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?
You're not overreacting. I'm a nursing student and I would NEVER do something like that. We can't do anything without clearing it with our instructor and the RN we're working with, especially when it comes to med administration. Stuff like that can get you kicked out of the program.
Wow! This is very shocking to me that this occurred. This would be an automatic failure at my school. No ifs, ands, or buts! The students would be kicked out of the program. As students we dont even have access to the pixis. Therefore we would not even be able to get a hold of medication without the nurse. That is very rude and daring of those students to do that. The school need to enforce stricter rules on passing medication.
The fastest way to get kicked out of the nursing program I am in is to pass meds without an instructor present. I wouldn't dare pass meds without my instructor. Even if you, as an RN, was right there with me, I would not be allowed to do it unless my CI was there.
First of all, WOW! As far as I know, this has not happened on my floor (& the team of nurses I work with would tell each other if this did happen). If that had happened to me, I would address this issue first with the students who are taking care of my patients - because I am taking those meds away ASAP. You do not have a license, therefore, you can not give meds without your instructor - No instructor - no meds given. Period. Secondly, I would talk with their instructor about this (I am lucky in the fact that we have the same instructors on our floors, so I have gotten to know many of them). I would also be notifying our manager as well as our director (our director is very personable and is easily contacted). This is a HUGE patient safety issue &liability issue as well. As an aside, I work in pediatrics...and this type of behavior would not be tolerated on our unit.
Good job reporting this to your supervisor. I hope things work out well...
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.
Sorry...forgot one thing... You should check with your hospital's policy regarding student nurses....at my hospital, staff nurses are required to NOT sign off on anything that student nurses do. Signing off on meds & procedures that are done by nursing students (and their instructors) needs to be documented by the student nurse and co-signed by the instructor (only!). It's good to know about what your hospital's policies are regarding to student nurses and to act within those parameters....this way you know the expectations, responsibilities and legal responsibility of all parties involved.
In our program, we are not allowed to pass any meds without our instructor in the room with us. It is their job to teach us. They all have access to the pyxis to pull the appropriate meds for us. We just have to communicate with the nurse as to what meds and interventions we will be able to perform each shift. Even now in my preceptorship for my final semester I am not allowed to pass meds without my nurse preceptor. For a student to just give meds without checking with you and without their instructor even on the floor is absolutely unacceptable. What if that person were on a BP med and their BP was too low to give it, etd? On the other hand, it sounds like some things need to be addressed more with the faculty and school. This kind of thing could be very dangerous for a patient!
I am an LPN and an RN student. While I have been working on the floor we were supervised by our instructor once and then we passed the meds on our own. Now if it was an IV push or hanging a bag our instructor was always present. She was also always present for any skills that needed to be performed.
Since all of us in our program were LPN's, which was a requirement into getting accepted into the program, I am sure this is why we were allowed to pass meds unsupervised.
My LPN course was similar, it depended on which quater we were on, whether our meds were checked or not. We did not touch IV's (except to D/C one with supervision, IV therapy is offered as a separate course.) So if your were in your last QTR and had been checked off on your med passes before you could independantly pass meds to your pt's. supervision req'd only for something you hadnt been checked off before (like maybe IM or something) Insulin ALWAYS req'd a double sign off, either from your inst. or the floor nurse.
I dont think training would be effective if you hold someone's hand every second, then the day they graduate they become independent. That wouldnt be safe. It's a ladder, a progression.
This was my experience in nursing school. As we progressed from clinical site and as well level of education less and less of what we did was required to be checked off by our instructor and/or nurse. Particularly in the area of oral med administration. We did however verify with our nurse on staff to what degree she expected us to complete our duties for the day. Additionally, we had both pre-conference and post-conference times (besides our class time) where we focused on the common drugs along with their S/E and most common ADVERSE reactions to occur. We were also instructed to not give meds we were unsure of without either contacting our instructor or nurse. This was the method in which they built our critical thinking skills, experience, and independence. Personally I thought it was great. How else would you learn the responsibilities of the nurse if you were merely doing the job of the CNA? Moreso, how else would you match head knowledge to practical knowledge?
With 3 students, all hopefully trying to get their med pass done on schedule, I really don't know how you would have been able to check all of their meds and such beforehand. I guess in the writers' case there should have been more communication between the nurse, the instructor, and the student regarding duties and expectations. Oftentimes during my clinical shifts my nurse and/or instructor were not even available to me as needed. Again, in those moments I would never do anything that I was not previously checked off to do, but the thought of sitting idly by and doing nothing didn't seem like it was a viable option when I was there to practice my nursing skills and gain valuable knowledge and experience. Hopefully, this incident at least gave you a new perspective in the responsibilties of working as a preceptor/nurse instructor.
As far as how I would have handled it, in your situation with your feelings regarding it, I would have sat down with the students in question and reviewed my expectations as well as their abilties. If need be I would also speak with the instructor to clarify what role the student's were expected to play while in their clinical and what skills they were capable of doing independently. Additionally, as I stated before I cannot even manage to understand how you (1 individual) would have so many students that were working under you. This would be an issue I would address to my charge nurse or nurse administrator. As stated before your license is on the line and as such placing you with so many students under your watch seems almost unethical albeit unsafe.
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.
Not all RN students are LPNs. Many, many RN students have gone directly into an associate's or bachelor's program in nursing intended to prepare them to take the NCLEX after graduation. Most RN programs do not require any form of nursing certification or licensure prior to entry.
What if that person were on a BP med and their BP was too low to give it, etd?
This very scenario is the process the student should be undertaking when they are getting report, talking with their nurse and/or instructor or perusing the client's chart as well as performing those routine things like taking vitals. It would be sad to me to think that there is a nursing program that is graduating students who have not already tackled this type of critical thinking and assessment skills as part of their program. The students do need to start working independently on at least these minor scenarios with the staff and/or instructor there to "alert" them to special considerations.
I wouldn't be freaking out as much as I would take this opportunity to really teach these students the need for more than a perfunctory knowledge of the hazards as well as benefits of pharmacology. Additionally this would be an excellent opportunity to have them learn that these steps (interventions) are the reason for why education (assessment) is essential. What if the patient had a low b/p, tachycardic, or was on a blood thinner, or was on insulin or whatever else scenario fits your floor that could be affected by the administration of a med? This is a classic learning opportunity. I think its important that we nurses really help the future nurses get a solid grasp of just how important and necessary our role is in maintaining and facilitating the health status of our patients.
However, as I said before based on the writer's post if this was an area that they personally felt uncomfortable with for whatever reason, by all means they should speak up for themself. Whether that be to the students, the instructor, or the nurse management team. You have a right to be heard and a right to exercise your license responsibilities, within the law, as you see fit.
I'm a student and I would never do this. For my security, my patient's safety, and to follow the rules, I have my instructor with me; only if she instructed me would I even consider passing meds with the RN. However, I'm only second semester and I am still iffy with my meds.
KattyRN
23 Posts
You're not overreacting. I'm a nursing student and I would NEVER do something like that. We can't do anything without clearing it with our instructor and the RN we're working with, especially when it comes to med administration. Stuff like that can get you kicked out of the program.