I flunked out of clinical today..

[Student2001]

I`m devastated.. This was my last semester.. 3 weeks away from graduation. What happened is I didn`t have my watch for clinical and that was a break in dress code.. and when I went to take a vital sign i was confronted with the problem that there was no clock anywhere around and I had no watch.. I went and took out my cell phone and used the timer to get the exact 30 second count. I had my back to the door at that point because i wasnt really sure my instructor wanted to see my phone out .. I couldn't feel the radial pulse so well.. I was nervous and recorded the wrong number. I handed them my vitals and it was way off.. the HR.. I looked at it and thought to myself that`s not right .. my instructor said go do it over again .. I did with another student and had a number that was way different but I used the apical pulse which I could hear much better. Now I get sent to the office and told that I falsified medical records to try to cover up my mistake of not having a watch. I am kicked out of the program .. my instructor said that she did not see my cell phone and that she was watching me the whole time.. that i was facing her and looking at the door to see if there was clock hanging.. This did not happen. I don`t know how I can prove it. Its basically my word against hers and i`m like devastated.. She keeps saying that my story changed.. that the second time i got the HR i got 117 and then told someone else it was 170.. which was completely false I even wrote down 170, with another student watching me right there (its a child, that`s why so high), and I`m not entirely sure why she would be so insistent to say this.. I was like flabbergasted at all of this.. shell shocked and maybe I didn`t express myself properly but I didn`t change my story .. I might have misspoke .. i mean hell when she took me to the waiting room to talk to me about this and I told her I listened to the HR for 30 MINUTES.. when obviously I meant seconds.. I`m just very upset right now.. 3 years of my life and it ends like THIS!!? Now I don`t know if i will ever go back into the program .. I need to write a letter in my defense for when the teachers have their meeting about this where they decide whether to take me back for next semester.. or any semester. It`s devastating.. I`m taking 1 day off to clear my mind and then start writing this tomorrow.. anyone have any idea what I can write.. I don`t know if theres anything I can do to get them to change their minds. This is so awful

[Student2001]

I'm a bit befuddled as to how this one violation was grounds for dismissal. Doesn't your program have some sort of warning process? Or have you had warnings for other things, and this was a "last strike" sort of deal? If that's the case, then I'm sorry to say but you're probably out of options If there isn't a warning system in place, and this is truly the first infraction you've had in an otherwise great clinical performance, then I think you would be able to appeal the decision with the Dean and if you explain yourself well you have a decent chance of readmission. Good luck, in any case!!

I have not had any strikes this semester.. I had a few "not mets" for writing my anecdote improperly and needing to re-do it but no serious write-ups. No warning.. just got call from administrator.. called into office to talk about "grave concerns about clinical performance" .. I honestly never even thought that something so simple as a watch could do so much damage BUT from the way the clinical instructor was talking she made it seem like a question of character/integrity.. that I falsified vital signs to cover up not having a watch.. i was shown in the worst light possible and I was so unprepared for it I just kind of stumbled though, got all tongue tied and cried. I don`t know how i`m supposed to prove I am honest and have integrity .. cuz the instructor is INSISTING that i`m lying and should just say the truth.. i`m like almost thinking of just agreeing to whatever she says just because I don`t know what else to do.. dean is on her side because she has a clear story.. her point of view is clear and when i am telling them what happened she stops me and says that is not true. how am i supposed to handle that. ugh. such a mess.

[ADN2B]

Why didn't you use the timer on the thermometer?

[Sunnyrah]

Oh my word, that is terrible! My dad is a doctor and he says he has a lot of respect for nurses but that he and a lot of doctors think that nurses have "sticks up their you-know-whats" when it comes to rules and that's one reason some docs don't respect nurses as much. I didn't really understand what he was talking about but I'm pretty sure this would be an example of it! I'm a senior in a program with an excellent reputation and we do not have uniform inspections, or at least I have never been checked for my watch, etc. I frequently forget mine! And we are allowed to have phones on the floor, for the most part it's actually EXPECTED because they provide us with a nursing software program with meds, injection sites, lab results etc. to be downloaded to our iPods or smartphones to use in the clinical setting.

