Responsible for 15-17pts 7a-3p med pass

VickyRN, MSN, DNP, RN · Oct 15, 2004

Is this standard practice for your school? I would voice your concerns to your program director. Do you have to accompany your students into the patients' rooms with each med? What sorts of medications are you administering--just PO, or PO, IM, SQ, and IV? The latter really makes a big difference, especially the IV meds. (This is not meant in anyway to take away from the gravity of giving PO meds, because, as we all know, they can have very serious side effects.)

Also, what is the time window for giving all of those medications at the SNF? In most nursing homes, there is a total 2 hour window: 1 hr before until 1 hr after. In most acute facilities, there is just the 1/2 hr window, which makes it very difficult to get all the meds given on the floor.

What about vital signs? Are your students taking the proper BP's and apical pulses before administering certain meds? And staff, are they supportive and appreciative of your help, OR, are they standing off in the distance with a suspicious eye, looking for every little real or contrived error?

If you have a good group of students, it may be doable. But, in the final analysis, it is your license that is on the line. If you are feeling uncomfortable, you need to speak with your director.

purplemania, BSN, RN · Oct 15, 2004

I create a grid with hours across the top and room # down the side. Then I tell each student to write in when a med is scheduled. The grid is posted in the med room. I mark off the med when it is given (either I see it being admin. or I read the MAR). At some point I make time to double check the MAR to be sure all scheduled meds are given. It is a worry, of course. PRN meds are written in as they occur. Of course, I usually have 5-8 pts, not the number you are talking about!

SandyB · Oct 16, 2004

Purplemania,

I have done up to 8...4 students doing 2 pts each. We didn't manage perfectly within the acute time frame but it was close enough that no one was upset with us. 17 for the whole day with each student assigned to 3 or 4 pts scares the *&^% out of me!

Vicky,

It is not standard practice for the school. Nor is it something I saw done in either my LVN or my RN program...which is why I asked here. We always rotated 3-4 students to pass meds with the instructor. The school wants to start this to give the students a more real life experience near the end of their LVN program and the SNF likes the idea too. Probably to find some new employees in about 4 months time. I suppose I don't have to go into the patients rooms (no one said), but I am co-signing the MAR so I figure legally I am suppose to go in with each student and watch the pt take the meds. No IV's since they aren't RN students....I hope the nurse in the SNF does them cuz I sure don't plan to!

You have the time window right. And I pretty much figure there is no way I would meet it with 5 students who aren't super good. Fortunately the staff is supportive (or they sound like it now-this hasn't been done before) and I think they would let the time window bend, as it often does in real life. As for BP's and pulses, I would expect the students to take them, not rely on the aides last recorded VS. Know what I mean? When I worked the floor I never figured the BP taken at 0730 was good for a 0900 med given at 0945, so I always took them and would expect my students to do so.

Today I had 5 students (who might go to this SNF next week) with me at a make up clinical in a hospital. No meds on make up days so I had them take one pt each, get a list of the meds and then I asked them what the meds were for....I never knew xanax was a bronchodilator! Maybe if they had known 90% of the meds I would be feeling safer with this idea of having them pass meds next week on half the floor of sub-acute. As it is, I will not only talk with my director...I will refuse to let them pass meds with me.

As always in nursing, it is better to be job hunting than to lose the license. (Most likely a different instructor will go try it but if not, then I know for sure this is the right decision! Either way it is the right one for me right now!!)

I appreciate the replies. It really did help me clarify my decision.

Sandy

VickyRN, MSN, DNP, RN · Oct 16, 2004

As it is, I will not only talk with my director...I will refuse to let them pass meds with me.
As always in nursing, it is better to be job hunting than to lose the license. (Most likely a different instructor will go try it but if not, then I know for sure this is the right decision! Either way it is the right one for me right now!!)
I appreciate the replies. It really did help me clarify my decision.
Sandy

Sounds like you made a safe decision. Usually 7 or 8 students with just one patient apiece is my limit. I know I personally would not be able to handle that situation safely. You are protecting yourself, your students, and (most importantly) the patients!

SandyB · Oct 16, 2004

Hopefully my director will see it that way.

I know I do!

Overall so far I love teaching...this is the first time in 6 months where I had to make a decision like this....most my previous nursing positions had stressful situation like this to decide what to do about weekly or monthly.

Thanks again Vicky!

SandyB · Oct 22, 2004

Update:

An instructor who went Wed and did the med pass said "never again" it wasn't safe, they didn't get lunch and it took 3 1/2 hrs for the 0900 med pass...the staff nurses did not jump in to help. In fact the one student with the treatment nurse was left by herself (the student!) to do all the treatments with no one watching! Sadly the student didn't complain and the situation wasn't discovered until the end of the day since the instructor didn't have time to check on anthing but meds, meds and more meds!

Thank you for your support...I did make the right decision! And now everyone at the college knows too. :-) (I'm also happy to say they didn't pressure me to go do it or threaten me. So I'll keep my job too!)

edited to say this was on 30 pts...they upped the number after I refused. Go figure......?????........ :uhoh3: