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?
All of the students in my program were given direct Pyxis access. The only things we couldn't remove were narcotics.
Same here, but the Pyxis didn't stop us from taking narcotics, policy did. So, when I needed narcotics I'd get my instructor or the RN responsible for my patient and they would observe me pulling the narcotic from the Pyxis, then observe me administering the drugs. But it was all done on my Pyxis account.
You have every right to be very angry! Please make sure you document everything and make copies for yourself. The fact that they gave medications to your patients without checking with you or the instructor first would have been grounds for getting clicked out of clinical when I went to school. I've been out a while but it was made really clear up front that if we ever did that we'd be out. It happened to one girl too so they were serious. We have electronic medical records so I'm not sure how you sign for your medications or if the students have access to do so (which they shouldn't without getting but I sure wouldn't sign anything. One of the clinical instructors doesn't have access to our EMAR for whatever reason and I won't let her give meds with students on any of my patients. However I 'm happy to take any student for the day and let them do the tasks with me supervising so they can get some little bit of experience. I cannot believe what some nursing programs allow and what some people think is okay. Just a tirade on clinical instructors although I shouldn't because that looks like a hard hard job!
Specializes in CT stepdown, hospice, psych, ortho.
I don't know if its an issue with anyone else but (as much as I love having students to mentor)...the instructor is responsible for their med pass. She often lets them give POs independently once they've demonstrated competence with the procedure and can rattle off their action, indication, etc etc. I would be ok with letting them give meds except for the utter chaos of this nursing program.
My pet peeve is that the instructor isn't supervising the documentation in the electronic MAR so I was having to do all these double checks and was constantly chasing the students around to make sure everything was administered and documented. They were constantly tying up the PYXIS struggling to do thier med speeches while they were pulling pills, giving meds 2 hours late, forgetting to open the clamp on ABX (with instructor supervision!) to the point that when my gentle complaining wasn't getting me anywhere with the instructor or the nurse manager so I just started refusing to take them.
Sorry, I hate it, and I make a point of grabbing the interested students for dressing changes and chest tubes and wire removal but it was such a clustermess with the meds.
It is really a shame because it isn't the student's fault that the instructor hasn't developed a more streamlined system (maybe reviewing the meds with the students in pre or post conference instead of right in front of the pyxis at crunch time anyone??) and that she isn't proficient in the electronic documentation. Those patients are ultimately my responsibility, I don't just "assume" their care when they leave the floor.
The sad thing is I think I'm an excellent teacher/mentor (looking to finish up MSN and get PM cert in education) but I don't have the right to insist the SNs give meds with me so the administration doesn't have the right to insist I have a SN. The instructor needs to have a long hard look at her policies and address some issues so that the student nurses can safely give meds in a timely manner that is properly documented.
I'm not stressing over an EC ASA being given two hours late, I'm talking about antirejection meds and other heavy duty meds that I didn't even get to give in school. I walked in on a student giving prograf SL without a mask on once. The instructor wasn't even aware it was a policy. It was a real "what the hell?" moment for me.
When I was in nursing school(last year). I gave meds once. During that entire time. My instructor was with me. I was so nervous and so cautious and made sure that I checked EVERYTHING so I knew.. and my instructor knew.. that I was doing it right.
If I was doing something aside from patient care(feeding, bathing, vitals, assessment for our care plan).. I wanted my instructor in there with me.. or at least another RN because I wanted to be critiqued and corrected if i was doing whatever I was doing wrong.
I don't understand how these nursing students are so confident that they are giving meds on their own without someone there.
Another one here that was never allowed to give meds without either supervision of our instructor or the nurse we were assigned to. Either the instructor has no issue with this or one student told the others it was ok and they all went along with it. My understanding is that students work under the instructor's license, so I don't get being so lax about a med pass.
Another one here that was never allowed to give meds without either supervision of our instructor or the nurse we were assigned to. Either the instructor has no issue with this or one student told the others it was ok and they all went along with it. My understanding is that students work under the instructor's license, so I don't get being so lax about a med pass.
Or it's the school policy.
In our school, first year students need direct supervision to give meds, second year students get checked their first time giving meds, and if they're determined to be safe, they can give meds independently -- except for IV pushes and narcotics. If I was ever unsure about anything, I would of course get my instructor (or the assigned RN if my instructor wasn't available).
That didn't mean that my instructor wasn't sometimes with me when I pulled or administered meds. She was and would ask me questions to make sure I knew what I needed to.....that was never a problem though.
