At the beginning of the semester in January, I was placed on a clincial action plan for my clinical performance. I did several labs on campus and wasn't allowed to go back to the clinical site until after spring break which was the second week of March. I worked really hard on my assessment skills and my patient care and I thought that I was doing really good until a couple of weeks ago when I got an "U" for time management skills and for not properly assessing the client during a 1st look and not getting my meds out before 10. After I got this "U", I was told that if I didn't improved by the next week (which was the week of April 9th). I would be placed on a clinical action plan again and possibly dismissed from the program. Well, the next week my CI said that I made incomplete first looks on my patients. I explained to my CI that I wasn't sure of what she wanted me to do on my first look because I hadn't been told and I'd basically been going into the client's room, looking at the client's position and assessing any fluids running and then going back later to do my head-to-toe assessments. She said that I should be doing a focused assessment during my first look. She also gave me a "U" for meds adminstration but she was the one pulling the meds from the Pyxis and when we got into the patients room to give the meds, she had missed two and had to go out and get them. She said this was my fault because it was my responsiblity to make sure that we'd gotten all of the meds even though she'd pulled the meds and was on the computer cart; not me. So, I took this all in stride and told myself that on the next clincial day, I would do better.
The next clincial day was the April 16th and I had no problems. However, on April 17th, that morning when I got report on one of my clients her IV rate was 150ml/h and when I went into her room the IV fluid was running at 100 ml/h. I assumed that maybe an order had changed or something and we hadn't been made aware yet and I charted the flow rate in my notes. That patient was placed on NPO which meant no morning oral meds but she did have a Lovenox sub-cut that needed to be adminstered. I went to do my assessment and care for my second patient and I got all of that done, then I went to the computer to look up my meds for adminstration.
A little background is that my CI has 6 students each with 2 patients and meds to give everyday which means there is bound to be some time issues, right? Well, I informed my CI at 0800 that my NPO patient had a Lovenox injection and that I was ready to give my po meds to my other patient. My CI zoomed off with other students, giving their meds and when it came time to give mine, the NPO patient had been transferred off the floor for a CT scan and the po patient had hers late.
I did my morning charting and went to check on my po patient who was getting ECG which I stayed and watched. By that time, my NPO patient was back on the floor and I asked my CI if we should give her meds. I had all of my drugs for her looked up besides 2 because I had sidetracked with the po patient. I told my CI all the info on the drugs and looked up the other 2 at the cart and with the Lovenox injection, I couldn't recall what was "special" about Lovenox and I had to go look it up (inject the bubble to seal the med) and after we got it out of the Pyxis, I had to figure the dosage (which I did). During that time, she zoomed off with another student and when she came back, I gave her all the info and prepared the injection. I had to waste some of the med and I asked my CI how I was going to waste the med if I couldn't get rid of the bubble. She said , "I don't know--you tell me. We're not going to give it until you figure it out." So, I stood there for about five minutes until I remembered that you hold the needle tip down so that the air bubble is at the top when you give it and then we went in to give the injection.
Today, she told me to meet her after class and said that she was placing me on a Clinical Action plan. She has written that I have poor time management skills because I didn't have 2 cards ready at the Pyxis and that I wasn't prepared to give the Lovenox injection (she stated that I had to return twice for additional info: (1) to give her the special instructions and the second time was the calculation that I had to figure). She said that even if she was on time, we wouldn't have gotten the Lovenox given out because it took me too long to figure out what I needed to do with it and that I disappeared and she didn't know where I was and I should have been looking up the 2 meds that I'd missed (in actuality I hadn't disappeared, I was with my other patient viewing the ECG) She also wrote that I improperly assessed the IV because even though I had it in my notes @ 100 ml/h, I should have questioned that it was incorrect because the Kardex (which isn't really up to date) and the chart (again, not really up to date) read the rate at 150 ml/h.
Today, during the meeting I did speak up and say I'd charted my info on the IV flow rate correctly and that even though it was a mistake to assume, I'd assumed that the doctor had changed the flow rate and the order hadn't come yet. I also stated she tried to make it seem like I wasn't doing anything when I was caring for my other patient and watching the ECG and that's the reason I didn't have the 2 meds looked up. I was told (with a really about analogy about my daughter climbing on monkey bars and the teacher not telling her to get down and that being an improper assessment of my daughter's monkey bar skills) that even though I charted correctly, I should have made my instructor aware of the discrepancy (which again, I shouldn't have assumed that the doctor had changed it but I am only a student and the doctor was in the room and I thought he had changed it and hadn't sent the order yet).
The issue that I have with being placed on a clinical action plan is that I feel like it is really extreme for the situation. I asked what the CI expected (as far as the first look is concerned) and then I implemented it afterwards. I try to get my meds given out and my charting done early. I charted my IV flow rate correctly. I asked the questions about Lovenox. I feel like I'm not being treated fairly. She states that I'm not making the connections necessary for a second semester student and that she doesn't know where my time goes (even though I chart where my time goes on my nurse's notes and in the computer) she worries that when I go into team nursing during the last semester which is a year from now, I'll be left behind because even though I do what I'm supposed to do, she is concerned that I don't know why I'm doing it and that if I don't pull it together in the 3 days left then I won't pass clinicals. I feel that being placed on a clincial action plan for this is unjust. I feel like just saying forget it and quitting.
I'm not playing a blame game here but I know that I've made great improvements in my care. I think that time management is something that comes with practice and I am also very tired of being the one that always gets called out and wrote up for some things that have to be learned and are out of my control. Anyway, I'm sorry this post is so long but I would appreciate some feedback. Thanks.
