What would you have done? Need advice.

[RookieRoo]

Hi fellow AllNurse people...

So I had a situation come up in clinical and I'm not really sure who to talk to about it.

I am finishing up my 3rd out of 4 semesters of RN school (accelerated program and we graduate this summer). The hospital I do clinicals at has a rather strict protocol on students passing meds; we may only do so IF our instructor is present and not at all in the ICU. Well, we are currently doing ICU clinicals now and the RN I was following happened to be the assistant manager of the unit, in working overtime as a floor RN. It was my second time following him and we had, I felt, established a pretty good rapport. He was great in showing me how to do things once, then letting me do them (with guidance) the next go round. Very helpful and I was trying to be on the ball with everything to show him i am capable and as a way of thanking him for teaching me.

So, multiple times he asked if we students were allowed to pass meds and I told him no. He kept saying that that was stupid, etc, for students who are about to graduate to not be allowed to pass meds, because otherwise how will we learn (not a bad point, but not THE point). So my second day of following him he asked me, after I was done doing an AccuCheck on a pt, if I had ever given insulin before. I told him yes up on the med surg floors and he asked if I wanted to just go ahead and give it and other meds with him, on the "down low." I didn't know what to think of this, and still don't.

On the one hand... I felt like I had good rapport with him and didn't want to break it. I'm hoping to be doing my capstone in the ICU this summer and he already said he would precept. It also felt like a good opportunity to learn. On the other hand, policy says no. My instructor says no. The risk of being caught by my instructor, who VERY CLEARLY and explicitly reminded us of the meds policy during our prebriefing... well, it made me feel like a kid grabbing a cookie hoping not to get caught.

I said no, and apologized, and told him I really wanted to but that I felt like it wasn't worth the risk of getting caught when I am about to graduate. He said okay and went ahead and gave it himself but I'm not sure what he was thinking (ie, if he was mad, thought I was ungrateful, etc). I know he put himself out there to offer that opportunity and I feel like I slapped him down. Maybe I blew the "risk of being caught" thing out of proportion, and I should have just taken the dang needle and done the med pass.

I'm not sure. Feel very conflicted, and I know I will see him again for clinicals this week so I feel like I need to get some resolution. What would you have done? Did I do the right thing?

[vanilla bean]

I found myself in a similar situation while completing my preceptorship on medsurg in the final few weeks of nursing school. I was allowed to administer meds with my preceptor (or another RN) present, but no blood administration and no IV push narcotics. My preceptor repeatedly asked me if I wanted to give the IV push narcotics and I would decline every time, remind her of the school's policy, and thank her for offering me the opportunity to practice. She thought the policy was stupid, so would never let it go. Eventually, I explained to her that it was not worth it to me to risk being expelled from the program when I was so close to successful completion. It annoyed her that I would never acquiesce (she would get snippy and passive-aggressive with me after my refusals), but I felt that was her problem, not mine. I would just plaster a smile on my face and kill her with kindness.

Stick to your school's policy and you won't go wrong.

[elkpark]

You were completely correct to not do anything with this nurse "on the down low." It was unprofessional of him to continue to ask after you declined the first time and explained why, and it was unprofessional of him to express any opinion about your program and its clinical policies (and, in fact, the policy is probably a requirement of his employer rather than your school).

[Jenngirl34RN]

You completely did the right thing! I was in a similar situation when a nurse I was working with in clinicals asked if I wanted to hang blood with her, which is one of the big no nos in both my school and the hospital policies, and she got crabby about it, but I did not care. Graduating and my future career are more important to me than hanging blood. It is certainly not worth the risk of being kicked out of your program over something as simple as an insulin shot!

[NICU Guy, BSN, RN]

You did the right thing and following the hospital's policy. The school was fighting that policy a year ago and obviously the hospital's legal department still hasn't budged. I believe you will be able to meds during your capstone. I don't recall my classmates complaining about not being able to do med passes during capstone at that hospital. I went to a different hospital for my capstone and they had their own rules about my med passes.

Hang in there, only 3 1/2 months to go until graduation.

[SopranoKris, MSN, RN, NP]

The issue we have is that our school policy is no meds unless the instructor is present. With 8 students on the floor and 4 of them doing med passes, we end up barely getting them done on time. Another school in our area doesn't do it that way. Their students are completely independent and just have s single nurse preceptor. They do everything.

The problem is that doctors & nurses will assume we can do everything independently, too. I've had a doctor say "I'm giving you permission to start fluids" after I've stated I can't due to policy. He actually said "well then, what good are you?"

I felt so pressured to just hang the fluids and get the IV started. But I knew I'd be booted out of the program in a heartbeat if anyone ever found out. It was hard to say no. But I've come so far, I'm not about to throw it all away because of peer pressure!

If I wasn't restricted by policy, I'd have done it in an instant. It sucks getting caught up in red tape.

[elkpark]

The issue we have is that our school policy is no meds unless the instructor is present. With 8 students on the floor and 4 of them doing med passes, we end up barely getting them done on time. Another school in our area doesn't do it that way. Their students are completely independent and just have s single nurse preceptor. They do everything.

The problem is that doctors & nurses will assume we can do everything independently, too. I've had a doctor say "I'm giving you permission to start fluids" after I've stated I can't due to policy. He actually said "well then, what good are you?"

I felt so pressured to just hang the fluids and get the IV started. But I knew I'd be booted out of the program in a heartbeat if anyone ever found out. It was hard to say no. But I've come so far, I'm not about to throw it all away because of peer pressure!

If I wasn't restricted by policy, I'd have done it in an instant. It sucks getting caught up in red tape.

In a way, this is a valuable part of nursing school in that it's another useful skill nurses need. There have been any number of times over my career that I've been requested, pressured, or "ordered" to perform something outside my legal scope of practice by superiors or physicians who either simply, sincerely didn't know or who knew but didn't care. Knowing when and how to say, "Sorry, that's outside my scope of practice, can't do it" and sticking to that in the face of significant pressure is a vital professional survival skill. :)

[LoriRNCM, ADN, ASN, RN]

Good job, you did the right thing. Imagine if something had happened. I take so much time pulling meds from the pixys because instead of just grabbing one from the drawer that pops open, I read the top of the screen and look over the actual dosage. It takes more time. There is another area of the screen that says "Remove one tablet" or vial or capsule or whatever. I look at the whole thing. Paranoid. I don't think you can be too careful.

[nurseprnRN, BSN, RN]

The problem is that doctors & nurses will assume we can do everything independently, too. I've had a doctor say "I'm giving you permission to start fluids" after I've stated I can't due to policy. He actually said "well then, what good are you?"

The classic response, which he might have recognized if he took any liberal arts classes, is, "What good is a newborn baby?"

You did the right thing. You can remind him later when you're in charge.

[kbrn2002, ADN, RN]

Yes you were absolutely right to respectfully decline the offer. It certainly isn't worth the risk. Besides, this nurse has already offered to be your preceptor, maybe this was his way of testing you a bit to see if you would break the rules. If it was, I'm thinking you passed with flying colors. After all, if you would ignore that rule while a student, what rules would you ignore as an employee?