Hello All!
If you have started or completed nursing school then you know the importance of passing medications safely and effectively. The 6 Medication Rights have been grilled into your brain since the day you were taught how to open an oral tablet package during class, and your biggest fear is giving the wrong patient the wrong medication.
Just for practice, let's all say the 6 Medication Rights together:
1. Right drug
2. Right dose
3. Right route
4. Right time
5. Right patient
6. Right documentation (Let's say it all together again: "If you didn't document it, you didn't do it").
As a nursing student you are able to shadow nurses during clinical and get the opportunity to pass real medication to real patients in order to practice the most important part of the nursing job. Giving your first SubQ injection of insulin is a big deal to most (At least, I know it was for me).
Most of the time your preceptors during clinical follow the medication passing rules correctly because they want you to see the correct way to pass meds, and they don't want to do it incorrectly themselves on accident. I personally was always paired up with nurses that were very diligent with their medication passing and always took the time to make sure I did it correctly as well.
However, I did have one instance during one rotation in which I was able to really see how it may seem so simple and easy to cut corners, but irreversible mistakes can be made.
This particular instance was during my second semester of clinical. I was paired up with a nurse that was very fast paced and had no problem delegating tasks to me. When it came time to pass medications this nurse's pace did not slow down, and he made no qualms about cutting corners in his routine.
In the medication room the nurse pulled out their list of patients in order to look them up in the system. Pulling out multiple baggies and alcohol wipe packets, he began writing numbers on each. The numbers represented the room numbers that each patient was staying in. Placing the bags off to the side the nurse began pulling medication out of the drawers patient by patient, slipping each vial or tablet into the respective clear baggies.
Now, if you have successfully passed your medication passing portion of nursing school, you will know that this is a giant first error in medication passing. In school, they teach you to go into the medication room one time per patient. Grab all of your supplies and medications for one patient, go to the patient room to administer all of their medications, then return to the med room to move down your assignment sheet until you are finished. Now, this is obviously a time consuming process but it provides simplicity and concentration. If a nurse is truly paying attention during this time the likelihood of having an error is very slim.
Silently flabbergasted and too shy to say anything to my nurse, I followed them out of the medication room and into our first patient's. The nurse had all of their room labeled, clear plastic baggies stuffed into their cargo scrub pant pockets ready to get the longest part of their shift completed.
For the first two patients the nurse did not let me administer medication. They silently whisked through the process without uttering a word to me, and barely communicating with the patient.
This is wrong because as a preceptor, they should have been open in communication with their nursing student. Also, this nurse should have explained each medication to the patient, the route that the patient was going to be receiving, and answer any possible questions the patient might have for the nurse.
With the first few patients completed and charted (at the bedside computer, as it should be done), we moved on.
Walking into the third patient's room we were greeted by waiting family members. I silently took my spot behind the nurse, ready to observe this insane process once more. The nurse logged into their system and began lining up their medications on the table in order to scan them. Across the room, the family members of the patient began attempting to communicate with the nurse - asking questions about the patient's treatment, physician rounds, and most importantly: what medications the patient was receiving in that moment. The family was clearly very involved in that particular person's plan of care and was eager to ask questions in order to stay updated - but the nurse I was with shut them down entirely. The nurse brushed their comments to the side, interrupting their sentences and stating something along the lines of "I don't have time to answer your questions, the doctor will be in here later and will be able to tell you. I am too busy this morning."
Are you covering your mouth in shock and waving your giant red flag at this absurd bedside manner yet? (I was while in the room!)
I had never seen a nurse act like this before in my whole entire life. Sure, nurses get annoyed and frustrated but I have never seen a nurse completely dismiss patient/visitor questions like this nurse did that particular day.
Moving on, it was time for the fourth patient to get their medication. In this room the nurse finally acknowledged my presence by asking "Do you know how to give injections?" But, before I even had the chance open my mouth to respond the nurse turned back to the pile of medications for that room number and said "Never mind, I'll just do it myself."
This is when the plot truly thickens.
The nurse went through the pile of medications for that room number, getting read to scan each one into the system. Suddenly, they realized that they had forgotten a medication and needed to go back to the medication room to get it. Thank goodness for computerized medication systems constantly checking health care providers on their administrations.
Imagine if the nurse never went back. If they had gotten too busy or caught up in something else on their way to the medication room. Now, everyone makes mistakes and this could certainly happen in a routine situation. But, this situation could have been completely avoided if the nurse would have taken things patient by patient instead of clumping everyone together in a rush.
The final room is the room that I had my last revelation that this nurse was not practicing safely and was probably never going to stop cutting corners.
In this room the patient was in extreme abdominal pain from their condition. The nurse had tried calling the physician for this patient several times prior to medication administration time without any answer - so getting in contact with this doctor was of extreme importance to this nurse.
The nurse finally allowed me to pull up medication into a syringe in this patient's room, but quickly ran out of the room once he heard that physician was on the unit. His parting words to me before bolting was "Give that."
Give what? I had no idea what medication this was - I had never seen it before and had no idea what it was supposed to do. I also had no access to the electronic system in order to document or look up the medication in question. Also, this was before I knew that you could unscrew the needle on a syringe and push medication through a port on an IV line - So I stared at this contraption wondering "How??"
I waited fifteen minutes for the nurse to come back, the patient laying in bed next to me moaning in complete pain and discomfort.
I explained to the patient that I did not feel comfortable administering this medication with supervision and was waiting for the nurse to return in order to receive direction.
Well, it got to the point where I had no idea when the nurse was going to return. I put the medication on the side counter so I wasn't that nursing student walking around with a full, unmarked syringe in my hand, and peaked out into the hallway. No one was there.
I walked down the hallway searching for the nurse or my clinical instructor to help me. I found neither of them so I returned to the room to continue to wait.
The nurse finally returned with the physician in tow.
The nurse asked me if I had given the medication, to which I answered that I did not. The nurse quickly shot over to my side of the bed and gave the medication, simply passing me off as a nursing student too afraid to give anything. I explained myself quietly as to not disturb the doctor who was now examining the patient, but the nurse did not pay my explanation any mind.
When the day was over and my clinical instructor called each of us one by one for evaluations and comments, I chose to speak up about my nurse's medication errors. The situation did not sit well with me at all and I knew that this was not a proper example for other nursing students to witness. I'm not sure if anything happened to that nurse, or if any of their shortcuts warranted any large medication errors (I hope not). I later learned that the whole unit did not like this nurse and did not agree with their practices.
That whole experience taught me the incredible lesson that it is so important to do things the right way - especially when it comes to passing medication. I did not see any major mishaps that day, but one was just waiting to happen at any moment. Every nurse finds small short cuts in order to make their day a little easier, but I firmly believe that when it comes to passing medications the more correct - the better.
I'm sure lots of nursing students have stories that are similar to mine, and I hope that those experiences teach you to do and be better when you are practicing yourself. Your nursing license is your nursing license. Cherish it and protect it by cherishing and protecting the lives of your patients by practicing safely. You worked so hard to earn your RN license - do not throw it away for a five minute time saver.
- Michelle
#BSNbabe
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