?Should students give IV push drugs?

Specialties Educators

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Dear All,

I have taught nursing in two schools. In the last program students did not do IV push meds. It was strictly a liability issue. Students would think if they did one okay they were cleared to give all IV push meds.

Faculty at the school I am teaching at now have mixed opinions. Most see it as a danger. the peds instructors want students to given IV push meds -- mostly b/c there isn't much else to do in that clinical.

We don't even have a check off for this skill. What are other schools doing and what is your rationale for that decision? Has anyone had any horror stories with IV push meds and students?

Zans

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Specializes in Trauma, MICU.

Well...I'm not an instructor...I'm a student, but I thought I'd answer anyways.

We are allowed to do IV push meds in our 4th (out of 5) semesters, which is cardiac. We are supposed to do it in front of our clinical instructor after she has checked our math calculations. However one of my instructors made us do them without her being present...not a good thing in my opinion. This semester (5th) we also will be doing IV push meds with our preceptor.

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Specializes in Peds, PICU, Home health, Dialysis.

Nursing student here as well -- my school (accelerated BSN program split into 4 continuous trimesters) prohibits students from administering IVP's their first trimester. Otherwise, students are allowed to give IVP's after that, with the supervision of an instructor.

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Specializes in Cardiac.

Not an educator, just a nurse. In my program, we could push IV meds, but it must always be with the RN assigned to the patient. Always.

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Specializes in critical care, management, med surg, edu.

Educator here. We do not push meds until the very last semester. Instructor must be present each time.

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Specializes in OB, NICU, Nursing Education (academic).

Educator here.........after a student has checked off in the skills lab, we do allow it. An instructor is present for anything that goes in an IV line, piggyback or push. (Sigh) I often think the patient is actually better off with the student (and instructor) doing it, since my students must know (they are quizzed prior to administration) that the drug dose is safe, it is properly diluted, and is given over the proper amount of time.

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I'm a student. We are allowed to do pushes in the presence of an RN. Now having said that I was doing a large lasix push and it was a long push and I was chatting with the patient and happened to look up in the middle of the push and saw that the RN had left the room even though she knew she was supposed to watch. My heart almost stopped. I could have gotten kicked out of the program if an instructor had seen that. I reminded the nurse that she had to stay for the entire push or we could get a syringe pump if one was available or she would have to do it next time. I also let my instructor know what happened.

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Specializes in ICU, CVICU.

Student here. We push meds in our last two semesters. We know that we have to be there with a professor but we don't have to check off on anything but we reviewed how to do it in the skills lab prior to the beginning of the semester.

I often think the patient is actually better off with the student (and instructor) doing it, since my students must know (they are quizzed prior to administration) that the drug dose is safe, it is properly diluted, and is given over the proper amount of time.

I completely agree...so many of the nurses on our floor make faces at us when we say "well, I'm going to give this drug over x minutes". I don't think the nurses know or even look up the safe dilutions or rate of administration.

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Student here. We push meds in our last two semesters. We know that we have to be there with a professor but we don't have to check off on anything but we reviewed how to do it in the skills lab prior to the beginning of the semester.

I completely agree...so many of the nurses on our floor make faces at us when we say "well, I'm going to give this drug over x minutes". I don't think the nurses know or even look up the safe dilutions or rate of administration.

I know what you mean. I am in my last semester and we are allowed to give all of our pts meds with a nurse or our instructor. One nurse I was with rolled his eyes at me when I was trying to draw insulin up and he happened to grab the vial after I had alcoholed the top. When he sat it back down and I alcoholed the top again - he rolled his eye's at me and said, "That wasn't really necessary." I just shrugged it off and said, "Well, better safe than sorry." However, this is also the same nurse that was going to give an IM injection with an 18G needle and when my instructor asked him why he didn't have a 22G he said, "Well that's all is here and I don't want to go all the way to the PIXUS and get a 22G.":nono: Needless to say, I went and got a box of 18G needles out and gave him one. I think if he's my nurse, I may just request another RN or else be sure to give myself my own injections.:uhoh21: LOL

At any rate, I do find that several unsafe practices are happening in the "real world" and I try make sure that MY practices are better than what I've experienced from others yet knowing that I am not perfect and that mistakes may happen.

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Student here:

Our school allows the students to push meds only during our final semester. We can only push 4/5 meds: Lasix, Morphine, Dacadron/Solu-medrol, and Digoxin. We have to be checked off on campus before we can administer them in the clinical setting. We have to do our first couple of pushes with our instructor present, and when she feels we are safe, then we can give it without him/her being present. Our nurse/preceptor is still require to supervise us and check our calculation before we give it though. Honestly, if i was the nurse, i would like my student to consult me before doing a skill like pushing IV meds as well.

Br

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Specializes in ICU, Education.

Don't the state practice acts have specific mandates for what a student is allowed to do (either in the presence of the nurse instructor or the assigned nurse)? My biggest fear is the liability of letting a student do too much or them messing up under my watch when I was actually watching student #10 while student # 1 pushed Labetalol rapidly....

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Specializes in OB, NICU, Nursing Education (academic).
Don't the state practice acts have specific mandates for what a student is allowed to do (either in the presence of the nurse instructor or the assigned nurse)? My biggest fear is the liability of letting a student do too much or them messing up under my watch when I was actually watching student #10 while student # 1 pushed Labetalol rapidly....

To my knowledge (not my state anyway) state practice acts don't spell out specifically what a student is allowed to do.....state practice acts consist of laws regarding the practice of nursing by nurses.

State Boards of Nursing (different than the practice act) DO oversee nursing education, but mostly they look at instructor qualifications and the effectiveness (NCLEX pass rates) of the individual programs themselves; and, of course, it is they that license nurses. They also set a limit of how many students an instructor may supervise, but again, specific outlines as to what a student may do?.....not so much!

Where I teach, students know that they may not give any med without the okay (and, usually presence) of the instructor. Shoot, they don't even have PYXIS codes and can't remove the meds without my knowledge or that of another RN. They absolutely NEVER give IV (piggyback or push) meds without me or another RN supervising (i.e. present).

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