Unsupervised Medication Administration by Unlicensed Nursing Student
Penalty
Summary
The facility failed to ensure that an unlicensed nursing student (NS) was properly supervised during the administration of medications, including high-risk medications such as insulin, liquid morphine, and other controlled substances. The NS, who did not possess a nursing license, competencies, or the required certification for medication administration, was observed administering medications independently to multiple residents without direct supervision by a licensed nurse. Observations included the NS administering insulin via pen and performing blood glucose checks without oversight, while the assigned RN was not present in the immediate area. Documentation and interviews revealed that the NS administered controlled substances and other medications to residents with complex medical histories, including diagnoses such as respiratory disease, dementia, chronic pain, diabetes, and hypertension. The NS was not a trained medication aide and was unclear about the scope of tasks she was permitted to perform, lacking immediate access to competency documentation. The NS stated she typically checked with a nurse before administering insulin but did not do so during observed instances. The RN on duty confirmed she had not seen the NS's completed competencies and was not acting as the NS's preceptor at the time. Further interviews with facility staff and the nursing program director indicated confusion and lack of clarity regarding the supervision and competency requirements for the NS. The apprenticeship program guidelines required direct supervision for medication administration, but this was not followed. The NS was allowed to work on the floor and administer medications without the necessary oversight or verification of competencies, affecting several residents who received medications from the NS during this period.
Removal Plan
- Review the nurse apprenticeship program.
- Provide re-education to nurse apprentice on program expectations prior to returning to work.
- Educate all staff responsible for administering medications and/or supervising a nurse apprentice on the apprentice program and review the orientation education agenda.
- Review all resident records for medication errors.