A surreal dismissal

MiaKeaRN · Apr 3, 2008

In my program, you would have been written up for the med issue. We are NEVER allowed to leave a med unattended. That would be the first unsafe in our records. We would also receive an unsafe and possibly dismissed from the program for the file name with the patient's name. Even if it was just the last name, it may still be considered a HIPPA violation. We are not allowed to remove any paperwork from the hospital with the patient's names or any other identifying data on it.....my instructor carries a huge black marker for us to black out names and record numbers, birthdates, etc. We use scissors to cut off the bottom and top of our patient data sheets, and black out the rest.....and our instructor looks at them before we take anything off the unit. When we are in class, we refer to the patient's by initials only....absolutely no names are mentioned.

With that being said, those 2 issues in one semester would be cause for dismissal from my program.

ohmeowzer RN, RN · Apr 3, 2008

In my program, you would have been written up for the med issue. We are NEVER allowed to leave a med unattended. That would be the first unsafe in our records. We would also receive an unsafe and possibly dismissed from the program for the file name with the patient's name. Even if it was just the last name, it may still be considered a HIPPA violation. We are not allowed to remove any paperwork from the hospital with the patient's names or any other identifying data on it.....my instructor carries a huge black marker for us to black out names and record numbers, birthdates, etc. We use scissors to cut off the bottom and top of our patient data sheets, and black out the rest.....and our instructor looks at them before we take anything off the unit. When we are in class, we refer to the patient's by initials only....absolutely no names are mentioned.
With that being said, those 2 issues in one semester would be cause for dismissal from my program.

yes i agree, leavng a med by the bedside is unsafe in the packet or not, if a visitor came by child or adult and took that pill and heaven forbid they have a reaction to it , then thats big trouble... i wait by my patient's bedside and watch them take every pill... if they don't want to take it then , i take it with me , if the pt asks me to leave it by the bedisde i say no , and explain i could loose my license for leaving pills at the bedside,

also if i hav a student that needs to do meds and the instructor isn't there.. i stand behind them and watch every pill given and hear the student explain each pill.. so yes that was a big mistake.. always remember ... safety first,,

then about the HIPPA violation , you should never take any info from the hospital about a pt... that is a big fine for the hospital and i am not sure but i think your instructor could loose her license because you are working under her license for a HIPPA violation... that's a federal violation and that's a big no no

i am sorry that this happened to you.. can you reapply and go back next year?

DermNP2Be · Apr 3, 2008

But she didn't use the last name... just the first name only in an email that she has a copy of. I don't think you should've been dismissed...

justme1972 · Apr 3, 2008

I'm a second semester student, 1st year...I'm going to be playing Devil's advocate here...this is how your school is seeing it.

On March 19 (nine months till graduation!) I received official notification of my dismissal from the school of nursing for actions that allegedly occurred in early February. Since then, I have spoken to students and instructors of other programs in the area and they, like me, don't understand why I was dismissed and not reprimanded. The reasons the school gave me:
1. I left a med unattended with a patient. That's true, but the 5 rights of medication administration were correct. The pill was still in the vaccume pack when I returned with my instructor. (Do you pass meds unsupervised at your school?)
We will eventually pass meds unsupervised at our school, but only after an RN has verified everything, and all we are doing is double checking the final identity and administering medication.
The 5 rights of medication did not apply in this case...it was the fact you left the med and didn't witness the patient taking it...you can't chart it as being given until you witness the swallow--remember, NCLEX hospital...not real life.
But the NCLEX hosptial is what you are being graded on.
2. The clinical nursing instructor told my school instructor that I placed a child in a soiled bed and refused to change the sheets. This is an exaggeration of the highest degree. The sheets were rumpled and as soon as I was told that the hospital's support staff would not be in to change the bed, I did change the linens. The school instructor addressed this problem with me, and I acknowledged that anything to make the patient more comfortable is a nursing responsibility.
They are seeing this as you not being proactive...unless you are told differently by the hospital or your instructor, if you see that it needs to be done, it becomes your job.
I would have changed the sheets and wouldn't have dared to ask someone else to do it...no child should have been placed in soiled sheets--at all--again, NCLEX hospital.
3. I was accused of using the patient's full name as the file name of an email attachment to the instructor. I used the patient's first name only and still have a copy of the sent mail on my computer which I showed at my appeal hearing. The date of this alleged incident was also wrong and I pointed out this discrepancy at my appeal as well.
I'm assuming you took Psychology before you were enrolled in nursing school and read case studies in your first semester of nursing.
Have you noticed that actual case studies always include only the initials of the patient?
Discussing it in person with your instructor is one thing, but not in written form. They are seeing this as a HIPAA violation...a first name (especially if it's a unique one plus specific symptoms can possibly identify the patient)...this is something you really, really have to learn now.
Am I crazy or was the school looking for a way to get me out? The only error I committed is a STUDENT error--and I was a student! A student with a 3.98 GPA!
If anyone can explain why the school was justified, I'd appreciate hearing from you.

