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 Emergency, Critical Care (CEN, CCRN).
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.
We had a very simple rationale for that: it's illegal unless that class's Faculty of Record (not the clinical instructor) put it in writing. Any student's deviation from the standards of practice set forth in the FOR's course documents could be punished by a written action, a semester failure or a dismissal (usually a semester failure, though we had a few students dismissed from the university).
The point is that the OP shouldn't have to explain to the SNs on her floor why you don't pass meds without a co-signature. That should be expected from the very first day of class. A student nurse is not licensed, certified or otherwise approved to pass medications, except as witnessed by his/her registered nurse clinical instructor, who guarantees the student nurse's work and allows the student nurse to practice under his/her license. Period, end of story. If the SNs in this program don't get that, then they don't need to be in a patient care environment. I'm sorry if I sound like a hard-nose, but that's it in black and white.
We had a very simple rationale for that: it's illegal unless that class's Faculty of Record (not the clinical instructor) put it in writing. Any student's deviation from the standards of practice set forth in the FOR's course documents could be punished by a written action, a semester failure or a dismissal (usually a semester failure, though we had a few students dismissed from the university).
The point is that the OP shouldn't have to explain to the SNs on her floor why you don't pass meds without a co-signature. That should be expected from the very first day of class. A student nurse is not licensed, certified or otherwise approved to pass medications, except as witnessed by his/her registered nurse clinical instructor, who guarantees the student nurse's work and allows the student nurse to practice under his/her license. Period, end of story. If the SNs in this program don't get that, then they don't need to be in a patient care environment. I'm sorry if I sound like a hard-nose, but that's it in black and white.
That does make sense, as what we could pass when alone and what we needed to get the RN/clinical instructor for was outlined in our course syllabus each term. There was no ambiguity, we all knew what we were allowed to do, and when we needed to go and get someone.
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.
Me either. I would never cosign something that I did not witness myself. Legally you shouldn't be cosigning something if you did not witness it. Isn't that what cosigning means?
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.
Thanks for your insight. As the RN responsible for patients, it is up to me to communicate my expectations. I have less than 1 years experience, so I'm not well versed in interacting with students in an RN position. I have learned a valuable lesson.
However, when I was told that I would be co-signing their medication pass with them, I ASSUMED that I would be seeing what they were doing before I signed. I see now that I ASSUMED wrong. I do not sign my name to anything that I do not see, read or witness, ever, in work or in private life.
My shift started in the middle of their shift. One of the students was actually at lunch, so I did not even have the chance to meet with her and "communicate my expectations". I didn't even kinow what she looked like.
Maybe it's not a big deal to you, and maybe you think I overreacted in thinking it was a big deal. But from the 7 pages of responses I have received, it looks like a lot of people DO think it's a big deal.
However, I plan to use this as a learning experience and go from there. From now on, I will find out in very specific terms what students will be doing and what is expected of me.
Whoa!! How were they able to manage this? How did they get it out of the pyxis? This is a no-no at my school and I know this would be grounds for some serious trouble if it happened at my school because we are not allowed to give medications without knowing it, why it's given and expected side effects and it must be checked with the primary nurse for the patient(s) you're caring for. I must say that after the first semester, we didn't get to have instructors on the floor hovering over us but it was important for us to check with the registered nurse before giving any medication. Even now, as I did my practicum I would always go over the medication with my preceptor and whip out my drug book if I was not sure of what I was giving.
The students need to be reported because they behaved carelessly, they may not have caused anyone harm but they could have.
It is the clicial instructors responsibility and not the RN's. I had an instructor like this who would always leave the floor and expect the already busy nurses to pass meds with the students. Let me tell you this did not go over with the RN's well at all.
When I have students on my floor the instructors always pass meds with them. I personally would not like that particular responsibility.
In my program, the instructor was given her own pixis account, and checked all the meds with us for at least a few med passes - then we could do it with the assigned nurse. Never alone.
Our instructor had to be present EVERY time we dispensed meds. From the time we walked into the pyxis room we would pull the meds and the instructor was in the room and verified what we pulled. Then we would go to the patients room and the instructor would ask us what allergic signs and reactions this med caused, what contraindications this med had, etc, etc. Then we would give the med with the instructor in the room. We kept a cell phone on us at all times so that way if we needed to give a med we HAD to call her before hand so she could be with us. We couldn't even give the med with the assigned nurse only being there the instructor ALWAYS had to be there.
What school are these nursing students going to? They do realize that they are messing with peoples licenses if they foul up by giving the wrong med or even if it is the right med you still need to know precautions about the patient.
Were these students RN or LPN students??? That would definitely make a difference.I am instructor for both RN and LPN. RN students are already LPN's and can give all po meds without a instructor or another nurse checking them. LPN students must have all meds checked by me the instructor. RN students must have all IV, IM, and SQ meds checked before they can give them.
I am currently a student and I would NEVER do this!! While I might not do meds with my instructor, I might do them with the staff RN who was assigned to my patient. By taking this on themselves, these students are not only putting the patient in danger (most important) but they are also putting the licenses of both their instructor and the staff nurse at risk. Their actions are selfish and irresponsible and a minor error on their part could have major ramifications! Course failure for them would be a gift.
I am a student. I would never, never, never do this. I am not licensed to do this. The RN/BSN on the floor must verify and okay all. It is under their license that this is done. How sad that the instructor did not teach this to the students. I would have no problem with the nurse on the floor stating what they expect of the students. Go ahead, please tell me. I'm here to learn.
My and my class mates keep our nurses informed even if our patients don't have any abnormals to report. Some have even taken to showing their primary RNs their documentation. I have only done it a couple of times when there were abnormals to report in my progress note.
murphyle, BSN, RN
279 Posts
We had a very simple rationale for that: it's illegal unless that class's Faculty of Record (not the clinical instructor) put it in writing. Any student's deviation from the standards of practice set forth in the FOR's course documents could be punished by a written action, a semester failure or a dismissal (usually a semester failure, though we had a few students dismissed from the university).
The point is that the OP shouldn't have to explain to the SNs on her floor why you don't pass meds without a co-signature. That should be expected from the very first day of class. A student nurse is not licensed, certified or otherwise approved to pass medications, except as witnessed by his/her registered nurse clinical instructor, who guarantees the student nurse's work and allows the student nurse to practice under his/her license. Period, end of story. If the SNs in this program don't get that, then they don't need to be in a patient care environment. I'm sorry if I sound like a hard-nose, but that's it in black and white.