# When to report a classmaste to your clinical instructor. - page 3

We are in our last semester of nursing school and it has become aparent, in our first week of our new rotation that one of our classmates does/did not know how to do perform some clinical skills. I... Read More

1. I agree with others. Speak with the student first, about what you've seen. If you haven't seen it, then don't go by others words. After you've witnessed something, speak to the other student in a closed off area. Tell them what you saw, how you think it should have been done (ex- this is how we learned to do it in class). I know people say there is "real world" nursing, but there is a reason we are taught to do things a certain way while we're in school.
As far as the tb, heparin, insulin thing, here goes. I use insulin syringes for insulin only. I use tb syringe for heparin. Granted, heparin comes in units. But, most of the vials I have seen (all of them actually) are 10,000 units per 2 ml. OUr insulin syringes are measured up to 100 units. I know you can convert and everything, but to me it's just easier to only have to do that one small bit of math and put it in a syringe that's just as accessible (and discomforting to the pt). My two cents. -Andrea
2. it depends on what you are using the heparin for... if you are just giving sq heparin for prophylaxis, any type of syringe with a sq needle will do; however if you are using the heparin to bolus for adjustment of a gtt, use a tb syringe so you can measure fractions of a cc. remember ordered/on hand x units? like if you need 1500 units bolus and you have 5000 units in 1 ml vials 1500/5000 x ml= a bolus of 0.3 cc heparin, meaused in a tb syringe. my 2 cents.
3. I think I must have misunderstood something in the original post. When he said "unprimed" piggyback, I took that to mean full of air, no fluid, which would of course be very dangerous to the patient. But no one else commented on that; so I think I must not know what unprimed means, or it means something different than what I thought it did. Enlighten me please? Thanks.
4. talk to your classmate....and I only say that b/c you only saw the heparin incident, not the IVPB one.

I think its scary that someone in their last semester of school wouldn't think to prime the line before attaching it to the patient. Maybe she hasn't had that much exposure to IVPB's??????

Our instructor would watch us do any procedure once, and then after we were "checked off" we were allowed to do it alone w/o any supervision. By the last semester we were pretty much functioning RN's who would know to ask questions or get assistance if we didn't know how to do something.

Some of my classmates and I were charting when we saw another classmate who drew up insulin and gave it w/o ever checking it with another RN. SCARY!!!!!! Even licensed RN's have to double check insulin! We spoke to the instructor who (after noticing other issues w/this student) dropped her from the last semester.
5. Quote from mattsmom81
Markb I am curious why you see yourself in a supervisory role when you are a student yourself? My advice: look to your own learning and let the instructor teach.

On second thought after rereading your original post I am rethinking my above response.l. My response was kneejerk ie here's another student already 'eating' their classmates.

The unprimed IVPB , if administered this way, would have likely introduced air into the patients venous system...harmful to the patient. If you didn't see her do it its hearsay and gossip however so be careful.

With availability factors, different syringes can SOMETIMES be substituted. However she SHOULD always be using the correct syringes whenever possible. Hopefully she did not give an incorrect DOSE to her patient. Nothing wrong with asking her 'couldn't you find the correct syringe?' and start a conversation that way.

Did you talk to her first before going to the instructor? I hope so...and I hope you encourage her to do things correctly if you are SURE she has done something incorrectly. (observed it yourself that is) If her response to you is surly and she does not see your concern, you CAN indeed go to your instructor.

I apologize for my first response and wish you luck. I should not have trivialized your concerns. We don't need any more bad nurses out there...and the bad nurses we have likely squeaked through nursing school uncorrected.

Best wishes.
Last edit by mattsmom81 on Mar 11, '05
6. Quote from mattsmom81
On second thought after rereading your original post I might, as a student, have legitimate concerns as well. My response was kneejerk ie here's another student already eating their classmates.

The unprimed IVPB , if administered this way (did you see her do it or did she correct herself I wonder) would have likely introduced air into the patients venous system...harmful to the patient.

With availability factors, different syringes can SOMETIMES be substituted. However she SHOULD always be using the correct syringes whenever possible. Hopefully she did not give an incorrect DOSE to her patient.

