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?
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.
Just to clarify - these were second year ADN students ready to graduate soon (a week? a month?). I knew that. These students got to the floor earlier than I started my shift at 7pm, so they had already done a med pass and assessments. Because all three students acted the same way, I believe it was most likely the way they had been doing things before I got there and no one had a problem with it.
I was told that I would be checking off their meds and documentation. I understood that to mean I would be looking at the medication BEFORE it was administered and checking it off on the MAR along with them. I realize now that I should never make that kind of assumption, and I should have clarified before starting my shift. I take responsibility for that. Like I said, I am a fairly new nurse and it never occurred to me that students would have that kind of independence. I graduated from a similar program and we were never allowed to pass meds without getting checked off. EVER. So now I know!
That being said, I still do not think I am comfortable with students, even if they are capable and confident, passing meds on my patients. If something happens, who is to blame exactly? And even if it is school policy, I should have the right to know what is going on with my patients. Just my humble opinion.
That being said, I still do not think I am comfortable with students, even if they are capable and confident, passing meds on my patients. If something happens, who is to blame exactly? And even if it is school policy, I should have the right to know what is going on with my patients. Just my humble opinion.
It's your license on the line...you do what you feel is right to keep your patients safe.
I just wish there was more of reality put into schooling these days. The safety net is long, long gone only weeks after being coddled and protected by licensed nurses. We NEED to have more realistic training to be safe.
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.
That is more the model our school works under. We have a three year program, so first year: all med passes are supervised, second year: the student needs to check off once per term. Third year, 2/3's of it are spent 25 - 30 hours a week with an RN doing preceptorship (not there yet). I assume students have at least as much responsibility as 2nd yrs and the rest is to be worked out between preceptor, student and clinical instructor.
There's never been something in lab that I couldn't touch/handle though....and really there's been very little on the floor that I haven't been able to be walked through after watching at least one. It's one thing I've really enjoyed at my school....we're very hands-on, while still being supported.
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.
Even when I started as a grad nurse, I was not allowed to pass meds without my preceptor checking it off. The day after I passed my NCLEX, it all changed - I was completely on my own. Even though I felt more than ready, I had no problem with that policy.
What surprises me most is the lack of consistency. And from the replies I have received, it seems like most people agree that students should not be passing meds on their own.
Even when I started as a grad nurse, I was not allowed to pass meds without my preceptor checking it off. The day after I passed my NCLEX, it all changed - I was completely on my own. Even though I felt more than ready, I had no problem with that policy.
What surprises me most is the lack of consistency. And from the replies I have received, it seems like most people agree that students should not be passing meds on their own.
Obviously, I'm still a student so only know my program. I'm not saying anyone's wrong or right. I was just saying how my school approaches the idea.
It's your license on the line...you do what you feel is right to keep your patients safe.
I just wish there was more of reality put into schooling these days. The safety net is long, long gone only weeks after being coddled and protected by licensed nurses. We NEED to have more realistic training to be safe.
Yeah, but having someone double check isn't that big of a deal, either.
Two things I wish my schooling emphasized more were clinical skills -( iv starts, giving injections, changing dressings, foleys, inserting ng tubes and such) and time management. I was good with the total patient care and med passes. I would have liked the opportunity to work with 4-5 patients at one time more than once or twice.
I'm really surprised by some of the answers here. Can someone clarify for me how an RN would sign off student's meds if she didn't witness pulling and/or administering them? I don't know that I would take anyone's word for what they had given when it would be my license on the line or me on a witness stand in a malpractice suit if something went bad.
Specializes in CT stepdown, hospice, psych, ortho.
I'm really surprised by some of the answers here. Can someone clarify for me how an RN would sign off student's meds if she didn't witness pulling and/or administering them? I don't know that I would take anyone's word for what they had given when it would be my license on the line or me on a witness stand in a malpractice suit if something went bad.
Here the SN has her own pyxis account. She cannot pull narcs but everything else is free reign. She is supposed to discuss the meds with her instructor and pull them and then administer them using her own name/password in our eMAR. The assigned nurse is supposed to perform and chart the assessment and give any narcs along with the appropriate evaluations but all tx and meds are supposed to be the SN's responsibility. I'd MUCH prefer taking a student nurse myself and mentoring her and checking the meds and teaching her the tx since the instructor never signs into our electronic documentation to document a single dressing change, etc. So if you weren't lucky enough to find your SN before the shift begins and let her know your expectation is to watch the dressing change so you can evaluate the wound (or whatever the treatment may be), you find yourself having to redo work to the pt's consternation. I have spent hours thinking about this problem and sharing my thoughts with our NM and CNS but there is a culture of doing it the same old way that everyone is comfortable with that makes them reluctant to trial a new way of mentoring these students.
