Some NHS trusts are wrongly allowing student nurses on extended clinical placements to carry out unsupervised medication rounds, a leading student representative has revealed.
More than 25,000 students opted to carry out paid extended clinical placements which were designed by the Nursing and Midwifery Council to support the coronavirus response.
“We are being remunerated at Band 4, but that doesn’t mean we are Band 4”
But concerns have been raised that because those in their final six months of study are being remunerated at Band 4, they are being expected to work like a qualified nurse at this level, rather than students.
Royal College of Nursing student committee chair Jessica Sainsbury told Nursing Times that she had heard from several students who were being asked to carry out drugs rounds without supervision.
“There are some trusts who are basically saying to students ‘you’re being paid at Band 4 and Band 4s in this trust, if they are competent, can do certain or all meds unsupervised, we’ll sign you off as competent, put you through the competency and then you can do it’,” Ms Sainsbury explained.
“So, the students are like ‘well actually, in a couple of months’ times I’ll be doing it anyway so why not?’. But that’s not within our scope of practice as students.”
Students had contacted the committee directly over the issue and via its closed Facebook group, she noted.
There had been a number of discussions between students in the group around what different approaches trusts had taken over drug rounds.
The fact student nurses on extended placements were no longer supernumerary was being used by some to justify them carrying out additional duties, but Ms Sainsbury said she did not believe this to be a strong counter argument.
“It just got to the point where there were so many different people saying ‘my trust says it’s fine’,” noted Ms Sainsbury.
The student nursing lead wanted to raise awareness of the issue and put a stop to it.
“The reason we are being paid is so that we are protected for if stuff goes wrong, things like death in service, and it is a pandemic and we are putting ourselves at more risk than we usually would – that is why we’re being paid, it’s not to make us do meds rounds,” added Ms Sainsbury.
Although carrying out medication rounds was a standard part of placement for final year student nurses, they should be done under direct or indrect supervision, she stressed.
“Of course, as final year students we do get to do, under direct, or indirect supervision, more meds rounds and we are practically doing it ourselves, but that is different in comparison to being signed off on a meds competency and doing your meds rounds on your own and that is what is happening in some places which is really concerning,” she said.
“Any care activities they do undertake should be with supervision”
“I don’t want to be all doom and gloom, but I’m looking at it in a sense of what if something goes wrong and how protected are those students really at the end of it?”
Students on extended placement were experiencing “conflict” over whether they should be following the advice of universities or their employer, she noted.
“Once you’re on a placement that is kind of your bubble and your world and now that we’re employed as well, although we are still students, I think some students have that kind of conflict – ‘do you do what your university says or do you do what your employer says?’,” said Ms Sainsbury.
“If your employer is saying, ‘no, it’s absolutely fine, if we think you’re competent to do meds unsupervised, you can do meds unsupervised’, what are you going to do?”
In a statement issued to Nursing Times, the NMC clarified that any care activities undertaken by students “should be with supervision, including the administration of drugs” and that students should not carry out any other activities that would not normally be part of their nursing course.
Moving forwards, Ms Sainsbury has been in discussion with the NMC to update its website under its ‘frequently asked questions’ section to further clarify its position for students on extended placements.
“I said to them as long it is in black and white from the NMC…then that will be something that students can wave in their practice facilitators face and say ‘look, I’m not meant to be doing meds’,” she said.
Commenting on the issue, Dr Geraldine Walters director of professional practice for the NMC, said: “As our emergency standards set out, students on extended placements should not be undertaking any activities that would not normally be a part of their course.
“Any care activities they do undertake should be with supervision, including the administration of drugs.”
Dr Walters encouraged students to first raise concerns with their university and assured they could also get in touch with the NMC to ensure its standards and requirements were being met.