I agree with those who are advocating honesty. Reheorifice what you would like to say until you can get all the through it calmly a few times. Write it down if you have to. Your clinical instructor's behavior sounds ridiculous. I would request a private meeting with the dean in this matter, or at the very least ask that the dean attend this disciplinary meeting. If she continues to interrupt you in front of the panel, I would say simply in as neutral a tone as possible something like "May I please be allowed/I would like to finish my statement without interruption?" I would hope that if she berates you like that in public, that some of the faculty on the panel would see how you could be too scared to admit that you forgot your watch!

[Student2001]

I can`t meet with anyone anymore. The nursing administrator said she got my point of view.. but I still got a very strong impression that I wasn`t the one who she believed.. it`s up to the review board and when they meet. I`m not sure what I can do other then concentrate on my letter.. God.. if I can`t get back into this program my life is seriously going to be screwed up.. this is such a disappointing change.. no clinical.. no studying anymore.. I was just getting ready to study for a test on monday and I won`t be able to anymore .. ive never been so utterly desperate to just be able to take my test but now I won`t get that chance. I`m praying for this tonight.. and i`m not the praying type. I need all the luck i can get

[violetgirl]

I'll pray too.

God, grant them the wisdom to know the difference, and let student 2001 continue in her studies.

Hear our prayer.

Amen.

[Student2001]

Thank you!!!

[Wrench Party]

This doesn't make any sense. I have never been in a hospital room without a clock, and if we are testing off on skills,

we are allowed to pause and backtrack if we forgot something important, state as such and have not started the procedure yet

(i.e. forgot alcohol swabs for giving a shot, for example).

On pediatric patients, I've seen the floor nurses regularly not trust one pulse, and take another for comparison. Children are hard to count on accurately because of their squirming and noise. I've also seen them repeat temps and RR as well.

Something else is up?

[Wise Woman RN]

Bless your heart.. that is so tough to hear.. Nursing school is hard. As far as watches go, when I started nursing school 22 years ago, I was so afraid of that very thing, I bought a water-resistant timex, and NEVER took it off.. seriously.. in case I had to check someone's pulse at the shopping center, or something.. LOL even now, I have my watch on at all times.. it's an addiction.. LOL Back then, we had such a strict schedule, that we were all looking at our watches and checking our calendars and schedules, and panicking if there were even a chance that we would be late, because that was a very serious infraction.. I am hoping that things work out for you, and will send good thoughts. Also, I agree with the others, always own up to your mistakes.. but be true to yourself.

Best,

Wise Woman RN

[jadelpn, LPN, EMT-B]

I have not had any strikes this semester.. I had a few "not mets" for writing my anecdote improperly and needing to re-do it but no serious write-ups. No warning.. just got call from administrator.. called into office to talk about "grave concerns about clinical performance" .. I honestly never even thought that something so simple as a watch could do so much damage BUT from the way the clinical instructor was talking she made it seem like a question of character/integrity.. that I falsified vital signs to cover up not having a watch.. i was shown in the worst light possible and I was so unprepared for it I just kind of stumbled though, got all tongue tied and cried. I don`t know how i`m supposed to prove I am honest and have integrity .. cuz the instructor is INSISTING that i`m lying and should just say the truth.. i`m like almost thinking of just agreeing to whatever she says just because I don`t know what else to do.. dean is on her side because she has a clear story.. her point of view is clear and when i am telling them what happened she stops me and says that is not true. how am i supposed to handle that. ugh. such a mess.

First off, do NOT admit to something that you did NOT do. That could affect you for the rest of your life.