I'm really surprised by some of the answers here. Can someone clarify for me how an RN would sign off student's meds if she didn't witness pulling and/or administering them? I don't know that I would take anyone's word for what they had given when it would be my license on the line or me on a witness stand in a malpractice suit if something went bad.
In our hospital there's nothing to physically sign off.
The hospital uses electronic medical records (EMR). As a student, I have an EMR account and an account in the Pyxis where the meds are held. I use the MAR that is part of the EMR, and pull meds at the appropriate time from the Pyxis using my account. I then administer them to my patient by logging in with my account to the EMR in the patient's room, scanning the patient's wrist band, then scanning each of the drugs....after each med is administered, I confirm in the EMR that it was administered.
If my patient needs meds that are given via IV Push or are narcotics, then I need to get my instructor or the RN assigned to my patient before I start the above process (with the obvious addition of counting the meds in the drawer when giving narcs). It looks the same in the system....they're just standing with me while I do it.
My instructor notes in the EMR for each patient a student is caring for, that she was on the floor that day. My EMR account notes that I'm a nursing student.
Now I'm of course communicating with my RN during the whole shift. He/She knows what is going on with my patient all through the day. I'm also in touch with my instructor during the day, and she also knows what's going on with my patient.
Here the SN has her own pyxis account. She cannot pull narcs but everything else is free reign. She is supposed to discuss the meds with her instructor and pull them and then administer them using her own name/password in our eMAR. The assigned nurse is supposed to perform and chart the assessment and give any narcs along with the appropriate evaluations but all tx and meds are supposed to be the SN's responsibility. I'd MUCH prefer taking a student nurse myself and mentoring her and checking the meds and teaching her the tx since the instructor never signs into our electronic documentation to document a single dressing change, etc. So if you weren't lucky enough to find your SN before the shift begins and let her know your expectation is to watch the dressing change so you can evaluate the wound (or whatever the treatment may be), you find yourself having to redo work to the pt's consternation. I have spent hours thinking about this problem and sharing my thoughts with our NM and CNS but there is a culture of doing it the same old way that everyone is comfortable with that makes them reluctant to trial a new way of mentoring these students.
We sit in the morning meeting with all the floor RN's and the CNA's. We then get with our RN before he/she gets report from the night shift. It was made really clear to us that before we do a thing with our patient/s we need to speak with the RN and the CNA clearly identifying what we will be doing that day, what we're specifically hoping to work on if the opportunity comes up and find out what their expectations are.
I'd be pulled off the floor if I didn't do that before seeing my patient.
I'm really surprised by some of the answers here. Can someone clarify for me how an RN would sign off student's meds if she didn't witness pulling and/or administering them? I don't know that I would take anyone's word for what they had given when it would be my license on the line or me on a witness stand in a malpractice suit if something went bad.
Yeah, I have a problem "signing off" on something I didn't witness. I can go back and reassess and sign off on that, but don't know exactly what medication went where unless you see it happen.
Even with the electronic systems, there is still no guarantee that the patient actually got the medication, just that med and the bracelet were scanned.
NightOwl0624
536 Posts
Just to clarify - these were second year ADN students ready to graduate soon (a week? a month?). I knew that. These students got to the floor earlier than I started my shift at 7pm, so they had already done a med pass and assessments. Because all three students acted the same way, I believe it was most likely the way they had been doing things before I got there and no one had a problem with it.
I was told that I would be checking off their meds and documentation. I understood that to mean I would be looking at the medication BEFORE it was administered and checking it off on the MAR along with them. I realize now that I should never make that kind of assumption, and I should have clarified before starting my shift. I take responsibility for that. Like I said, I am a fairly new nurse and it never occurred to me that students would have that kind of independence. I graduated from a similar program and we were never allowed to pass meds without getting checked off. EVER. So now I know!
That being said, I still do not think I am comfortable with students, even if they are capable and confident, passing meds on my patients. If something happens, who is to blame exactly? And even if it is school policy, I should have the right to know what is going on with my patients. Just my humble opinion.