MedError/Dismissal...What2Do

jeepgirl, LPN, NP · Jun 18, 2005

...Heh, I'm a nursing student and I'm like 4weeks from graduation but unfortunately I made some critical errors including a med error this past week and I'm about to be possibly dismissed. I was told however that I have a chance to present my case and be possibly put on probation but since I never had this experience before I dont know what my chances are of getting the probation vs dismissal.
Basically what happened is that I gave a blood pressure medication when the pts BP was like 96/61 and didnt remember to inform the charge nurse about the low BP. The other thing is that I totally forgot to assess the dressing on a spinal surgery patient and still forgot to chart that, and never remembered to go back and assess this pt at the end of the shift. This happened on an extremely busy day. These where the two most recent incidents and from the way our director reacted where the most serious. Previously before though I had been written up for asking if I could use the tubing for Potassium to administer an IV antibiotic, plus not remembering if a pt of mine had bladder cancer.
Now our handbook says that for such offenses "a student may be placed on probation or a recommendation for dismissal may be made" so theres still a chance of me getting probation versus getting an all out dismissal. Our director says I should write my version of what happened and strongly present my case come Monday (6/20), but I've never been in this situation before and dont know what will go well in the ears of nursing faculty. So I basically came here for help and welcome all advise on how I should go about presenting my case, and what I should present (paperwork, essays, e.t.c). I really welcome all advise no matter how silly or unrelevant it might seem. Thanks.

Hello,

I think that when you are in there with your instructors, and in your essay, you will have to be very careful about what you say. Be careful not to point any fingers at anyone... I would just focus on yourself. I would make sure to explain that you now understand why your mistakes were mistakes. Write up your version of the events. In your essay, I would outline that you now know the importance of why the issues your instructors are worried about are important and why your mistakes were wrong. Give rationals... for instance: "A patient with a recent surgery must be assessed frequently because _______."

Don't foo foo away anything of their concern... that will leave a nasty taste in their mouth. Validate their feelings (theraputic communication, anyone?). I say that because if you don't, you'll turn them off pretty quick... not something you want to do, but it would be easy to do accidentally if you don't plan out what you're going to say in advance. Oh, and even though you will plan what you need to say... make sure you listen carefully to what they ask you, and let them guide the meeting. I know from personal experience that if I am nervous about a meeting and try to plan out what to say... I sometimes have a hard time listening. But that can make yourself shoot yourself in the foot! So be careful about that.

I do think that maybe one or two of those events you mentioned are just from being new / learning. But if it sets off a red flag with an instructor... I think almost anyone could have a really rough time.... especially when you have those really hectic clinical days there at the end where you are in charge for the first time being "the nurse".

I would make sure to explain your reason for wanting to enter nursing and why you wish to continue in nursing school. I think that you should also make a sort of "action plan."

For instance, if a big part of why you were so out of sorts on this clinical day is because of lack of organization, I would sit down and write out how you plan to address that problem. For instance, you might work out a rough schedule ahead of time to plan your clinical day. What about working on prioritizing? Stuff like that will help. If your charting is a problem, I would make an effort to go through and review the major priniciples of charting with an instructor. Most of the time, instructors are more than happy to sit down and one on one with their students in off class / clinical time.

Good luck! You'll do great... let us know how it went. Just keep your composure and you'll be ok... sounds like you still have a pretty good chance to stay in. Just go in there, have yourself pulled together and prepared. That will show them a lot about you and your will to complete nursing school!

brotherbear · Jun 18, 2005

Hello,
I think that when you are in there with your instructors, and in your essay, you will have to be very careful about what you say. I would make sure to explain that you now understand why your mistakes were mistakes. Write up your version of the events. In your essay, I would outline that you now know the importance of why those things are wrong. Give rationals... for instance: "A patient with a recent surgery must be assessed frequently because _______." Don't foo foo away anything of their concern... that will leave a nasty taste in their mouth. I do think that maybe one or two of those events you mentioned just from being new / learning. But if it sets off a red flag with an instructor... I think almost anyone could have a really rough time.
I would make sure to explain your reason for wanting to enter nursing and why you wish to continue in nursing school. I think that you should also make a sort of "action plan." For instance, if a big part of why you were so out of sorts on this clinical day is because of lack of organization, I would sit down and write out how you will fix that. For instance, you might work out a rough schedule ahead of time to plan your clinical day. What about working on prioritizing? Stuff like that... that will help. If your charting is a problem, I would make an effort to go through and review the major priniciples of charting with an instructor. Most of the time, instructors are more than happy to sit down and one on one with their students in off class / clinical time.
Good luck! You'll do great... let us know how it went. Just keep your composure and you'll be ok... sounds like you still have a pretty good chance to stay in. Just go in there, have yourself pulled together and prepared.... that will show them a lot about you and your will to complete nursing school!

