HSNS 206: Analyzing RN & Student Nurse Roles in Medication Error

This report analyzes a case study involving a medication error with Mrs. Melissa Mendez, a 72-year-old patient, to differentiate between the roles and responsibilities of Registered Nurses (RNs) and nursing students, particularly in medication administration. It highlights the RN's accountability for medication errors, emphasizing the importance of double-checking medications, understanding drug interactions (trimethoprim and methotrexate), and assessing patient status. The report contrasts this with the supervised role of nursing students, who are not ultimately accountable for errors under RN supervision. It identifies specific nursing practices that contributed to the error, such as a lack of critical thinking and awareness of the medication system. The report also discusses relevant guidelines and practice standards from the Nursing and Midwifery Board of Australia (NMBA), emphasizing the need for compliance to prevent medication errors. Desklib offers a platform to explore similar solved assignments and past papers for students.

Running Head: TRANSITION TO AUSTRALIAN NURSING PRACTICE
Transition to Australian nursing practice
Name of the Student
Name of the University
Author note

1TRANSITION TO AUSTRALIAN NURSING PRACTICE
Introduction
The assignment deals with the case study of Mrs Melissa Mendez are a 72- year-
old woman admitted to hospital for rheumatoid arthritis flare up. She was prescribed 20mg of
methotrexate to be taken weekly, prednisone 10mg daily, and simvastatin 40 mg at night daily
for her cholesterol. Later she was diagnosed with urinary tract infection and the medical officer
prescribed trimethoprim 200 mg twice daily for three days. A medication error occurred as a
result of drug interaction with the trimethoprim and methotrexate. The care provision was under
registered nurse. The aim of the assignment is to distinguish between the roles and
responsibilities of the Registered Nurse and the nursing student. The differentiation is made
about responsibility and accountability for administrating medication. The assignment will
identify and discuss the Registered Nursing practices that contributed to this medication error.
Lastly, it will discuss and critically analyse the guidelines and practice standards for the
Registered nurse (NMBA, 2017) in relation to the case study and relevant medication policies.
Roles and responsibilities of the Registered Nurse and nursing student
A registered nurse must prevent the harm to the patient by recognising her
responsibilities. Registered nurses are held responsible for the medication errors (Kumaran &
Carney, 2014). They must adhere to the requirements for medication. Registered nurses are
responsible for double checking the medication. Prior to the administration they must conduct
the mandatory drug tests and give to the appropriate ward (Kumaran & Carney, 2014).In regards
to medication management, the registered nurse must verbalise the information about the drug.
He/she must know the right medication, right dose, right time, right patient and right route of
administration (Cashin et al., 2016).

2TRANSITION TO AUSTRALIAN NURSING PRACTICE
On the contrary, the nursing students cannot take any care that is not within the scope of
practice. The nursing students always must ensure direct supervision from a registered nurse for
medication management. Therefore, in case of medication error, the nursing student will not be
accountable or is held responsible for adverse consequences. It is because he/she was supervised
by RN. However, the nursing student is responsible for mandatory hospital-based drug test prior
to its administration like the registered nurse (Cashin et al., 2016). Both the registered nurse and
the student nurse must ensure that they are giving the right patient, the right medication, right
dose, and at the right time through right route. The registered nurse and the student nurse are
both accountable to people in the care as well as to the nursing regulatory authority for
medication error. Both are accountable to the public and their employers for medication errors.
The RNs are accountable for their behaviours, actions and responsibilities inherent in their
profession. They both are also accountable for their actions and decisions, documentation of the
medication administered to the patients (Cashin et al., 2014).
If registered nurse delegates activities to the nursing students that are to be undertaken by
others, the RN remains accountable for the delegation decision. It means the RN is accountable
and responsible for monitoring the performance of the nursing student to prevent medication
error (Cashin et al., 2016). Prior to delegating the nursing tasks to nursing students, the RN must
conduct assessment of the risks and capabilities. The student nurse cannot delegate the RN for
any task or assess the capabilities of other nurses (Keers et al., 2013). Overall it can be concluded
that the RN is more accountable and responsible than the nurse student regards to any aspect of
care and not just medication. RN has more roles than the student nurse including team leader,
administration, unit manager duties in addition to medication administration and management
duties. Unlike the student nurse, the RN undertakes more complex care.

