Nursing studies

Medicines management for nursing students: what you need to know

Do you feel daunted by this area of practice? Read expert advice on five key issues

Do you feel daunted by this area of nursing practice? Here, we draw on guidance and expert advice, plus the experience of a third-year student, to support your learning

Picture: iStock

Medication management is an essential part of nursing practice, but as a complex and wide-ranging subject, it can be a daunting one for nursing students.

From administration routes and doses and contraindications and side effects, to effective communication with patients and safe storage and disposal of medicines, there is a lot to consider.

To help break these issues down, we asked five questions fundamental to safe medication practice.

1. What are my professional and legal responsibilities in relation to medication management?

The section of the Nursing and Midwifery Council (NMC) Code on preserving safety says medicines should be administered ‘within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations’.

In addition, the NMC standards of proficiency for registered nurses list the competencies needed for medicines administration. These are evidence-based, reflect best practice and include recognising the various procedural routes for medicines to be administered, and the law, policy, regulation and guidance that underpins them.

Professionally, practitioners should be accountable for safe administration, respond to adverse or abnormal reactions, and be able to carry out accurate drug calculations and checks.

Health numeracy and safe drug calculations

The NMC standards for pre-registration nursing programmes say every programme should include a health numeracy assessment relating to nursing proficiencies, including calculating medicines, which must be passed with a score of 100%.

Safe medicate is the standard exam. ‘Students do this in the first, second and third years of their degree, and it’s across all four fields and midwifery,’ says Clare Churcher, senior lecturer in adult nursing at the University of South Wales.

‘Some see this as a maths test and another hoop to jump through, but it’s actually an essential clinical skill that students need to take very seriously.’

‘Setting a target of learning one or two drugs comprehensively was more effective than trying to learn a lot of drugs at the same time’

Fiona Fitch, third-year adult nursing student

2. What do I need to know before I administer medicine to a patient?

The six rights (Rs) of medicines administration are a helpful prompt, says the National Institute for Health and Care Excellence (NICE).

They are:

  • Right person Confirm the identity of the patient, wherever possible in person, alongside checking their name band. Remember that names can be very similar and people may share the same birthday.
  • Right medicine Double-check labels, being especially careful with drugs that have similar names to others.
  • Right route Remember some drugs can be given by multiple routes.
  • Right dose Check that the dose on the drug chart and on the medication itself match.
  • Right time For example, does the medicine need to be taken before or after food? Is the interval correct since the last dose was given?
  • Right documentation Record immediately after the drug has been given, never before, even if you are about to administer it – you may get called away and be prevented from doing so. You should also stay with your patient until you have seen them take the medication, otherwise you cannot document it as administered. ‘If it has not been recorded, you haven’t given it,’ says Ms Churcher. ‘Remember that the medicines chart is actually a legal document.’
Confirming the patient’s identity – the first of the ‘six rights’ Picture: iStock

Some organisations also refer to the rights of the patient, specifically the right to decline, and the right reason – whether the medication is appropriate for the patient.

‘I would also add the right response,’ says Ms Churcher. ‘Is the patient responding to the medication in the way you’d expect? For example, if they are taking pain medication, is it doing the job? If not, you may need to think about having the prescription reviewed.’

Knowledge of drugs’ therapeutic effects, dose levels and adverse effects is essential

For Ms Churcher, the Royal Pharmaceutical Society’s Professional Guidance on the Administration of Medicines in Healthcare Settings, published in 2019 and applicable across the UK, is a key document. ‘As nurses, we are guided by this,’ she says.

Nursing students should understand as much as possible about the medication they are administering, advises Ms Churcher. ‘If they don’t know enough about it, they shouldn’t be administering it. They need to know about its therapeutic use, why the patient has been prescribed it, what a normal dose is and any adverse effects. If they have any concerns, they should be discussing them with the prescriber.’

Third-year adult nursing student Fiona Fitch says recalling drug names and remembering their therapeutic effects is among the most challenging aspect of medicines management.

‘Try as I would to learn a bulk load all at once, it didn’t ever seem to sink in,’ she says. ‘Setting a target of learning one or two drugs comprehensively was more effective than trying to learn a lot of drugs at the same time.’

