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?
I'm a student now and for my patient's protection and my own protection there is no way in heck that I would EVER give a med unless the instructor had checked first. I've made a mistake in a calculation and thank goodness the instructor was right there to catch me before I even touched the meds!!! Wow. I just can't imagine being so.....brazen....as a student. OP - you have every right to report this to the clinical instructor and talk to those students if you see them again. Make it clear that for the safety of the patients and their own safety and YOUR own safety, you will not allow that. Good luck to you and let us know how this turns out!
Specializes in med/surg/tele/neuro/rehab/corrections.
Please remind me but I thought I recall a case that went around and discussed here on allnurses of a fresh mouthed student giving an injection to a patient and was unsupervised. Patient died and nursing instructor lost license and was being charged.
That's why I too would be concerned about students coming in to give meds to patients and no instructor. horrors
To Murphyl- When I was a student nurse All nursing students had access to the pyxis. We had our own password, Id code, and they even had our fingerprint for us to get in. Thus this is not uncommon.
On another note what those students did was wrong, wrong, wrong! And the instructor need to be on one floor with all the students or either they just dont give meds.
I'm 50 days from graduating and we cannot pull meds without our instructor present, much less give them to patients -and NG no less. I am seriously floored and rather appalled.
Regardless of their school's policy, it is what YOU are comfortable with in the end - and obviously, you aren't comfortable with how they did it. I don't think you'd be out of line at ALL to sit down with their instructor and tell them how you want meds done.
I think every program is different. I'm graduating in two weeks, so I do everything on my own. I have my insulin double checked per protocol, but all PO's, NG/G tube meds, injections I do on my own. I can do IVP's as long as I let the RN know "Hey, I'm going to give 131 Nexxium now." We have access to the pyxis and the only thing we cannot pull is narcotics. We can give them, just can't pull them.
Now, this is not how it always was. In the beginning the instructor had to check all meds, after time it was ok to check them with the RN, then we eventually got to where we were competent enough to do them alone. Same situation with procedures.
As a nursing instructor, I would immediately remove any student caught administering medications in the clinical setting without me or another licensed nurse present as they are well aware that this is the standard of care at our school. End of story. Even if we are to assume (a dangerous thing to do) that all students are passing the correct medications to the correct patients, there is a risk that the patient will be given double the dose if both the primary nurse and the students are administering medications without communicating. The lack of communication is nearly worse than an unsupervised med pass! How upsetting this must have been for you!
I would alert your nurse manager, the student liaison, the risk manager, and the instructor. This school should not be allowed to have privileges if this continues. As instructors, it is impossible for us to be every place at once, but we should establish clear guidelines for safe practice. In my state students are not licensed and may only dispense medications with supervision, although this may not be the case in other states. The fact that it is more than one student who did this indicates that there may be a lack of safe practice and supervision by the instructor.
It is so frustrating to hear these stories and I'm sorry this happened to you. As an instructor, I bend over backwards to ensure my students are prepared and professional and that I communicate with staff and am acccessible to students at the clinical site.
Last semester I actually had a manager say "It's so nice when your students are here. When 'school x' is here, we never see the instructor!" - and this was a 1st semester course! There is nothing like doing your best to promote a good experience for both students and staff, only to have others undoing the work with scary practices and lack of supervision. I can only wonder why someone would choose nursing education if they don't like to educate (which last time I checked, required actually being present!)
You have every right to refuse students from this school if they refuse to use basic safety and communication skills.
I would speak with the instructor first to double-check what was supposed to happen and see if there was a miscommunication somewhere.
I say this only because in my program, as a second year student I have my instructor witness me pulling then administering meds for the first time of the term. Then, unless it's an IV push, a narcotic or something I haven't done before, I am allowed to give meds independently. I of course follow protocol and have insulin or heparin double-checked with an RN (my RN or my instructor). I have a Pyxis account that is registered to my thumb print and access it myself to pull my meds.
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?
I have full pyxis access, as a nursing student, at the hospital I'm at this semester.
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.
You are right... we keep narcotics and heparin in the pyxis, along with some other drugs needed stat. We keep the rest in a med cart, and I am assuming that the students got the code from the day nurses. It wasn't from me! I went to get some heparin from the pyxis, and that is all that one pt got, so I was ok with that. Most of the other drugs were already pulled from the med cart - I "caught" one student about to give them, but two other patients got all their meds without anyone checking them off.
P.S. Having the med cart open... that probably isn't good!
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.
I agree with that... all students were from the same program. I made the mistake that the program was run the same way mine was!
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.
THANK YOU! You can bet I will never assume anything from a student again, and if I have to look like a b***h, then so be it. I couldn't even pass meds when I was hired as a grad nurse until I passed the NCLEX!
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?
All of the students in my program were given direct Pyxis access. The only things we couldn't remove were narcotics.
CBsMommy
825 Posts
I'm a student now and for my patient's protection and my own protection there is no way in heck that I would EVER give a med unless the instructor had checked first. I've made a mistake in a calculation and thank goodness the instructor was right there to catch me before I even touched the meds!!! Wow. I just can't imagine being so.....brazen....as a student. OP - you have every right to report this to the clinical instructor and talk to those students if you see them again. Make it clear that for the safety of the patients and their own safety and YOUR own safety, you will not allow that. Good luck to you and let us know how this turns out!