The experiences of final year nursing students in administering medications: Shifting levels of supervision

Background - Unintended medication errors made by health care professionals continue to be a major concern in hospitals, medical centres and aged care facilities throughout Australia. Nurses play a vital role in preventing errors so consequently undergraduate nursing students are taught that to administer medications safely they must adhere to specific protocols and be personally supervised by a registered nurse. While safety measures may be reinforced to students, previous studies have not explained what occurs when students actually administer medications to patients in the clinical setting. Aim - This thesis reports on a study aimed at identifying the experiences of final year undergraduate nursing students in administering medications. Research Design - A grounded theory approach using constant comparative analysis was undertaken to develop a substantive theory to explain this process. A sample of 28 final year nursing students from an Australian university provided the data to permit the development of the theory. Findings - This study identified that supervision was central to the medication administrationexperiences of students. Students were confronted with registered nurses who presented or provided them with shifting levels of supervision when administering medications to patients. Shifting levels included the registered nurse; being near, being over or being absent. The shifting levels failed to meet the supportive supervision required of students and created internal conflict for them. Students responded to the conflict through a process of Contingent Reasoning. Contingent Reasoning involved students making a decision and then actioning behaviour which could be categorized into one of three levels. At level one the student would do whatever was asked of them, at level two they would negotiate so as to come to some agreement with the registered nurse and at level three they would refuse to administer medications unless personal supervision was available. The reasoning was driven by a desire of the student to get through meaning, to pass the clinical placement. However, in an effort to get through students were willing to accept levels of supervision from registered nurses that were less than ideal. In turn this influenced medication errors as reported by students. Conclusion - In unveiling the substantive theory it became apparent that the central issue of shifting levels of supervision and students responses to this has significant implications for safe medication administration practices of undergraduate nursing students when undertaking clinical placements in health care facilities throughout Australia. Ultimately patient safety is at risk because inappropriately supervised undergraduate nursing students can make medication errors.