3. What should I do if I make or witness a medication error?

If you have made a mistake, be honest and report it as soon as you recognise what’s happened,’ says Louise Terry, associate professor and reader in law and ethics at London South Bank University. ‘Covering up is not acceptable.’

While there may be a fear of punishment, patient safety must always come first, she advises, with any errors – whether your own or someone else’s – reported immediately to your practice supervisor.

RCNi Learning module: Reducing medication errors

‘The reality is that sooner or later, even if no harm was done, things come to light,’ says Dr Terry, who is also a fitness to practise investigator at the university. ‘It goes to the heart of your integrity.’

The likelihood is that if you do everything you can to alert others as quickly as possible, you won’t be penalised, she says. ‘It will be recognised that you are a student and are learning and you did everything you could once you realised,’ she says.

Reflection and support following a medications error

Reflecting on the reasons why the mistake happened is important, Ms Churcher believes, with possibilities including error, miscalculation or ignorance. ‘Students may be asked to write a reflection, looking at what happened and what they would do if something similar happened in the future,’ she says.

For the small number of students involved in medication errors, sources of support include your personal tutor, and university counselling or chaplaincy services. Individual placement providers may also offer support.

‘Students must take responsibility for what they are doing. If you’ve not done something before, you need to say that’

Louise Terry, reader in law and ethics, London South Bank University

4. What should I do if a patient declines their medication?

When patients refuse medication, it needs to be recorded. ‘You should also ask why,’ advises Ms Churcher. In some cases, there may be a perfectly valid reason, such as a painkiller prescribed when the person isn’t experiencing any pain, or they know they have an allergy to the prescribed drug.

Mental capacity

But a key question, she says, is whether or not the patient has the mental capacity to make that decision, for example if they have advanced dementia or a mental illness that impairs their ability to understand the consequences of refusing medication. The student should discuss the situation with their practice supervisor or practice assessor on the day, Ms Churcher suggests.

Communication with patients is central, says Dr Terry. ‘They know what medication they are on, the time frame of when they should have it and whether they need to take it with food.’

Picture: iStock

5. What should I do if I am asked to do something I feel is outside my competence?

Nursing students should never do a drug round alone, but always supervised by a registered nurse, says Ms Churcher. ‘For students who are unsure about what they can and cannot do – if they’ve been told they cannot do something on one placement, why might it suddenly be okay on another? – there are lots of people they can check with, including practice supervisors and link lecturers.’

Staying within boundaries of student competence

Students also working as healthcare assistants when not studying can sometimes think they are acting in the best interests of their patient, when they step outside the boundaries of their student role, says Dr Terry.

‘I always remind them that they must be aware of which hat they’re wearing,’ she says. For instance, as a healthcare assistant someone may have achieved the competencies to be able to replace a catheter, but as a student, they cannot do that procedure until they have been formally trained.

At the outset, the objectives of the placement should be identified and agreed between the student and their practice supervisor, says Dr Terry.

‘Students must take responsibility for what they are doing. If you’ve not done something before, you need to say that. Those in practice won’t know exactly what you’ve done and not done, so you must speak up, asking what you need to know and learn to be able to do it safely. That’s your accountability as a future healthcare professional.’

Top tips from a nursing student

Fiona Fitch

Third-year adult nursing student Fiona Fitch, who is studying at the University of Suffolk, says:

  • Go out of your comfort zone Pull yourself away from doing tasks you know how to do and grab all the opportunities for learning that you can. I found doing the drug round challenging at first, and the fear of being asked questions I didn’t know the answer to was difficult
  • If you’re feeling overwhelmed, tell your colleagues Mine have been really supportive and patient with me during drug administration. Had I been put under more pressure, it would have added to my stress, which is not conducive to learning
  • Repetition and continuing practice improves your knowledge As drugs appear that you haven’t heard of before, you can learn them one by one. This is a more sensible and productive approach than trying learn too many at once
  • If you don’t know something, say so Then put a plan in place to improve your knowledge. Being a nursing student regularly teaches me how much I don’t know – and how much I didn’t even know that I don’t know
  • All nurses were students once It can feel intimidating thinking about how much others know and you don’t, but there are gaps in all our knowledge. Nurses with decades of experience still come across drugs they don’t know and have to look them up. Everyone is always learning

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