In our school, first year students need direct supervision to give meds, second year students get checked their first time giving meds, and if they're determined to be safe, they can give meds independently -- except for IV pushes and narcotics. If I was ever unsure about anything, I would of course get my instructor (or the assigned RN if my instructor wasn't available).
That didn't mean that my instructor wasn't sometimes with me when I pulled or administered meds. She was and would ask me questions to make sure I knew what I needed to.....that was never a problem though.
True, but in this case the op was told she was supposed to check off their medication. So I have to guess that maybe because the instructor was off the floor, the students didn't follow policy.
I would be expelled from my program had I have done this.....this is a no no where I go to school. But then again, our instructor stays on the floor with us the entire time. We are only allowed to do vitals, bedbaths and showers w/o having her in the room.....we can't do anything w/o her being there. I would not be confident enough to pass meds by myself yet......geeze. How rude for them to take over like that!!!
Seriously? Did anyone bother to ask at what point in their schooling they were at?? Granted a brand new student should not have passed medications without being checked off to safely do that task, but you are assuming they have never done meds before! A person has to be given some trust to do the job they have been trained to do. IF they were not trained in lab or simulation situations then they should NOT have been set with a NEW RN to pass medications in the first place. The instructor, RN and students should have had a meeting to clarify what was expected of ALL of them for patients safety sake.
Just because YOU are not confident enough to pass meds by yourself yet, does not mean they were not.
I'm a LPN in the last semester of my RN program. In the real world, I'm licensed and am more than capable of giving meds by myself. In student world, my license doesn't apply. Each rotation, we still have to initially be checked off on med administration (everything from PO to IV meds) and then we are given the ok to do it independently...and when I say 'independently', I mean with the RN we have been assigned to instead of our clinical instructor. I've spoken with several nurses who are beyond uncomfortable when students take it upon themselves to answer patients questions regarding care or give meds because some don't bother communicating with the nurse what they have done. They don't remember to chart things. Unless these students were doing some kind of final preceptorship (and it doesn't sound like they were), I don't think they had any business administering meds without having the nurse present.
Specializes in CT stepdown, hospice, psych, ortho.
Seriously? Did anyone bother to ask at what point in their schooling they were at?? Granted a brand new student should not have passed medications without being checked off to safely do that task, but you are assuming they have never done meds before! A person has to be given some trust to do the job they have been trained to do. IF they were not trained in lab or simulation situations then they should NOT have been set with a NEW RN to pass medications in the first place. The instructor, RN and students should have had a meeting to clarify what was expected of ALL of them for patients safety sake.
Just because YOU are not confident enough to pass meds by yourself yet, does not mean they were not.
I have no problem with a competent student administering PO meds IF
- they document accurately every time in the eMAR and are performing the interventions necessary such as checking BP before giving antihypertensives, giving SSI even if patient is NPO, wearing PPE when administering hazardous meds, giving meds on time and not 2 hours late without telling someone they were going to be late giving them, not giving applesauced meds to pts on aspiration precautions, not giving meds down an NG tube that hasn't had placement verified by xray --- and I had all of this happen before I finally said, that's it. When it became evident that talks with the instructor and managment on the floor weren't getting these problems addressed, I refused to continue sharing my patients and having to fix the resulting mess that was totally preventable.
Seriously? Did anyone bother to ask at what point in their schooling they were at??
You have a good point, although it may not apply in this particular situation.
Many people believe students need a check-off EVERY SINGLE TIME they pass meds--I'm not saying someone who holds that opinion is right or wrong, but I'm asking you to think of it differently. If I'm a last semester student only two weeks from graduation and four weeks from NCLEX, there will be a really good chance I'm going to do it on my own for 5-10 patients in a matter of weeks.
Odd, that. Maybe there should be a point during schooling where students are expected to work under the possibility of their own license rather than the active license of the RN supervising them.
Something similar happened in my foundations lab. The instructor would show us different needles, but wouldn't let us touch them. I thought it ridiculous because in only a couple of weeks, we would actually be handling those "dangerous" needles filled with drugs and administering them to actual patients.
True, but in this case the op was told she was supposed to check off their medication. So I have to guess that maybe because the instructor was off the floor, the students didn't follow policy.
True, I was more responding in the context of all the posts that were surprised with the idea of students passing meds independently at all.
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CuriousMe
2,642 Posts
Same here, but the Pyxis didn't stop us from taking narcotics, policy did. So, when I needed narcotics I'd get my instructor or the RN responsible for my patient and they would observe me pulling the narcotic from the Pyxis, then observe me administering the drugs. But it was all done on my Pyxis account.
Peace,
CuriousMe