clinical instructor problem or is it me?

[studentnurse162484]

I am in my third semester of nursing school. This incident occurred the 4th week of my medsurg clinical rotation. Up to this point, I had received all satisfactories on my clinical evaluation and no negative comments. I have always received outstanding reviews from my previous CIs.

Ok so to the problem, it was my first and only turn to pass meds this rotation. I would like to add this was my first time doing an IV flush/push or using a needless syringe in general. The patients RN pulled all the meds and my CI placed them in a black pencil holder. We went over the meds in the holder and compared them to the MAR in the hallway. MY patient had an IV med that I needed to draw up. My teacher told me to draw up the med in the hallway so I did, then I removed the needle from the syringe. I carried the black pencil holder with meds inside in one hand and the needless syringe in the other.

I lay the bag down next to the computer. (The MAR was already pulled up from before we left the room.) My CI pulls the meds out of the holder(most were PO, one was subcut, and then a NS and Heparin flush). I lay the needless syringe we had drawn up next to the meds. My teacher proclaims "What is this?!" I point to the now empty vile we used to fill it up in the hallway. she stated, "you never ever do this. this is a huge no no. YOu cannot do this..." I immediately felt awful but honestly I was unsure of what I did wrong. I almost felt that since she said "what is this" she had forgotten we drew it up in the hallway together. So I thought I should have labeled it because I remembered reading/learning in class to label syringes you draw up. That is all I thought I did wrong. Then we scan the drugs laying on the countertop in no particular order. My teacher was going so fast I wasn't really able to make sure we had scanned everything. It's like she knew what she was scanning, and didn't want to wait for me to read the drug name and make sure it was there. I honestly felt like she was doing it all and was just going to let me administer them. Then she checks the blood return and lets me admin the normal saline...she stands behind me at the computer and hands everything to me over my shoulder. We finish that procedure and she says next I would give the subcut then do the PO and she leaves the room with the bag and I complete their meds. It all felt very rushed. I left thinking what just happened?! (in regards to the IV push) The whole time she was just handing me stuff and I didn't have time to stop and think what I was really doing. I wouldn't have known if she had given me the wrong med it was happening so fast. A few hours later she walks in to the room holding the black pencil pouch and asks if the patient was on ibuprofen. I say yes. She checks the MAR and comes back and says you forgot to give this so I immediately give it. So that was my day...

Now fastforward to my clinical evaluation ticket. She gave me one S and the rest were S- which technically she can't even do its either an S or U. Her comment stated that I failed to cap or label a syringe. I forgot to give a med at the schedule time and I didn't finish charting before I left for lunch. She stated that I was halfway through my rotation and needed to step it up to meet basic requirements. I really took it personally because if we are almost done with the rotation why is she jut now saying I need to step it up. Why didn't she say anything to me previously?

I was at a loss for words. I went home and cried. I spoke with some of the other students in my clinical who had done IV meds and they said they didn't label the syringe. THey also stated they didn't usually chart the assessment until after lunch. This was the first week I hadn't completely charted my assessment before lunch. I didn't think it was a necessity to cap the syringe if I was immediately going to give it to the patient.I didn't even realize I should have done it until she wrote it in my evaluation. Being my first time doing anything with needless syringes, why didn't she walk me through the procedure slower? Why didn't she tell me in the hallway to cap it and label it as a reminder? I honestly feel like she was setting me up for failure. Why did she wait til after to reprimand me instead of reminding me while I was preparing the syringe to teach me the importance of these things. As far as the medication admin error, I didn't get to check the black bag to see if I left anything out. Witht previous CI, we would go down the MAR one by one. I didn't even pull the meds out of the bag. I believe I had a part in not noticing I did not give one med but I feel like she was also to blame and should have taken some of the responsibility. The reason she was in the room and scanning the meds with me was to make sure I gave meds in their entirety and correctly.

To make matters worse, at lunch in front of thte rest of my class, she stated that I was just not with it and my head was off today. We have one more week and this week I will have two patients. I am just terrified to ask her for any direction or questions. I hope and pray I get a helpful RN and easy patients, because I don't want to have to do a skill I hven't performed before in fear of getting unsatisfactories. I just feel like she is very inconsistent. How can we know what we shouldn't do if she doesn't walk us through it.

Honest opinions would really help. This has been bothering me all week and I just can't get it off my mind.

[NurseGirl525, ASN, RN]

You have to cap syringes. I'm first semester and that was emphasized as a part of infection control. You also needed to slow down if you weren't comfortable but by third semester you should have some of this down. In first semester we are already practicing med passes hard and heavy. Everyone has bad clinical days. You just need to move on to the next one. I hope you learned some things and can move on and do better next time. I know I learn better from my screwups. I know there are certain things I will never make the mistake of again. You are learning. It's ok.

[psu_213, BSN, RN]

It sounds like a bad situation all around. If meds have to be pulled from a pyxis or the like, you should do it. You should be the ones scanning the meds, and you should know what each pill as.

I generally like to pull up IVP meds in front of the patient--I have had patients before who have said "how do I know that is what you say it is?" when I have pulled up the med before entering the room. Plus, it reduces changes of a mix up with syringes.

