Author Beware: Medical Students

I've blogged here a lot about the trouble many authors have with scope of practice issues. Scope of practice is what the licensing board says you can and can't do to a patient. Every licensed healthcare professional has a defined scope of practice. For nurses, it is managed by their State Board of Nursing. For doctors, it is the Board of Healing Arts.

You can find other posts I did about scope of practice here, here and here.

I recently came across a novel written by a doctor that had an interesting medical scenario. In short, a medical student was running amok killing patients by overdosing them on potassium. Below are a few highlighted portions from the novel. I'm using asterisks instead of characters names to further disguise the story to protect the author.

This portion is written from the medical student's (the killer's) POV:

I was helping them (nurses) with their work. I've fixed IV pumps, drawn blood, placed catheters, even changed bedpans. It's got me into their good graces, and a lot of them now pretty much trust me with anything. Like giving medications. 

They'd pull the IV bag from the electronic medication dispenser, log it into the system, hand it to me, and go back to doing the twenty other things they were trying to do at the same time. They never gave me or my poor little bag of potassium a second thought. 

And why not? They'd seen me give IV medications to patients hundreds of times. Not one of the-- not a single one-- even bothered to check to see if the patient actually needed potassium, much less confirm that I'd actually given it."

Honestly, it's hard to know where to start with the medical inaccuracies this small piece of fiction highlights.

1. A medical student is not licensed healthcare provider. Therefore, they practice under someone else's license. They are managed by their attending physician or resident. They are not monitored by nursing. A nurse is not going to let a medical student do these things to her patient. The most a medical student does is obtain a patient history, do a physical exam, and observe procedures by other physicians. If this author had made the medical student a resident-- the scenario would be a little more plausible.

2. Every nurse is not that stupid. Sure, one nurse allowing a medical student to give her potassium I could believe. But, as in the novel, up to fifty? Remember, the nurse is likely more liable than the medical student under this circumstance. These nurses would all be fired. Nurses are not that blase about their licenses. Without one, even a license with a minor mark, and that nurse will not be working in nursing ever again. Medical students are learning. A nurse's job is to protect her patient. We don't trust medical students to be competent in what they're doing for that reason alone.

3. The author also misses another layer of protection. Medical dispensing machines are another layer of protection. Hospital medications are approved for dispensing by the hospital pharmacist. So, a pharmacist can look up a patient's lab results and check whether or not they need the potassium as well. All these medication orders on patients that don't need potassium is going to raise some serious alarms. Can you override the medication dispensing system? Yes, but you better have a good reason. Many hospitals have removed concentrated forms of IV potassium because an error could be so potentially deadly to the patient. Also, patients who receive a bolus dose of IV potassium need to be placed on an ECG tracing (or continuous heart monitoring.) In this instance, they are generally in the ICU or on telemetry and not a basic med/surg unit.

The scenario could be plausible if written another way. Overall, the author needed a seasoned ICU nurse to review the manuscript.