MedError/Dismissal...What2Do

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...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.

Specializes in orthopaedics, perioperative.

Well what a bind to be in! Never been in such a situation before, but I can imagine how scary it must be. The best thing to do is sit down, type out in order what happened from your point of view, how you felt about xyz, why xyz was wrong, and how you could change things so that xyz don't happen again. I.e., "I was wrong to not inform the charge nurse about the low BP. I was very busy and things got confusing. Next time I will chart it and inform the charge nurse asap." Just being honest with what happened and conveying how sorry you are is the best you can do at this point. Good luck! Oh, and always keep a copy of what you wrote for your records. ;)

Specializes in MICU.

first of all, i am a nursing student and i am not trying to make you feel any worse than you already do, but .....

"critical errors including a med error this past week"

this was a critical error and apparently, not the first one you have made (you used the plural and past tenses which implied that there were other mistakes in addition to this med error). everyone makes mistakes, but the idea is to learn from them. i think the school is right to contemplate dismissal since your actions continue to put patient safety in jeapordy.

as students, we don't carry a full load of patients, so imagine what the outcomes could be when you are under the time management stresses of caring for 6 patients at once. i would be nervous if the school allowed you to graduate and you took on the workload and responsibilities of an rn.

our school drills it into our heads that they can dismiss us at any point in time for med errors (actually, there is a huge list of things than can result in immediate dismissal from the program). it all revolves around patient safety (and the school's reputation -- that is just my opinion though).

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.

i can only speak from my experience in my school, but if you give a med that you don't know it's indications, side effects, adverse effects, etc, etc, etc... if you give it and don't look it up first, then shame on you. they drill this point into us -- look up the drug before you give it. i am not trying to beat you down, but this about more than "oops, i forgot to tell the charge nurse" ... as you claim. not only did your actions put the patient in danger, but you jeapordized the nurses license that you were working under.

let's think how this could have happened:

a) didn't take the bp (or didn't look at it before giving med if the aid took it)

b) didn't realize that the patient was hypotensive already and htn med would not be appropriate

c) didn't know about the med you gave - so you didn't look it up which means that you couldn't have done any pt teaching while administering it and how can you watch for side effects if you don't know the desired effect of the med (not to mention contraindications, adverse effects, combatibilities, etc).

all of these scenarios are big deals especially since you are not a new nursing student -- you are 4 weeks from graduation. you should know better.

... 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...

i think you should own responsibility and quit trying to look for a way out. i know it would stink to be so close to graduation and get kicked out, but maybe you should prepare for that possible consequence. it sounds like the school has given you opportunities to correct prior instances of carelessness (you mentioned being on probation).

lifelongstudent

ps. i do feel bad for you. after rereading my post and almost deleting it, i am chosing to post it because i think you should hear the truth. i know a lot of people will send you hugs and tell you "poor student, i wish the best for you, it will all work out ok"... and although that is comforting to read, i feel that it is not a realistic approach. i am not trying to be hateful - and please don't read the post that way. i am just saying that this sounds serious and i think you should be prepared.

Hi 50Cal

As you are a nursing student, were you assigned to be buddied with an RN. As normally when working in hospitals nursing students should be buddied with RN. Well that is where it happens where I live and do my clinical practicums, as its also the RN to make sure you are doing the right thing, assessing your skills and countersigning your medication that you give alongside with her. You can have your independence but communicate with the RN to let her know what you have done. I am just wondering where was your RN as it is her responsibility too. You are not a qualifed nurse as yet, you are a nursing student. The RN you were supposedly with is the qualified one and should be assisting you as she too has questions to be answered as the onus is on them too.

I hope your case goes well :) Best of luck

Specializes in Emergency Dept, M/S.

Tough situation. I'd be very upfront with what went wrong, WHY it went wrong, admitting responsibility, and most importantly, when faced with the situation again, what you would do differently. Instructors want to see you learn, so take the opportunity to do that. If you have to start carrying a notebook or PDA for reminder notes, then you should do that. I think just saying "we were so busy and things were confusing" (as a classmate did once) is definitely NOT the way to go.

We all make mistakes. None of us are perfect. The point is to acknowledge them, admit to them, and learn from them. I hope things go well for you on Monday.

Specializes in Med/Surg, Ortho.

Actually that is a good question. I have yet to see any student give any oral or IV med without either an instructor or a licensed RN beside them as they pour up the med, usually with the student giving their speel on the med as they do it. Where was the instructor or the Rn assigned to that patient and why were you allowed to pour up and give those meds without anyone double checking you.

I also can understand why they may be looking at letting you out of the program. These instructors are basically letting you work under their license and they are responsible for EVERYTHING you do. If a patient goes bad because you didnt remember, or didnt bother to think of certain serious points in giving a med, or informing the RN of a problem, their programs continuation at that clincal site, as well as their career and reputation is on the line.

Sorry this happened, if it isnt the first time, it might be difficult for you to convince them to let you continue to graduation without some serious remediation.

In our school, our clinical instructors work very closely with each student. We have to have all our meds laid out and looked up. She goes over each med with us and we check to see if there are certain things like low BP which prohibit giving the med. I have personally held meds on at least 3 patients due to low BP. In each case i charted why it was being held and informed the RN who had that patient. Think that whoever was respnonsible for checking your meds dropped the ball a little. But needless to say, you should have been better prepared as well. Just my opinion.