Heh, thanks Jeepgirl for the advice. That was really nice of you. What did you mean by "Don't foo foo away anything of their concern....that will leave a nasty taste in their mouth"

jeepgirl, LPN, NP · Jun 18, 2005

Heh, thanks Jeepgirl for the advice. That was really nice of you. What did you mean by "Don't foo foo away anything of their concern....that will leave a nasty taste in their mouth"

Hello!

What I really mean by that is don't make light of anything at all that they bring up. Even if it really is something petty... just validate it and move on. Good luck!

brotherbear · Jun 18, 2005

Hello!
What I really mean by that is don't make light of anything at all that they bring up. Even if it really is something petty... just validate it and move on. Good luck!

Thanks

WriteStuff · Jun 18, 2005

Hi 50cal,

Every Nurse has made med errors - some of them serious. We are human. If a Nurse ever tells you she has "never, ever, made a med error", she/he is lying.

Whether you are a student nurse or a seasoned nurse with 50 years under your belt...the bottom line will always be: zero tolerance for medication errors. That will never change, for obvious reasons.

You are asking for advice.

1. Own it, without being patronizing and whining. Just own it. "I made a terrible error. This is why I made the error. When I realized I made an error, this is what I did immediately. This is what I could have done to prevent this particular error. This is what I can do in the future to prevent medication errors."

2. Put it all in writing.

3. Put in writing all of the negative outcomes you can think of -or find by researching....regarding your failure to inspect that dressing. Some might be this: I failed to look for - (a) abnormal swelling and/or bleeding at the site, even hemorrhaging into the spinal column, (b) abnormal presence of large amount of "clear" fluid on the dressing - which could be leaking spinal fluid, © green yellow or brown drainage with a fetid odor, indicating infection, (d) the wound has eviscerated - the staple sutures have not held, and the wound is gaping, - these are some of things a Nurse pays attention to with wounds and dressings. Every one of these requires IMMEDIATE intervention. To not inspect a dressing, especially a post-op dressing, immediately, and at regular intervals can lead to disasterous consequences. It is NOT the patient's responsibility to keep us informed.

Treating medications errors lightly, or failing to follow-thru with assessments and treatments is inexcusable. Your instructors are not looking for "excuses" from you. They are looking to see if you are taking this as serious as it is, and have the ability to do the critical thinking required around all of it. They will "size-up" your attitude toward it. Does she SEE the seriousness of this or not? Is she indifferent about it all? Is she more worried about herself than the patients involved? Then they will "size-up" your plan of action regarding both incidents. Did she take IMMEDIATE action to protect the patient, once the error was discovered?

The reason we are "licensed" in the first place is to give evidence to the general public and those we serve, that we have met the minimum standards required by our board of licensure to ensure the safety of the public.

Your instructors will put you on the "hot seat" to test your marketability in terms of the public's safety. Because this is what a Board of Nursing would do as well.

Do keep us informed. Good luck with your future in nursing.

brotherbear · Jun 18, 2005

Hi 50cal,
Every Nurse has made med errors - some of them serious. We are human. If a Nurse ever tells you she has "never, ever, made a med error", she/he is lying.
Whether you are a student nurse or a seasoned nurse with 50 years under your belt...the bottom line will always be: zero tolerance for medication errors. That will never change, for obvious reasons.
You are asking for advice.
1. Own it, without being patronizing and whining. Just own it. "I made a terrible error. This is why I made the error. When I realized I made an error, this is what I did immediately. This is what I could have done to prevent this particular error. This is what I can do in the future to prevent medication errors."
2. Put it all in writing.
3. Put in writing all of the negative outcomes you can think of -or find by researching....regarding your failure to inspect that dressing. Some might be this: I failed to look for - (a) abnormal swelling and/or bleeding at the site, even hemorrhaging into the spinal column, (b) abnormal presence of large amount of "clear" fluid on the dressing - which could be leaking spinal fluid, © green yellow or brown drainage with a fetid odor, indicating infection, (d) the wound has eviscerated - the staple sutures have not held, and the wound is gaping, - these are some of things a Nurse pays attention to with wounds and dressings. Every one of these requires IMMEDIATE intervention. To not inspect a dressing, especially a post-op dressing, immediately, and at regular intervals can lead to disasterous consequences. It is NOT the patient's responsibility to keep us informed.
Treating medications errors lightly, or failing to follow-thru with assessments and treatments is inexcusable. Your instructors are not looking for "excuses" from you. They are looking to see if you are taking this as serious as it is, and have the ability to do the critical thinking required around all of it. They will "size-up" your attitude toward it. Does she SEE the seriousness of this or not? Is she indifferent about it all? Is she more worried about herself than the patients involved? Then they will "size-up" your plan of action regarding both incidents. Did she take IMMEDIATE action to protect the patient, once the error was discovered?
The reason we are "licensed" in the first place is to give evidence to the general public and those we serve, that we have met the minimum standards required by our board of licensure to ensure the safety of the public.
Your instructors will put you on the "hot seat" to test your marketability in terms of the public's safety. Because this is what a Board of Nursing would do as well.
Do keep us informed. Good luck with your future in nursing.