3TRANSITION TO AUSTRALIAN NURSING PRACTICE
Registered Nursing practices that contributed to this medication error
In the given case study, the registered nurse administered the medication prescribed by
the medical officer without recognising the drug interactions. In this case, the nurse did not seem
to have recognised the difference between the accountability and responsibility. In this case, the
registered nurse did not take adequate time for appraising the status of the Mrs Melissa Mendez
in regards to medication safety. The RN did not have the provision to administer medication
personally when the patient’s health turned unstable. Although not having that provision, the RN
should have medically assessed the patient (Nursesstaging.elcom.com.au, 2017). The RN did
not seem to have an awareness of the medication system. The case study indicated the RN
lacked awareness on promoting accuracy and safety in all aspects of medication administration,
charting and dispensing.
The RN did rely entirely on the medical practitioners. RN is member of the facility's
Medication Advisory Committee and has the right to participate in risk management (Roughead
et al., 2016). However, the RN in the case study did not participate in promoting best practice in
administering medication to Mrs Melissa Mendez. She did not engage in critical thinking or
assessing the patient condition for implementing the evidence-based practice. It was not known
to her that trimethoprim and methotrexate drug interaction was harmful to Mrs Melissa Mendez
until her condition was unstable. She appeared to have lacked awareness of various drug
interactions or adverse drug events (Nmb.nsw.gov.au, 2017). A medication review was essential
which was not demonstrated by the RN. It was the role of the registered nurse to assess and
determine the safety of administering medication as ordered by the medical officer (Parry et al.,
2015).

4TRANSITION TO AUSTRALIAN NURSING PRACTICE
Registered nurse standards for practice
As per the “Nursing-and-Midwifery-Board Australia” (NMBA) “National competency
standards for the registered nurse” (RN), he/she must demonstrate the understanding of the
primary health care principles. The RN must demonstrate the understanding of the nursing in
general. The nursing care provided by the RN should be consistent with the current nursing
standards. It must be consistent with the general practice guidelines and standards. The nursing
care must be in accordance with the guidelines, legislation and regulations. The RN must build
professional relationship with other nurses (Nursingmidwiferyboard.gov.au, 2017). The RN must
engage in professional development activities actively. He/she must collaborate with other health
care professionals to develop the nursing role within the general practice. The RN must also
demonstrate the nursing leadership in her professional practice (Anmf.org.au, 2017).
The registered nurse must integrate the nursing and the health care knowledge, attitudes
and skills to provide safe and effective nursing care. RN must be competent in undertaking the
nursing assessment and implement care plan as per the scope of practice. He/She must be able to
implement evidence-based care to avoid error in medication. The health promotion and
prevention must be relevant to the practice community. The RN must support, advocate and
empower the care users to actively participate in their health care. The RN must facilitate a
respectful, safe and inclusive environment and understand diversity in practice community. The
RN must promote health literacy and self-management by delivering evidence-based health
information. These standards will help RN to evaluate the quality and effectiveness of care
provided (Nursingmidwiferyboard.gov.au, 2017). These standards have been effective in
reducing the medication error. However, it will be more effective with the regular inspection and

5TRANSITION TO AUSTRALIAN NURSING PRACTICE
audit of compliance with these standards. Auditing will ensure that the staffs are compliant with
the standards owing to stringent actions taken for non-compliance.
As per NMBA the RN in the general practice environment must demonstrate the
proficiency in using clinical software, information technology, and decision support tools for
care delivery. Interventions must be prompted using the registers and the reminder system.
He/she must participate in research activities for quality improvement and policy making. RN
must maintain the professional and therapeutic relationship with care users (O'Brien et al., 2014).
However, not all the nurses are successful in maintaining therapeutic relationship due to lack of
awareness. Failure to build therapeutic relationship does not enhance the care. It mainly happens
due to ineffective communication skills and sensitivity to patients (Cashin et al., 2014).
The administration of medication by RN should be practised in accordance with the
Nurses and Midwives Board's policies, legislations and guidelines. The legislations are “Poisons
and Therapeutic Goods Act 1966” and “Poisons and Therapeutic Goods Regulation
2002” (Nmb.nsw.gov.au, 2017). In aged care the delegation and supervision for medication
should be followed by the RN as per the guidelines of “ Australian Nursing and Midwifery
Council,” as well as the council’s code of conduct (Nursesstaging.elcom.com.au, 2017). These
legislations have been found to help in reducing the medication error by allowing the nurses to
questions the aspects of the medication administration (Levett-Jones & Bourgeois, 2015).
Following the guidelines by RN would have eliminated the distress caused to Mrs Melissa
Mendez.

6TRANSITION TO AUSTRALIAN NURSING PRACTICE
Conclusion
The patients in the aged care take medicines, and may take more than one medicine for
different health conditions. The safe administration of medication reduces errors and maintains
the health and quality of life. Mrs Melissa Mendez is a 72- year-old woman suffered from
medication error due to drug interaction between trimethoprim and methotrexate. The
assignment presented the roles and responsibilities of the RN and compared with those of a
nursing student in regards to responsibility and accountability for administering
medication. Overall, it can be concluded that the RN is more accountable and responsible than
the nurse student regards to any aspect of care and not just medication. The assignment then
identifies and discusses the Registered Nursing practices that contributed to this medication
error. Lack of critical thinking, assessment, and awareness of medication system are the some of
the common factors contributing to the medication error. Lastly, it discussed and critically
analysed the relevant guidelines and Registered nurse standards for practice as well as
medication policies (NMBA, 2017). There are many guidelines, legislation and standards
exclusively for RN that if implemented correctly may prevent medication error. In case of Mrs
Melissa Mendez, there was lack of compliance with these standards led to medication error.

7TRANSITION TO AUSTRALIAN NURSING PRACTICE
References
Anmf.org.au. (2017). Australian Nursing and Midwifery Federation Standards funded by the
Australian Government Department of Health. Anmf.org.au. Retrieved 3 December 2017, from
https://www.anmf.org.au/documents/National_Practice_Standards_for_Nurses_in_General_Pract
ice.pdf
Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., ... & Fisher, M. (2016).
Standards for practice for registered nurses in Australia. Collegian.
Cashin, A., Stasa, H., Dunn, S. V., Pont, L., & Buckley, T. (2014). Nurse practitioner prescribing
practice in Australia: Confidence in aspects of medication management. International
journal of nursing practice, 20(1), 1-7.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Causes of medication
administration errors in hospitals: a systematic review of quantitative and qualitative
evidence. Drug safety, 36(11), 1045-1067.
Kumaran, S., & Carney, M. (2014). Role transition from student nurse to staff nurse: Facilitating
the transition period. Nurse education in practice, 14(6), 605-611.
Levett-Jones, T., & Bourgeois, S. (2015). The Clinical Placement-E-Book: An Essential Guide
for Nursing Students. Elsevier Health Sciences.
Nmb.nsw.gov.au. (2017). Administration of Medications - Nurses and Midwives
Board. Nmb.nsw.gov.au. Retrieved 3 December 2017, from
http://www.nmb.nsw.gov.au/Administration-of-Medications/default.aspx

8TRANSITION TO AUSTRALIAN NURSING PRACTICE
Nursesstaging.elcom.com.au. (2017). Delegating the Administration of Medications - Nurses and
Midwives Board. Nursesstaging.elcom.com.au. Retrieved 3 December 2017, from
http://nursesstaging.elcom.com.au/Delegating-the-Administration-of-Medications/
default.aspx
Nursingmidwiferyboard.gov.au. (2017). Nursing and Midwifery Board of Australia - Registered
nurse standards for practice. Nursingmidwiferyboard.gov.au. Retrieved 3 December
2017, from http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/
Professional-standards/registered-nurse-standards-for-practice.aspx
O'Brien, A., Giles, M., Dempsey, S., Lynne, S., McGregor, M. E., Kable, A., ... & Parker, V.
(2014). Evaluating the preceptor role for pre-registration nursing and midwifery student
clinical education. Nurse education today, 34(1), 19-24.
Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse
medication administration error: A narrative review. International journal of nursing
studies, 52(1), 403-420.
Roughead, E. E., Semple, S. J., & Rosenfeld, E. (2016). The extent of medication errors and
adverse drug reactions throughout the patient journey in acute care in
Australia. International journal of evidence-based healthcare, 14(Medication Safety
Issue: 3), 113-122.