Finally--don't be too upset about the S-…it has to be much better than a U.

[Conqueror+, BSN, RN]

I disagree with most of the posters. You are a STUDENT so saying this is a no no without being specific was wrong. Also, taking the pouch and then saying that you forgot the med is unfair. If she handed them to you and then took the pouch away SHE forgot to give it. How could you even double check ? I still peek in the cup to see if everything is gone. I've been a nurse for 21 years and when I give meds I am responsible but no one is interfering either. With that being said suck up the S- and move on. DO NOT make an enemy of this woman because you need her. She does NOT need you. Clinical performance is 99% subjective so...Snitching and complaining is a good way to make things harder on yourself. How would you feel if you found out later that the person you went to is actually her sis in law or bff ? Despite what anyone tells you your goals are to 1. Graduate 2. Pass boards. We all learned our true skills on the floor taking care of patients. Spending 30 minutes to give 5 meds will not help that much once you get hired. Hang in there and focus.

[Fruit Sucker]

Your CI sounds like a disorganized mess. I've had one like that, and it makes it really hard to learn. Rushing the students through things and doing it for them is not okay, these people get paid to TEACH. I would file a complaint with the school.

As for labeling the syringe, it does sound like you made a mistake, and I'm sorry to hear that it upset you so much and you received a bad grade. I would speak to your clinical coordinator and let her/him know about the situation. Just learn from your mistakes, we all make them and that's why we are in school learning. Unfortunately, it's hard to learn when you're dealing with an instructor who doesn't manage their time well and gets flustered during meds.

[KelRN215, BSN, RN]

I didn't think it was a necessity to cap the syringe if I was immediately going to give it to the patient.I didn't even realize I should have done it until she wrote it in my evaluation.

What did you learn about IV meds in your classes/skills labs? Anything that is to be administered intravenously must be kept sterile. This is critically important. Perhaps you are not used to this because it's not necessary with oral liquid suspensions or meds to be administered via GT (the gut isn't sterile, the vascular system is) but patients can get very sick very fast if bacteria is introduced into the blood stream.

As far as labeling meds goes- I consider that to be a must too. Recently, my brother was in the hospital following spinal surgery. He wouldn't listen to me about where he should have surgery and opted for a hospital I wouldn't take my cat to because he has a tiered insurance plan and his co-pay was less at this substandard institution. Well, when I went to visit him and watched the nurse administer what he said was decadron and toradol, I cringed as neither was labeled, he didn't flush with saline following the pushes, didn't scrub the hub with alcohol AND didn't change gloves after emptying the foley/before pushing the IV meds. I was this close to calling the next day and asking to speak with the nurse manager about this. The unlabeled syringes part bothered me just as much as the rest of it. Once you remove something from its original pharmacy dispensed container, it MUST be labeled.

[Everline]

Oh, do I feel for you. Your instructor sounds a lot like mine was in my third semester. (I don't honestly know how I made it through. I sometimes have bad flashbacks, lol.) She wanted us to do things fast and with confidence, regardless of whether we felt (or were) properly prepared to do them. If I were to do that rotation over again, knowing what I know now, there would have been a time I would have stopped everything, asked to speak to my instructor outside of the room and told her that I needed to slow things down for the sake of patient safety. Truth is, her complaining about me not being fast enough would have been far preferable to any complaint she could have made about me making med or patient care errors of any type. I somehow got through without getting dinged, but it was not an optimal learning experience by any means. You may find that you have to speak up for yourself, both for your own learning and for the sake of the patients.

That being said, there was something missing in your previous semesters if you didn't know to label and cap the syringe. I understand forgetting under the stress of being watched by an instructor who is pressing you. But you should have recognized what had gone wrong almost immediately. My advice to you is to learn from it and move forward in a smarter way. Review med administration of all routes again, watch youtube videos, and etc. and go forward better prepared. You can do it. Don't let this hold you back. You are a student who will make mistakes, but you can rise above them and become better.

[klone, MSN, RN]

Well, when I went to visit him and watched the nurse administer what he said was decadron and toradol, I cringed as neither was labeled, he didn't flush with saline following the pushes, didn't scrub the hub with alcohol AND didn't change gloves after emptying the foley/before pushing the IV meds. I was this close to calling the next day and asking to speak with the nurse manager about this. The unlabeled syringes part bothered me just as much as the rest of it. Once you remove something from its original pharmacy dispensed container, it MUST be labeled.

Wow. I'd have to say that not changing gloves between tasks would have bothered me a LOT more.

[SoaringOwl]

I don't understand why your CI was scanning for you, or doing anything for you. They should be there to observe you, and if there's a teaching moment, they should stop you, or tell you in the hall after. I never had a CI scan for me, or have control of meds. It was also very unprofessional of her to make a negative comment about you in front of others. She or he doesn't sound like an ideal instructor. I agree with the poster who advised you to bring in a third party to show you're trying to correct your mistakes so they don't fail you in the end.

[LadyFree28, BSN, LPN, RN]

Think positive; you had a VERY teachable moment; label and cap syringes; double check, and even CIs are human.

And remember to advocate for yourself, even in front of your CI.

Take your mistakes as they are; they hone you for a better nursing practice when you get out there into the real world.

Best wishes.