Quick question to some of you more experienced nurses...
Last week we had students on the floor. I work the 7pm-7am shift, so we usually don't still have students at this time. I was working with 3 different students that covered my 5 patients. They were going to pass 2100 meds.
I was told that I was to check off their medications and to just look over all documentation. These students were so quick that they passed the medication without checking with me or their instructor first (instructor was on another floor with other students the entire time). I caught one of them as she was starting to mix the concoction to put down the NG tube, and another one I saw because I had to get something out of the pyxis for her, but 3 of my patients got meds by a student that were not checked off by a registered nurse.
I have been a nurse for less than a year, and have not worked with students very often. As a student myself, I would have never, NEVER done this. This situation was upsetting to me. Some people I work with thought it was outrageous, and others didn't seem very surprised. I sent off an email to my manager, but have not heard back from her. I did learn a lesson to say up front what I expect when working with students.
My question to you ... does this happen on your floor? Am I overreacting? How would you have handled it?
Specializes in Cardiac Telemetry, Emergency, SAFE.
I know that in the program I attended, the 4th (last) semester students are able to have the primary RN or the INstructor check the meds before going and giving them independently. I NEVER would have dreamed of giving even tylenol when I was a student without someone looking at it first.
It sounds like a call to the instructor is in order, whether to clarify or condemn. If that fails, risk management would be next on my hit list.
I'm very surprised you didn't have to get meds out of the Pyxsis for ALL the students. How the heck did the rest of them GET the meds to give? I never did a clinical rotation at a facility that gave students a password to get in and out of there as they pleased. I think it would be a good idea, after they get the report, to find out exactly what they plan on doing for each patient (procedures, meds, etc.) so you can say, okay...that's ordered for such and such a time, so come get me at (10 minutes prior) and we'll go see him/her together.
Specializes in Emergency, Critical Care (CEN, CCRN).
...Hang on a second, where'd these kids get the meds from, if you didn't pull them and the CI was off the floor? In every facility I've been in, everything from Tylenol on up was secured in the Pyxis. Do the SNs have Pyxis access also (shudder), or did some other RN pull for them?
In my program as with many others, your clinical instructor had to be the one to pull from the Pyxis for you, and he/she had to co-sign your MARs unless you had made arrangements in advance with the CI and your staff RN for the staff RN to do your pulls and co-sign you. (I made that arrangement on a few occasions, since we were on a very large unit for Med-Surg 1 and my instructor trusted that I knew what meds I was handling and how to administer them safely.) I can't think of any situation, even a preceptorship, where an RN wouldn't be checking off the SN's work prior to administration. As others have said, the SN is practicing under your license, so really they shouldn't be doing anything without checking with you first.
Those students would have earned an immediate dismissal in my program, and the CI would have his/her tail in a very painful sling. You were well within your rights to complain.
Edit: Ninja'd by whodatnurse. Great minds think alike!
First and 2nd semester (ASN) we were not allowed to give any PO meds without checking them w/RN or instructor and then having them witnessed being administered properly by RN/instructor. 3rd semester we would do med check drills w/instructor on all meds to be given prior to going on the floor, and then we could administer all PO meds unsupervised. Injections or IV push we needed someone present. 4th semester we did medication tests to be sure we were safe and knowledgeable, and then we could do all PO meds unsupervised w/out every shift checks--this was with the understanding that there were "spot drills" on meds by the instructor. Also, any new meds we hadn't ever given before, we were to read the medication books about any SE/precautions/administration guidelines, etc. and ask questions of RN/instructor. Also, if she didn't trust us on our knowledge, she would basically stick with that student like glue to keep the patients safe. (There were a couple that you wonder how on earth they graduated.) Injections/IVs/IV push needed someone else present. However, I will say that by my internship on 4th semester, my RN would drill me prior to going to do an injection/IV/IV push and then send me in. But by then I had proven myself to be responsible and well-versed on the meds.
...Hang on a second, where'd these kids get the meds from, if you didn't pull them and the CI was off the floor? In every facility I've been in, everything from Tylenol on up was secured in the Pyxis. Do the SNs have Pyxis access also (shudder), or did some other RN pull for them?
Because someone else made it seem "ok" for these students to give meds without a check-off. Why would the OP see FIVE separate students do the exact same thing on her floor?
EDIT: BTW, students at my school have the code to the med cart, but we are required to get a check-off prior to administering. In fact, the med cart is usually UNLOCKED and in the hallway of the floor I'm on. Anyone could pull open a drawer and grab something. It's a bit of a mess on that floor, as you might suspect.
