Patient safety in medication administration is an important issue in nursing. One of the RNs’ and LPNs’ fundamental responsibilities and roles is administering proper medication dosages since drugs treat most illnesses in modern medicine. Scientists note that nurses make common errors in medication administration, which may cause dramatic effects on patients’ health (Härkänen et al., 2019). Inadequate dosages and skipping medications are the most common mistakes when administering medications for children and older patients in nursing houses (Härkänen et al., 2019). Therefore nurses must follow the relevant guidelines to avoid making mistakes when administering medication. They also should understand the effects of various widespread medications like pain relievers, antimicrobial or antipsychotic drugs (“Medication administration module,” 2017).
Professional boundaries in relationships between nurse educators and student nurses is another important topic. In such types of relationships, both sides should adhere to the rules of professional conduct and act in a responsible, conscious, and ethical way (“2014 ACA Code of Ethics,” 2014). This paper aims to discuss patient safety issues concerning medication administration and the professional boundaries between the nurse educators and their students.
Role of the Nurse in Medication Administration
There is plenty of guidelines related to the nursing roles and the scope of the nursing practice. The guidelines regulating the nurse’s role in medication administration are fundamental because the proper dosages, attentiveness to the names of drugs, and a deep general understanding of the medication effects ensure patient safety and a high level of nursing services. The Texas Board of Nursing developed the guidelines that regulate this issue.
In The General Cautions, the BON reminds nurses that there are four types of drugs with significant addictive potential which should be administered with caution: opioids, benzodiazepines, barbiturates, and carisoprodol (“Practice guidelines and interpretive guidelines,” 2021). The BON emphasizes explicitly that the incidence of non-therapeutic administering of these drugs has significant public health implications.
To avoid the negative consequences when administering such drugs, the nurses should comply with Board Rule 222, relating to Advanced Practice Registered Nurses with Prescriptive Authority. The nurses who administer the pain relievers should also comply with Board Rule 228, relating to Pain Management. When administering these potentially addictive drugs, the nurses should take care of the patient’s safety and adhere to the Board rules, the rules of the Texas State Board of Pharmacy, and the US Drug Enforcement Administration (DEA) (“Practice guidelines and interpretive guidelines,” 2021).
The administration of these strong pain relievers also requires compliance with the Texas Health and Safety Code, §481.0762 (a). Noteworthy, the Texas Health and Safety Code, §481.0762, requires that agencies that have a license to prescribe these drugs should create guidelines for the safe administration of opioids, benzodiazepines, barbiturates, and carisoprodol. Additional considerations include compliance with the Texas prescription monitoring program (PMP), and the nurses should check the Texas PMP, before administering the controlled substances.
Texas Health and Human Services Commission, an agency within the Texas Health and Human Services System, developed the general guidelines that present the nurse’s role in medication administration. First, the guidelines imply that the nurse should be utterly attentive to administer medications safely due to the wide variety of related dangers (“Medication administration module,” 2017). The nurses should know the routes of medication, how the particular drug affects the elderly or younger patients, and the federal regulations for specific medicines. Moreover, RN and LPN must report the medication errors and supervise the unlicensed personnel providing the medication administration.
The position statement 15.252 of the Texas Board of Nursing (BON) requires that the nurses are expected to know the common medical diagnoses and the drug therapies related to them, as well as other related medicines. The nurses also should ensure safety and “monitor, document, and report responses to medications, treatments, and procedures,” including when composing tasks for other health care workers (“Medication administration module,” 2017, p. 5).
It is essential that the nurse knows the rationale for the effects of medications and treatments and performs a correct administration, as required by the Texas Administrative Code (TAC), Title 22, Part 11, Chapter 217, Rule §217.11 Standards of Nursing Practice 3. According to the document, the RN and LPN should “accurately and completely report and document the administration of medications and treatments” (“Medication administration module,” 2017, p. 6). They also have to clarify the order of treatment regimen they find inaccurate by communicating with the appropriately licensed practitioners.
The legally authorized practitioners like physicians, podiatrists, dentists, and others usually order the nurses to administer particular medications and treatments. However, the nurse should analyze these orders to ensure they comply with the BON requirements and the demands of the health care facility (“Medication administration module,” 2017). The professional training that all RNs and LPNs undergo when receiving their certificates includes gaining knowledge about medication administration; therefore, RN and LPN are assumed to be experts in this field.
The nurse’s role implies that they will assign tasks to unlicensed assistive personnel, including the tasks on the medication administration. RN should supervise LPN, and both RN and LPN supervise the unlicensed personnel. LPN cannot delegate tasks but can assign specific tasks to unlicensed personnel (“Medication administration module,” 2017). The LPN must elaborate and provide the unlicensed personnel with detailed instructions. In this case, the LPN must ensure that this person has adequate education, experience, and knowledge to perform the assigned task. As a rule, the LPN can assign medication administration tasks to a Certified Medication Aide (CMA).
The certified nurse ensures patient safety related to medication administration by responsibly performing their role. This role implies that the RN and LPN will supervise the Certified Medication Aide and perform the medication stewardship (“Medication administration module,” 2017). High-quality medication stewardship means that the nurses are good stewards of their resident’s medications in general and in three particular fields.
These are antimicrobial medication stewardship, antipsychotic medication stewardship, and pain medication stewardship, including understanding pain, assessing chronic pain, developing a care plan, and managing chronic pain starting with non-pharmacological management. In other words, the nurse ensures that the medications are administered for the right reason because sometimes medications can be given in excess or underused by patients who may forget to take the dosage. The nurse should therefore control the medication administration process to be a good medication steward for patients.
Professional Boundaries between a Nursing Educator and a Student Nurse
One of the roles of the RN is educating the student nurses and developing the educational plans. Therefore, RNs and student nurses often work together in close contact and should respect the professional boundaries. According to the 2014 ACA Code of Ethics approved by the ACA Governing Council, there are particular roles and relationships between counselor educators and nursing students (“2014 ACA Code of Ethics,” 2014). The nursing educators and the student nurses should abide by the rules implied by these roles to respect the professional boundaries.
Firstly, there is a prohibition for sexual and romantic relationships between nursing educators and nursing students since such relationships can impede their professional roles. Sexual harassment is forbidden as well; counselor educators should also discuss the possible risks when engaging in personal, romantic, or sexual relationships with the former students (“2014 ACA Code of Ethics,” 2014). Professional nurses should avoid any nonacademic relationships with the student nurses; the nurses do not accept any forms of fees, services, or reimbursements. There may be some formal professional relations between the nurses and student nurses, like “attending a formal ceremony; conducting hospital visits; providing support during a stressful event; or maintaining mutual membership in a professional association, organization, or community “( “2014 ACA Code of Ethics,” 2014, p. 15). But in this case, the nurse and the student should also discuss the potential risks.
Thus, the critical issues of patient safety related to medication administration and the professional boundaries between the nursing educators and their students were discussed. The professional nurse should comply with many practice acts, regulations, and guidelines related to medication administration. It is also vital for the nurse to be attentive when administering the medications that the drug addicts can use. Certified nurses who provide education for student nurses should respect the professional boundaries, avoid personal relationships with their students, and do not harm them in any form, including the demands for money reimbursements and sexual harassment.
References
2014 ACA Code of Ethics. (2014). Web.
Härkänen, M., Vehviläinen-Julkunen, K., Murrells, T., Rafferty, A. M., & Franklin, B. D. (2019). Medication administration errors and mortality: Incidents reported in England and Wales between 2007 ̶ 2016. Research in Social and Administrative Pharmacy, 15(7), 858-863.
Medication administration module. (2017). Web.
Practice guidelines and interpretive guidelines. (2021). Web.