, let's call it confidence. Some times it's a little misplaced.

I really was joking about not being able to breathe on the patient without an instructor but we did have to write out out assessment on a piece of paper and have the instructor check it before we wrote on the permanent record.

There are a lot of factors in play and it's been interesting ready what other hospitals allow/don't allow

[ObtundedRN, BSN, RN]

Let them have access to whatever NAs can chart, VS, I&O, etc. Assessments should only be done by a RN and should be 'read only' for students.

So you want RN students to learn how to be NAs? I'm sorry, but I strongly disagree. The nursing students need to be able to chart their own assessments so they learn to do this, and learn the responsibility. Imagine precepting a new nurse that has never charted an assessment. What a nightmare that would be!

As a student, we charted our own assessment and everything else, except admission/discharges. We never documented the teaching records, but could've if we wanted. The instructor HAD to co-sign the assessments, so if there was something wrong (like the example of psoriasis documented as pressure ulcers) then it would have been corrected. And it can always be uncharted as well. And the primary nurse still documented their own assessment. Our nurse practice act states that nursing students are held to the level of a licensed nurse. Also, if there was ever any documention that wasn't co-signed, the nurse manager ran a report that showed any unverified documention, and gave it to the nursing instructors to go back over.

[netglow, ASN, RN]

If there is not a progressive responsibility in clinical experience, IMHO, why have it?

Class time was a waste of my time IMHO. I would have rather been completely on my own and only come in for exams. As far as lab goes I feel the same. Let me come in and practice on the dummies on my own, and then come in for skills exams. I would have been able to keep my FT job this way too.

IMHO, the only use I had for the college was access to the clinical setting. If I was not allowed to fully care for my patients that last semester, I would have had no use for the program at all. I would have been happy with an on-line program.

Think about it. Those nurses who vent on how much work it is to precept NGs are getting nurses who have had a crappy clinical rotation. There are so many colleges who keep their students away from full clinical experiences.