Thanks for the advice. I'll copy and paste it, then save.

DAREINGTX · Jun 18, 2005

I have a couple of questions being a nursing student myself.

1. How many patients are they giving you that you could forget to assess

a post op spinal dressing??

2. What have you're instructors been teaching you that you would give

BP meds to a pt with that pressure??

brotherbear · Jun 18, 2005

I have a couple of questions being a nursing student myself.
1. How many patients are they giving you that you could forget to assess
a post op spinal dressing??
2. What have you're instructors been teaching you that you would give
BP meds to a pt with that pressure??

u wouldnt normally give it with that BP thats my point. We had 3 pts and it was very busy day

austin heart, BSN, RN · Jun 18, 2005

Why where you allowed to pass meds with out an instructor or a preceptor?

UM Review RN, ASN, RN · Jun 18, 2005

I agree with the others, but I too have a question: What were the actual consequences to those two patients?

Did anything have to be done to compensate for the patient's low BP after the meds were given?

I don't understand why you'd have a problem for asking about tubings though. You're in school to learn by asking questions, so you really shouldn't be penalized for asking. I'm always asking the Pharmacy questions like that. That's how I found out a lot of information that only Pharmacists know.

Not remembering bladder cancer is a biggie, of course, and as the others said, in all these cases, you need to be honest and "own" the responsibility because they all are errors (or in the case of the tubing, could lead to an error) that could significantly affect the patients involved.

True, we all make mistakes. Which is why students require close supervision.

Please keep us updated, ok?

grannynurse FNP · Jun 18, 2005

...Heh, I'm a nursing student and I'm like 4weeks from graduation but unfortunately I made some critical errors including a med error this past week and I'm about to be possibly dismissed. I was told however that I have a chance to present my case and be possibly put on probation but since I never had this experience before I dont know what my chances are of getting the probation vs dismissal.
Basically what happened is that I gave a blood pressure medication when the pts BP was like 96/61 and didnt remember to inform the charge nurse about the low BP. The other thing is that I totally forgot to assess the dressing on a spinal surgery patient and still forgot to chart that, and never remembered to go back and assess this pt at the end of the shift. This happened on an extremely busy day. These where the two most recent incidents and from the way our director reacted where the most serious. Previously before though I had been written up for asking if I could use the tubing for Potassium to administer an IV antibiotic, plus not remembering if a pt of mine had bladder cancer.
Now our handbook says that for such offenses "a student may be placed on probation or a recommendation for dismissal may be made" so theres still a chance of me getting probation versus getting an all out dismissal. Our director says I should write my version of what happened and strongly present my case come Monday (6/20), but I've never been in this situation before and dont know what will go well in the ears of nursing faculty. So I basically came here for help and welcome all advise on how I should go about presenting my case, and what I should present (paperwork, essays, e.t.c). I really welcome all advise no matter how silly or unrelevant it might seem. Thanks.

As a former clinical instructor, I would like to make a few observations.

1. A student that does not know the possible negative outcomes of giving medication to a patient with a pressure of 96/61 RED FLAG.

2. A student that forgets to assess a spinal dressing RED FLAG

3. A student who forgets to inform a charge nurse of a pressure of 96/61 RED FLAG.

4. A student that forgets a patient diagnosis RED FLAG.

5. A student that ask about the compatibility regarding two different drugs and not apparently looking up the information possible RED FLAG.

I am sorry but as a former clinical instructor, your alleged five incidents would make myself seriously question your safety in a clinical setting. At best, I would recommend you repeat the entire semester. At worse, dismissal.

To receive the first outcome, you need to owe up to your alleged mistakes. You need to explain your apparent failure to look up and know the drug reactions and when to administer certain drugs. You need to explain why you failed to monitor the postop patient and his dressing. You need to take responsibility for your alleged failures and I do mean take responsibility. Do not blame the business of the day or others.

I am not criticizing you but merely making observations. Similar observations that the faculty of your program are presently making. We have the responsibility to ensure that all of our students practice in a safe manner. An error or two is forgivable. Five is an indication of serious problems and presents serious safety considerations, for the instructor, other students, patients and the program.

You make take or leave my observations and recommendations, as you wish. They are presented in hopes of helping you to recognize and correct your errors.

Grannynurse :balloons: