Failing a student in clinical

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I had a student in the last stretch of clinical before he goes into a preceptored clinical. In the preceptored clinical, they are basically on their own and can ask questions to the preceptor. Graduation is in June. This student read an order for insulin wrong and drew up 6 times the ordered dose. The student commented that it seemed like a bit much. I was watching and asked the student to read the order again. He continued to say the wrong dose. I told him he could have killed this patient. The student commented that he is "there to learn, that's why I pay tuition." At this stage of clinical, I find this to be unacceptable and dangerous. I could not pass this student. He had been warned for weeks that he needed to improve. He received weekly written evaluations and we discussed ways to improve. He is now contesting this and feels that I was not fair. Your thoughts?

I agree with you. I would have failed him. As much, or more, for his defiant attitude, as for the fact that he made such a serious mistake. If he had taken ownership and acted as if he cared about his patient I would have considered advocating for him to return to the program. But with that kind of attitude, I could not support him returning.

Specializes in ICU.

It sounds like he's a danger to his patients, not CARING enough to accept responsibility for his error. He's lacking in both intelligence and maturity.

Perhaps he needs a year or two doing something other than nursing school to grow up a bit.

Wow. This is unbelievable. I would fail him.

Think about how he will act when someone isn't watching over him....

Specializes in Nursing Education, CVICU, Float Pool.

I know at my school we just lost a senior student 2 weeks ago, and here it is 4 weeks from graduation. However, as a student nurse who in a matter of a few weeks may become a practicing Nurse, mistakes like that shouldn't really happen. Especially if you were instructed to look at it again. Our policy is, at the desk it is a learning opportunity, at the bedside it is a patient care or medication error and results in an unsafe practice, and possible dismissal. But last semester you should have your routine worked out and be sure of what your doing. Especially with insulin which requires 2 RNs to verify, at least at our hospital. We lost tar senior student and others in my class, due to insulin. Also, our school is big on taking professional accountability and civility, regardless of the circumstances. Those qualities have saved a lot more people than they hurt in nursing school.

Specializes in ER.

I agree! If he had fallen to his knees sobbing over the incident, I might have been able to counsel him and expect him to remember this grievous error, but since he was flip about it, he's gone!

I have only written up one student in my life! I was working in the ED and had a lady with chest pain coming in EMS. They had not been able to start a line, so as they rolled through the door, I asked the student to get her into a gown and put her on the monitor and I would get the lab and IV supplies. The student defiantly told me that SHE was in a BSN program and she would never have to do "aide's work" and she would find an "aide" to do it. I was furious!! I told her to sit at the desk until I could get back to her and that she was not ever allowed in one of my patient rooms again.

She said they told her in school that she would always be a manager because she had her BSN and she didn't need to do "scut work". I explained the rules of the game, wrote her up and sent her home. I never saw her again, so I hope she is flipping burgers somewhere!

I also recently had a student who was in a group of other students and needed to be checked off on one more IM med to complete a particular requirement and that was the last day of clinical. I had an order for one, and asked him if he wanted to do it. He said, no, his friend had just showed up and he was going to lunch and he would do it when he got back. I was flabbergasted! Of course I gave the med, and I guess he was out of luck.

I'm not bashing students and have had many great experiences with students who I knew would thrive in nursing, but there are always a few that you just have to wonder about!

Nursing is a very dangerous profession and arrogance and failure to understand fundamental principles are recipes for disasters.

I also recently had a student who was in a group of other students and needed to be checked off on one more IM med to complete a particular requirement and that was the last day of clinical. I had an order for one, and asked him if he wanted to do it. He said, no, his friend had just showed up and he was going to lunch and he would do it when he got back. I was flabbergasted! Of course I gave the med, and I guess he was out of luck.

I'm not bashing students and have had many great experiences with students who I knew would thrive in nursing, but there are always a few that you just have to wonder about!

Nursing is a very dangerous profession and arrogance and failure to understand fundamental principles are recipes for disasters.

Shaking my head at this. I guess there's always been students like this, but it really does seem that the numbers increase with every year that goes by.

In my opinion, you were right. The only thing I may explore is the possibility that he has a vision problem? You said that TWICE he got the dose wrong? Was it a hand written MAR or order? Sloppy?

Specializes in ED.

Woah. I'm only a pre-nursing student.. but I WOULD NEVER EVER act in a manner like that. I guess some people just don't have any morals or a conscience. I am constantly hearing/reading stories like this; with those attitudes, they do not deserve to be nurses. It takes away from those of us who REALLY do care. As a student, I would NOT blame you nor be mad at you for failing me if I acted in such a way. You guys seem "student friendly" and I hope I'm lucky enough to get a chance to work with nurses like that. I ask a lot of questions- only ones I can't answer myself- and I like to "know/see" the WHOLE picture of how and why something works the way it does. I'm just scared of getting someone who won't like my inquisitiveness. I see there is hope though lol :)

Yup totally, drawing up and giving insulin is semster one stuff.......no way someone can graduate without being able to do that......

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i had a student in the last stretch of clinical before he goes into a preceptored clinical. in the preceptored clinical, they are basically on their own and can ask questions to the preceptor. graduation is in june. this student read an order for insulin wrong and drew up 6 times the ordered dose. the student commented that it seemed like a bit much. i was watching and asked the student to read the order again. he continued to say the wrong dose. i told him he could have killed this patient. the student commented that he is "there to learn, that's why i pay tuition." at this stage of clinical, i find this to be unacceptable and dangerous. i could not pass this student. he had been warned for weeks that he needed to improve. he received weekly written evaluations and we discussed ways to improve. he is now contesting this and feels that i was not fair. your thoughts?

everyone makes mistakes, but the attitude is dangerous. he deserved to fail!

Specializes in ICU.

Was the MD's order hand-written and illegible? Even so, a student nurse should know what the patient's blood sugar is, and should know if the dosage is a safe range or not, unless it was lantus or some other type that doesn't peak. I am sometimes shocked at how much insulin some patients require.

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