The first two would have got you dismissed from our program (but only after the second infraction)...but not the 3rd....that is an instructor 100% over-reacting...but they looked at it more closely because of the other two.

DermNP2Be · Apr 3, 2008

Yes, I always use only the initials as well... I just didn't know that using the first name only to an email to your prof would get you dismissed from the nursing program. I hope things work out for you.

Abishag · Apr 3, 2008

I'm going to, to quote the above poster, "play devil's advocate here" as well...but those are just the "listed" reasons for dismissal...is it possible there were other smaller mistakes that happened often?

I know my friend told me that when she was in nursing school that if they thought someone was a little scatterbrained (not saying you are by any means) that they would zero in on that person until either they proved themselves or forced them out. It is patients lives we're talking here. If there were a lot of little mistakes that weren't worthy of dismissal, they may have decided to stretch the "worthyness" of the bigger mistakes...JMHO. I honestly don't mean to sound harsh...

I'm not saying that is you, I'm just saying there are always four sides to every story (yours, the instructors, the patient's, and the truth!).

Maybe you could appeal or ask if you could re-enter next semester?

NurseBrittney · Apr 3, 2008

I was really nervous about starting clinical to the point where I was nearly in tears. I asked if there was anything that could straight up fail me in clinical and her response was "A med error"

knot4me · Apr 3, 2008

Thank you all for your comments, but I think I have to give more details so that you have a better understanding of my mistakes.

About the med--yes, I left the med unattended with a patient who was alone, because he didn't want to take it from a student nurse. I was 100% in charge of obtaining and dispensing the meds without supervision--just a vera-scan. Yes--I know that was a mistake and it was addressed by the instructor at the time (Feb 1).

About the bed--we were told at orientation to that hospital of the support staff's role. The child was in diapers and fed a very restricted diet thru a G-tube, so a "soiled" bed was an impossible occurrence.

About the name--I used the first name ONLY as the file name for an email attachment. (Not Cher, Madonna, or Prince). Throughout the care plan, I used only the initials. Also, being the anal-retentive person that I am, I BURNED all the paperwork that we were permitted to take from the hospital, so that the patient's info remained between myself and my instructor only. (Point of fact, I felt uncomfortable having access to that much info in hard copy in my home.) We repeatedly discussed patients in class using only their first name, so the standard was set before my email was submitted.

I KNOW that I made mistakes, but if they were severe enough to cause dismissal, why did it take the school over a month to act?

I've already been encouraged to apply for another nursing program by a past instructor who knows all the facts and my past academic record. She, like me, questions the school's timing of the dismissal--it was too late to be accepted for the fall programs of other schools.

I guess my real question is--since I admit to one mistake, but so adamantly defend myself for the other 2 accusations, should I pursue a career in nursing or is my sense of nursing skewed?

Abishag · Apr 3, 2008

Maybe the bed linen situation was just a misunderstanding?

Because initially when you said "soiled linens" my thought was not about that the child pooped on them but that they were 24+ hours old. I think of soiled as having either spit up, dead skin, poop, pee, or just wrinkled. Is it possible they expect a linen change every 12-24hrs regardless of whether the child pooped/peed on them?

If that is the case and soiled just means old to them, maybe you should let them know that wasn't made clear?? I know sometimes definitions change with the applications...

FuturoEnfermera · Apr 3, 2008

i personally think it's absurd that you'd be kicked out for any of that or any combination of those events. yikes! i'm so sorry this happened to you. when i hear stuff like this i feel like i'm in the only nursing program that wants its students to succeed. i know of multiple med errors that students in my program have committed and no one was kicked out because of it. if you're worried about getting kicked out if you don't change the sheets right how can you possibly concentrate on actually learning anything well??

ohmeowzer RN, RN · Apr 3, 2008

i am glad you are reapplying to a new school... i bet you will do very well... take care