?Should students give IV push drugs?

[Zans]

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

[Lstcats]

This all surprises me what is practiced around the country. Students are strictly forbidden to give any IV push meds at any time during school. They may watch the nurse give D50 or Lasix or whatever med. There have been a few times that I push the med and show them how and with their hand let them just gentle push with me guiding them but not the entire med. I just want them to get the feel of it. And, at no time whatsoever do my students ever give any meds including po meds without me there. We sit down and go over each med and they have to tell me what the med is for and why the patient is taking it. They have to have med cards for every drug which is school policy in every college I have taught at (3 colleges PN & RN in Massachusetts). Then, we take the MAR and get the medss and sign them off and take the MAR into the room and they have to check name bracelet etc. I stay with them the entire time. It i s unsafe for any instructor to not monitor the student giving meds. Med administration is a big deal and med errors are on the rise. In FL and in other states there are mandated courses for your license in medical error prevention. I know that other states practice differently but this is what is done in 3 colleges that I have taught at. Of course, in the PN program 3rd semester is a little different because students do meds for about 15 pts. I won't teach that semester as I feel it is extremely unsafe for a student to try and do that especially when previosu semesters they have only had one or two or maybe 3 patients. That is my opinion.:prdnrs:

[cardiacRN2006, ADN, RN]

This all surprises me what is practiced around the country. Students are strictly forbidden to give any IV push meds at any time during school. They may watch the nurse give D50 or Lasix or whatever med. There have been a few times that I push the med and show them how and with their hand let them just gentle push with me guiding them but not the entire med.

What a shame.

So the first time these poor students give IVP meds it's as a nurse after they graduate??

How scary for them!

What's the point of school if they can't learn it there?

Watching D50 isn't the same as giving it. And if the teacher is at the bedside, I can't possibly see why they can't push it themselves. Watching is useless. They can watch ER or gray's anatomy if they wanted to watch it. Clinical is DOING, not watching.

I mean, really? You need to guide their hand with a simple IVP med???

I bet they are terrified when they get our of school!

[hypocaffeinemia, BSN, RN]

I agree with CardiacRN. I graduate in exactly two months and twenty days, and I already have a position as an ICU nurse where I currently work. Considering the sheer amount of IV medications in this setting, I'd be in over my head if I had no experience at all delivering medication by this essential to acute care route.

Luckily, I've been safely administering IVP medications for the last two semesters. In fact, after my instructor checked me off I've been doing all medications with merely the presence, or in some areas like ICU, merely the notification of the nurse caring for the patient. With the practice I received, I've feel (minimally) competent by this stage, as I should.

My school and instructor have even facilitated my desire to go into critical care by allotting me increased clinical hours in ICU/CCU versus med/surg this semester and allowing me to, with the primary nurse's supervision, titrate drips. It's may sound scary to you, but it's essential teaching.

[cardiacRN2006, ADN, RN]

My school and instructor have even facilitated my desire to go into critical care by allotting me increased clinical hours in ICU/CCU versus med/surg this semester and allowing me to, with the primary nurse's supervision, titrate drips. It's may sound scary to you, but it's essential teaching.

Fantastic! You already have a nice head start. Your school seems awesome!

[iteachob, MSN, RN]

My OPINION (based on 10+ years in academia)

It's absolutely essential that students be allowed to DO things in clinical. I agree with CardiacRN2006.....seeing is not the same as doing. I also find it hard to believe that clinical instructors are too scared/cautious to let a student push a drug under supervision! Who says you can't? The state? I highly doubt that. Your school policy? It's misguided. This is a disservice to students and the public. Nothing magical happens at licensure as far as the physical ability to push a drug goes.....

In addition to their clinical experiences, in KY, where I have taught for 10+ years, students are required to do a preceptorship before they can even get their license. They do EVERYTHING that a licensed RN does (under supervision, of course).

[Lstcats]

I can't comment specifically that it is MA BORN law that student's not administer IVP during school but it is the policy at some schools I have worked at. And, in MA new grads have to pass the state boards first before they can obtain any position in nursing. No such thing as GN as in other states. And, that I know is BORN of MA regulations. Very strict here.

[Whispera, MSN, RN]

With my students, if a med is needed, we talk through the administration at length before entering the patient's room. The first time an IVP is given I give it. The second time the student might give it, with me bedside, if he or she can convince me he or she knows how. The tell me what they'll do, I don't tell them this second time, before entering the patient's room. Both of us have to agree that the student is ready to do it. Sometimes by the end of clinical time I have been known to feel comfortable enough with SOME students to have them tell me what they're going to do, and stand outside the room while they do it. We debrief afterwards. Going solo is never a goal in my clinicals, just a possibility.

[RochesterRN-BSN, BSN, RN]

Damm! An 18 guage needle-- totally unacceptable !!! LOL Those size needles are really just for drawing meds up or maybe for a SEVERE TRAUMA in the ER!!

Yes there are some viscus meds that push slower with a smaller needle but it still works!! But it goes quicker if you use the 18/19 to draw up--ie Ativan....its like olive oil! I sure hope that nurse never has me as a patient--he would so not come near me with an 18 or 19G needle!! ---you got to learn something from him though...what NOT to do! LOL

As far as pushing meds.....I went to the U of Rochester and we were not allowed to ever push meds--in any semester. I don't think LPNs push them either. We couldn't even push saline to do a flush. They were very strick. We had a guy in my class that pushed a med in peds and almost got kicked out! He did it with the RN so the preceptor didn't know.

[knittwhit]

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.

I am currently supervising my students with IV push meds. Our policy is that the student can only give IV push under the direct supervision of the instructor. They have had to demonstrate competencies in the lab prior to the clinical setting and must calculate dosage/push rate and give indications/side effects etc. before we administer. The reality is this route is becoming the standard and these students are going to be expected to have these competencies when they enter the workforce. The more we reinforce good practice now, the safer and more confident they will be when we are not there walking them through the process.

[iteachob, MSN, RN]

I can't comment specifically that it is MA BORN law that student's not administer IVP during school but it is the policy at some schools I have worked at. And, in MA new grads have to pass the state boards first before they can obtain any position in nursing. No such thing as GN as in other states. And, that I know is BORN of MA regulations. Very strict here.

In Kentucky, students have to complete an internship, that encompasses time before graduating AND after.....before they can even sit for the NCLEX!

I believe we are the first state to require this........and the only one! Now that is strict!

[shygoofyone]

We're not allowed to push anything, including flushes....Kinda makes it difficult to check IV patency, doesn't it?

[iteachob, MSN, RN]

We're not allowed to push anything, including flushes....Kinda makes it difficult to check IV patency, doesn't it?

I'm speechless.......you apparently are at one of those schools that believes a license suddenly enables your IV medication capabilities!