Did you talk to her first before going to the instructor? I hope so...and I hope you encourage her to do things correctly if you are SURE she has done something incorrectly. If her response to you is surly and she does not see your concern, you CAN indeed go to your instructor.

I apologize for my first response and wish you luck. I should not have trivialized your concerns. We don't need any more bad nurses out there...and the bad nurses we have likely squeaked through nursing school uncorrected.

Best wishes.
And, I wonder, what was the other student doing while watching the first student hang the IVPB unprimed??? Or what were you doing when the student drew the heparin up in the insulin syringe? Just standing there? I had a fellow student stand and watch me do a finger stick blood glucose from start to finish, after which she mentioned that I had forgotten my gloves. Well, yes, that is true, I had. But why did she not tell me ahead of time?? :angryfire :angryfire

Please note, that such things can be handled gently by not acting like a know-it-all, but by acting "confused", and saying that you thought you remembered it this way...was there something you missed?

NurseFirst
7. Quote from NurseFirst
And, I wonder, what was the other student doing while watching the first student hang the IVPB unprimed??? Or what were you doing when the student drew the heparin up in the insulin syringe? Just standing there? I had a fellow student stand and watch me do a finger stick blood glucose from start to finish, after which she mentioned that I had forgotten my gloves. Well, yes, that is true, I had. But why did she not tell me ahead of time?? :angryfire :angryfire

Please note, that such things can be handled gently by not acting like a know-it-all, but by acting "confused", and saying that you thought you remembered it this way...was there something you missed?

NurseFirst
I think you need a time out.
8. Quote from mattsmom81
Markb I am curious why you see yourself in a supervisory role when you are a student yourself? My advice: look to your own learning and let the instructor teach.

Sorry but I think that reply was slightly out of line. 1 nursing students need to help each other learn. 2 It is NEVER too soon to be a patient advocate. The insulin thing still befuddles me would you actually concider pushing heparin with an insulin syringe if a JCAHO rep were watching you. I know the syringe adds up to 1 ml, but do research more then one med error has occured from this system, in any event nursing students need to do things the proper way. They'll learn enough bad habits on the floor post grad. To the OP personally I would inform the student and let it at that, but if I saw a trend it would need to be taken to the instructor, mind you not as a punnishment but as a weakness that needs addressed. everyone has an occasional knucklehead moment, I will remind everyone that students operate under an instructors license if something unsafe were going on it should be her right to know
9. Quote from KrisRNwannabe
we also pull IVs and PICC lines by our selves.

Okay, maybe I've been in the NICU too long and am not familiar with PICC lines in adults. But as an RN myself, I've NEVER pulled a PICC line! We always have an MD or NP do it because of the risks of it breaking off into the venous system. It's considered an actual procedure where I work, and not something an RN - much less a student nurse - is allowed to do.

Must be different in adults, since no one else commented on this???
10. Quote from NurseFirst
And, I wonder, what was the other student doing while watching the first student hang the IVPB unprimed??? Or what were you doing when the student drew the heparin up in the insulin syringe?
This, I agree with.

Ask your instructor next time you see him/her what s/he wants you to do when you do see something being done wrong or unsafe. That instructor needs to address this to your class as a whole if the instructor is unable to be there or arrange for a staff RN to be there.

I don't think it's a good idea to just watch someone make a mistake without intervening in what ever way is acceptable by your program.
11. Quote from Gompers

Must be different in adults, since no one else commented on this???
I'll comment on it.

IMO, it is very unsafe to allow a student nurse to pull a picc line without supervision.
12. We use tb syringes to draw up insulin and heparin on our unit. The 1 ml syringe has marking for both 10th of a ml and for units.
13. Quote from begalli
IMO, it is very unsafe to allow a student nurse to pull a picc line without supervision.
Thanks! I wondered if maybe RNs might do this in the pediatric/adult setting, but to have a student doing something like that...talk about liability!!!

Of course, where I work the PICC lines are thinner than dental floss (<2fr) and we've had incidents where docs have DC'd lines that broke off into the baby, requiring emergency trips to nuclear medicine and even the OR. This is why, as a nurse, I refuse to pull one.