Have a Great Day And Be Safe

Jerry

thats cool man. i would certainly say that was the first thing i did, to get prepared for dismissal. i mean i try to train my mind to believe i have been dismissed already, taking steps to enter another program. this is the only way i can handle the strong anxiety. knowing i've prepared to enter another program helps me. so if they do decide to give me probation then its a surprise as opposed, and if i get kicked out it'll be no surprise and i wont be devastated by it. i really appreciate you for being real about your opinion.

first of all, i am a nursing student and i am not trying to make you feel any worse than you already do, but .....

"critical errors including a med error this past week"

this was a critical error and apparently, not the first one you have made (you used the plural and past tenses which implied that there were other mistakes in addition to this med error). everyone makes mistakes, but the idea is to learn from them. i think the school is right to contemplate dismissal since your actions continue to put patient safety in jeapordy.

as students, we don't carry a full load of patients, so imagine what the outcomes could be when you are under the time management stresses of caring for 6 patients at once. i would be nervous if the school allowed you to graduate and you took on the workload and responsibilities of an rn.

our school drills it into our heads that they can dismiss us at any point in time for med errors (actually, there is a huge list of things than can result in immediate dismissal from the program). it all revolves around patient safety (and the school's reputation -- that is just my opinion though).

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.

i can only speak from my experience in my school, but if you give a med that you don't know it's indications, side effects, adverse effects, etc, etc, etc... if you give it and don't look it up first, then shame on you. they drill this point into us -- look up the drug before you give it. i am not trying to beat you down, but this about more than "oops, i forgot to tell the charge nurse" ... as you claim. not only did your actions put the patient in danger, but you jeapordized the nurses license that you were working under.

let's think how this could have happened:

a) didn't take the bp (or didn't look at it before giving med if the aid took it)

b) didn't realize that the patient was hypotensive already and htn med would not be appropriate

c) didn't know about the med you gave - so you didn't look it up which means that you couldn't have done any pt teaching while administering it and how can you watch for side effects if you don't know the desired effect of the med (not to mention contraindications, adverse effects, combatibilities, etc).

all of these scenarios are big deals especially since you are not a new nursing student -- you are 4 weeks from graduation. you should know better.

... 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...

i think you should own responsibility and quit trying to look for a way out. i know it would stink to be so close to graduation and get kicked out, but maybe you should prepare for that possible consequence. it sounds like the school has given you opportunities to correct prior instances of carelessness (you mentioned being on probation).

lifelongstudent

ps. i do feel bad for you. after rereading my post and almost deleting it, i am chosing to post it because i think you should hear the truth. i know a lot of people will send you hugs and tell you "poor student, i wish the best for you, it will all work out ok"... and although that is comforting to read, i feel that it is not a realistic approach. i am not trying to be hateful - and please don't read the post that way. i am just saying that this sounds serious and i think you should be prepared.

Specializes in L&D.

Saying it was very busy isn't going to get you anywhere. We're always busy and believe me, you'll be much busier as a graduate than you've ever been as a student. I can't believe you were written up for asking about giving a medication though a tubing with potassium running. That's what you do when you don't know, you ask someone who does. It's wrong to fault someone for asking a question. There are no dumb questions.

Think about what happened and why it happened. What can you do to prevent this from happening again. Why did it not occur to you that administering a blood pressure lowering medication to someone with low blood pressure might not be a good idea? How did you forget to assess your patient's wound? If you were that busy, perhaps you should have told your charge nurse that you were behind and needed help. Asking for help doesn't always go over well with the powers that be, but it's better than possibly harming your patient.

Perhaps you need to repeat this semester. Rather than wasting all the time, effort and money that has gone into getting you this far along in your training by throwing you out of the program, repeating this class with a new awareness of the areas of practice you need to focus on may be of benefit to all concerned.

Good luck

All you can do is be honest and let them know it will never happen again. I guess I'm just confused as well since our instructors all the way until we graduate HAVE to check on every medication we are giving, and if it's a BP med they ask us what the BP was...I just had the same thing happen Friday. My pt's BP was 110/62 and she was on a lasix and a potassium sparing diuretic but b/c our instructor is required to stand over our shoulders as we prepare our meds, she noticed and we held her BP med after talking to the nurse. I just can't believe that your instructor or RN wasn't around to catch that.

Well good luck...will keep you in our thoughts.

Ginyer

I guess what struck me about your post is that you said you are 4 weeks to graduation and still making errors like this. I think for a first semester student, these kinds of things aren't such a big deal because the instructor is holding their hands. I have one more semester to go but our last semester was the last one on the med surg floors and our instructors were trusting us to do those checks on our own. they did not oversee our med administration becuause at that point in the program, we were knowledgable enough to give our meds alone.

With that said, I think the best approach (if you want to stay in the program) is to admit that you were wrong. As nurses, we are responsible for knowing the action, blah blah blah of meds. that is what separates us from medication dispensers (don't know the real name for them).. we are required to THINK not just dispense meds at the right time. Anyway.. I think it is important to let the faculty know that YOU know that. That you KNOW that you should have taken the BP and so on. You realize that you made a mistake and that you have learned from it.

On the other hand.. I would think that if you are that close to graduation and still making those kind of mistakes, that maybe you need to repeat the semester and I would see if you can get a spot to repeat. I just would want to make sure i knew what I was doing befor I got out into the real world and made mistakes as an RN. All nurses make mistakes some time in their career unfortunately. no one is completely perfect but I think that with a lighter load (as a student) you should not be making those kinds of mistakes so often. If you are not confident (but still cautious) that you can do it, I would stay in school another semester.. Anyway.. hope that helps.. good luck..

Specializes in Med-Surg.

I know I'm off subject here, but can I get educated on the significance of K+ tubing? That hasn't come up for us yet and I'm curious. Thanks.

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