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 CT stepdown, hospice, psych, ortho.
CuriousMe, yes thats how it was when I was in school. We didn't do anything or go anywhere without telling the assigned RN and the instructor what was going on. I'm sure they were sick of me reporting every tiny detail
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.
Curious Me, would you have a problem with a nurse that still asked to check off your meds before you gave them even though your program has different expectations? I can just see some students rolling their eyes and having all kinds of nasty things to say about that nurse.
By the way, I do like working with students. Most of the time. I just have never been in this situation before.
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.
I'm curious though (the screen name name is not coincidence ), in an EMR system how would an RN "sign off" on something?
Curious Me, would you have a problem with a nurse that still asked to check off your meds before you gave them even though your program has different expectations? I can just see some students rolling their eyes and having all kinds of nasty things to say about that nurse.
By the way, I do like working with students. Most of the time. I just have never been in this situation before.
I have no problems with someone who wanted to check off my meds....as I said my instructor might come up beside me at any point and ask me questions about what I'm giving and why as she watches what I do. The only thing I might find frustrating, is getting with that RN while she's not busy doing something else. I hate standing around waiting.
Honestly though, no matter how annoyed/frustrated/whatever I might be.....I'd never roll my eyes at an RN that I was working with. No matter how many times they tell me otherwise, I generally feel like I'm a PIA to them as I tend to ask a lot of questions (at appropriate times of course). I appreciate their time and attention.
I have no problems with someone who wanted to check off my meds....as I said my instructor might come up beside me at any point and ask me questions about what I'm giving and why as she watches what I do. The only thing I might find frustrating, is getting with that RN while she's not busy doing something else. I hate standing around waiting.
Honestly though, no matter how annoyed/frustrated/whatever I might be.....I'd never roll my eyes at an RN that I was working with. No matter how many times they tell me otherwise, I generally feel like I'm a PIA to them as I tend to ask a lot of questions (at appropriate times of course). I appreciate their time and attention.
Thanks for the reply. I don't know how you would sign of electronically. (We are still old-fashioned with paper). I know waiting around is irritating. Actually, I remember very well how frustrating it was most of the time as a student. Just keep looking ahead to the finish line, it will be worth it!
Thanks for the reply. I don't know how you would sign of electronically. (We are still old-fashioned with paper). I know waiting around is irritating. Actually, I remember very well how frustrating it was most of the time as a student. Just keep looking ahead to the finish line, it will be worth it!
What we do at our facility, is on the EMR, when doing the final check before medication administration, there is a section that says "Co-signature - Student Use". You click it, then enter the name of the person who is co-signing your meds (your instructor or the primary RN). Then, when they log-in, a pop-up shows up on their screen that they have meds to co-sign, and they just acknowledge it and it's all set. The same thing happens automatically with our charting.
Specializes in Emergency, Critical Care (CEN, CCRN).
Thanks for the reply. I don't know how you would sign of electronically. (We are still old-fashioned with paper). I know waiting around is irritating. Actually, I remember very well how frustrating it was most of the time as a student. Just keep looking ahead to the finish line, it will be worth it!
In the one facility I rotated through where SNs were allowed to chart electronically, the notes/MAR/whatever would "pend" until your CI or staff RN clicked through and checked the "Co-Sign" tab for each care task you charted. Patients with tasks completed requiring co-signs would also pop up a different color in the co-signer's patient list.
I, too, am surprised by the amount of variation in practice.
It might behoove you to do some research. Does your hospital have a policy that addresses student med passes, and if so, what is it? What is the school's policy on this--ask for a written copy. Do these policies agree? Does your state board of nursing have a position on what they expect in terms of supervision of student med passes? Who would they hold responsible if a mistake was made and a patient harmed?
And may I just say that I hate the now-common practice of of a clinical instructor having groups of students on 3 -4 different units. The instructor drops the students off at the nurses station at the beginning of the shift and is never seen again until she picks up the students at the end of their scheduled time, essentially leaving all teaching and supervision to the staff nurses. Then asks, "How did Sally do today?" so she can write her clinical eval for the day. I do like teaching, so I don't resent the students, but there are times I'd like to say: "Here's how Sally did today. Now, can I have a cut of your paycheck since I did your job today." I know this won't change anytime soon--not enough money and not enough personnel available in the school system--but I just gotta rant!
In my program as long as we have another student double check our PO meds we can give them. Most of the facilities we go to have nurse servers that have everything in them except narcotics so we dont need to get in the PYXIS. This has been the way since the 3rd quarter of the program. As the nurse monitoring them you should let them know what you expect and want from them so that everyone is on the same page otherwise they may not know.
THIS situation is not a big deal. You (OP) failed to communicate your expectations to the students. Next time, make it clear that you expect to review the medications with the students first.
The OP failed to communicate his or her expectations of the students. Remember, these are STUDENTS. They aren't well versed in what is legal or illegal. Turn this this into a learning opportunity for BOTH.
As a student I like to upfront with what skills I can do and my limitations. I like the RN to do that same and by doing this I find that no boundaries get crossed and I get the most out of my learning experience.
cb_rn
323 Posts
CuriousMe, yes thats how it was when I was in school. We didn't do anything or go anywhere without telling the assigned RN and the instructor what was going on. I'm sure they were sick of me reporting every tiny detail