Specializes in Emergency, Critical Care (CEN, CCRN).
Hmm. I'd buy that if this hospital had a med cart, but the OP specifically mentions accessing a Pyxis for another student's meds. I refuse to believe that any hospital would allow students Pyxis access, so in a straight Pyxis system someone had to have pulled the meds for them, and by OP's description it wasn't her or the CI. Does this hospital use some kind of hybrid system, then - scheduled meds in the Pyxis, everything else in a med cart?
These students should follow the protocol of their program. If they, as students can't do this then imagine what kind of RNs they would be once they get licensed? These routine checks are done to prevent errors and also to teach them that they cannot skip standards of care. I say these students are dangerous. Better talk to their instructor and notify your manager as soon as possible.
These students should follow the protocol of their program. ....I say these students are dangerous.
What is the protocol of their program, though? Maybe the implication in llg's response was right on...maybe the issue is with the program itself, and, unless the issue with the program is resolved, students from that school will continue to do things in this fashion. Maybe it's not the students, but that they were taught it was ok to do it this way.
My opinion is based on the OPs description that MULTIPLE students were doing it this way. If she comes back and says that they were all from the same program, then it really does point to the program as the issue.
As an aside, we had a med cart that we used, and only narcotics were kept in pyxis--which we needed to have the RN pull for us. At another hospital in which I did a clinical rotation, it was all in a med cart.
Unless things have changed, student nurses are considered unlicensed personnel, thus working under a RN, who is legally responsible for their actions. Normally this is/was the CI, how can she be in two places at once, and in her absence just who was (or is) responsible for the student's actions.
As the RN on floor job number one is your patient's safety. You don't know what those students pulled and administered, and am here to tell you if something went down, the OP's fresh new license could be in serious jeopardy, not to mention a whole lot of legal woes.
To the OP: CYA my girl. CYA! You were quite correct in being upset and should insist on something in writing or as clearly as you can get it just what duties students are supposed to be performing and who is responsible for them in their instructors absence. If other RNs don't see it as a problem, fine, let the students loose on their patients.
Nip this thing in the bud now, otherwise where will it end? If students feel free to access, prepare and administer meds without supervision or within proper proceedures, lord only knows what one student may think is within her "scope of practice" to do next.
While there may have been some lack of communication or maybe even a misunderstanding on the part of the students, they should know better. I'm a third semester student and I always, always, ALWAYS have my instructor or the nurse that I'm working with for the day check off my meds with me before I give them. Even if I've given the meds to that patient before. For patient safety, and my own peace of mind! I really do think you need to speak up about this group of students. If there was miscommunication or a misunderstanding, then their instructor will have to sort that out. And, if I were you, in the future I would always tell students at the very beginning of the shift, when you're introducing yourselves that your expectation is that they will check all meds off with you before administering them, or they will be reported to their instructor. You have to protect yourself and your license- you don't need rogue students risking patient harm by administering meds with no supervision!
Nip this thing in the bud now, otherwise where will it end? If students feel free to access, prepare and administer meds without supervision or within proper proceedures, lord only knows what one student may think is within her "scope of practice" to do next.
I'm starting to see a trend here in this discussion. Which makes me want to be redundant. Which I hate.
The student, the student, the student. How about the program, the program, the program? Some of my frustration with my own experience as a student is WANTING to do things safely, but being taught MULTIPLE ways of doing things. Once I become really frustrated, I look it up!
Let's recap: The OP was supervising THREE students. (I said five earlier...but it was three.) I'm assuming they are all from the same program. If they aren't, I will eat my words that come next, and apologize to all. They ALL did the exact same thing, which I agree was bad, bad, bad.
I am convinced that they were all taught incorrectly. As students, we are learning. If we are taught the wrong way, we will continue to do things the wrong way. The program director needs to get a real reaming from the nurse manager. The students need to be told in no uncertain terms by whomever is supervising them that she wants it done a certain way. Also, in the OP's post, some of her co-workers shrugged their shoulders at the OP's concerns...that's concerning too.
Crux1024
985 Posts
I know that in the program I attended, the 4th (last) semester students are able to have the primary RN or the INstructor check the meds before going and giving them independently. I NEVER would have dreamed of giving even tylenol when I was a student without someone looking at it first.
It sounds like a call to the instructor is in order, whether to clarify or condemn. If that fails, risk management would be next on my hit list.