Now what? You can dispute this? You have to reappply for clinicals? You have to redo the semester? I would get out my notebook and think about a cover letter. Of all the things that the pp have suggested. Provide some character references. Perhaps from some of your classroom instructors. Were there any other nurses who you perhaps worked in clinical with who you clicked with? That the nurse praised you and your skills? Ask if that nurse would be willing to write a letter on your behalf to add to your packet. Once you have all of the information to support you, make an appointment with the administrator. See if the school guidance counselor can facilitate the meeting. I would also be honest that this is the first you have been told/learned of "grave concerns" in your clinical performance. (and quite frankly, that is on your clinical instructor for not pointing any grave concerns out to you prior to this...just my own thoughts, don't say this!!). The school has your transcript, and has on file that you have passed successfully up until this incident. The pulse rate is just ONE thing that is looked at, did you get the other vital's correctly? Do you have a job where your boss can attest to your integrity and character? And I would top it all off with "I was unprepared for the initial set of inquisitions. Should my intergrity been questioned, I am shocked that it took until 3 weeks prior to graduation for this to come to light. I am not a liar. To suggest so on hear-say is inappropriate, and equally as shocking. I made an error, and I readily admit that I did. With time and experience, my reaction would be more controlled to being reprimanded and demeaned in such a fashion". At this point, to stand up for yourself is the only way to go. Bring written proof of your character and integrity as a person and in your clincals. Even if they say, OK, another chance, you will most likely want an alternate clinical instructor. Or perhaps take your transcript, transfer it to another school, and retake clinicals in a different school. Good luck with this, and do NOT go into another meeting unprepared to defend yourself. Even if you have to say "I understand what you are saying, and I need the opportunity to defend myself. Can we re-convene next Monday and what would be a good time to do so?" Deep breaths, try not to cry. Also, just another thought, do you have a person at the school who is your counselor--meaning the person that you go through to talk about what classes you need, etc? Do you have a class/student rep? Speak at length to them about this as well. I continue to question the motives of a clinical instructor who--3 weeks prior to graduation--is that over the top on one part of a set of vitals. NOT that it is ever correct to make stuff up--and it is not, and you know that, but honestly, something smells fishy with all of this.

[jadelpn, LPN, EMT-B]

Just read you could not meet with anyone, anymore. So be 100% sure that the packet of stuff you present for the review board is over-kill. And that you are prepared to face them with this information. Really make use of student services as well. Good luck and let us know what happens.

[BostonFNP, APRN]

I am sorry you are going through this, it must be very stressful, but life will go on, and one bump in the road will not ruin your career or life.

From an outside perspective, if I were on the review board, this is what I would think:

1. The smaller problem is this issue about falsifying medical records. The story just doesn't seem to add up, and unless we are missing something about how this was documented, then honestly I see this as a technicality that the instructor is using to bring up a bigger problem.

2. The bigger problem here, based on this story, is that you don't seem particularly comfortable or competent in your role as a RN. Not having a watch is not the issue. Not feeling a good pulse is not the issue. The issue is how you handled it. You didn't think it through and you didn't seek out a colleague for help, instead, you seem to have guessed at a heart rate. You then charted a value you didn't feel comfortable with. That shows poor judgement for a final semester student, and it could have put this child at risk. Have you done this before? Have you put false values in other charts? Have you struggled with other tasks an covered it up? These are the questions I would be wondering about in deciding to dismiss you.

How old was the patient? What heart rate did you initially document after palpating? What heart rate did you get apically? What rate did your colleague report? What did you change in the chart?

[Double-Helix, BSN, RN]

I highly suspect that we are not getting the full story here. Clinical instructors do not suddenly decide to make up stories about their students to get them kicked out of the program. An instructor with which the student has no previous complaints would not suddenly take a mistake so simple as forgetting a watch and falsely turn it into an infraction that gets the student dismissed from the program. Students pay for nursing school, which in turn pays the instructor's salary. What could possibly be her motive for lying about a student?

It sounds like the instructor might have seen you doing the vitals with no watch on, and no clock in the room, and documenting them. It's impossible to accurately count a heart rate or respirations with no way to keep time. Doing so would be a falsification of documentation, irresponsible, and potentially cause harm to the patient. Now, if you really used your cell phone to record time, did you tell her that? Or would admitting to cell phone use also get you reprimanded? Perhaps since your instructor never saw the cell phone she thinks you were lying about using it, and instead were just estimating the vital signs.

You stated that you knew you forgot your watch, "had your back to the door because you weren't so sure your instructor wanted to see your cell phone out." That was a deliberate attempt to hide your phone because you either 1. knew you shouldn't have your phone or 2. Didn't want anyone to see your phone and find out you were using it because you forgot your watch. You stated that you "couldn't feel the radial pulse so well" but continued to take the vital sign anyway then you "were nervous (because you knew you were doing the wrong thing?) and recorded the wrong number" (because you were hurrying and not paying attention so you wouldn't get caught with your phone?)

Now, I don't have nearly enough information to know what really happened, but it's clear form what you wrote that 1. You knew at the time that more that one of your actions were wrong and 2. My advice would be to honestly admit your mistakes, apologize, and ask humbly to be let back into your clinical.