Ceased placement due to not taking vital signs properly

FullGlass, BSN, MSN, NP · Apr 2

What school are you going to? From what you said, the placement site completely over-reacted. You are a student! Of course you are not going to know everything. Your school should have assigned someone from the school to be the liason between you and the placement site; also that faculty member should be ensuring that you are getting what you need from the placement. Contact that person. You should also have an advisor; contact that person. If that doesn't work, then go up the chain to the Dean, if necessary. If the school won't help you, demand another clinical placement site. Let us know what happens.

It is important to know how to do VS manually, but if that is something you are struggling with, then the proper course of action is to give you more practice with that.

Good luck!

ponderingDNP · Apr 9

It was much easier to blame the trainee instead of the trainer. This facility sounds like a punitive one. Non-punitive organizations do not allow such behavior. Someone failed to evaluate your training to ensure skills competency prior to delegating unsupervised tasks.

If there's any justice, the cardiologist would point that out to Miss Make-No-Mistakes-Or-Else. Your school made the same failure prior to sending a sheep to walk amongst wolves. It reminds me of the local school systems here in that they no longer teach writing in primary education curriculum, yet expect students to be able to later sign their names. Where do these people come from? Common sense is no longer common at all. 🤔

Anne RN BSPA · Apr 10

This sounds unfair. Based on my past experience as a nursing instructor, I do not believe this was handled properly. I recommend you retain an attorney to help you with this, the sooner the better.

Tomascz, ASN, RN · Apr 10

Subjective assessments like the one you apparently failed can be used unfairly to eliminate students from nursing programs who the instructors or others "feel" are not up to some unwritten standard in their performance or aptitude for the job.
A core part of instruction is making sure your student has had a reasonable opportunity to learn the skill being taught. You, OP, are after all, being charged a fee for this service and, should your instructor, or their contractor, not exercise due diligence in making sure you have had a reasonable opportunity to learn the skill, can be found liable for fraud.
If you decide to contact a lawyer (and you probably should) try to find an RN who has gone into the legal business. There are a few and there need to be more, IMO.
Good luck.

londonflo · Apr 11

Tomascz said:

A core part of instruction is making sure your student has had a reasonable opportunity to learn the skill being taught.

Was it required that you be a CNA prior to enrolling? Were the manual assessment skills taught in a previous skills lab? Were you required to do a return demonstration?

Did you sign out a BP cuff to practice outside of lab if you were hesitant with competency on the skill (s)? I would propose a plan citing everything you want to do now to become proficient with manual VS under all conditions. It might be in your best interests to write out a remediation plan for continuing in this cardiac rotation and all further rotations.

Tomascz said:

You, OP, are after all, being charged a fee for this service and, should your instructor, or their contractor, not exercise due diligence in making sure you have had a reasonable opportunity to learn the skill, can be found liable for fraud.

I have never heard of a fraud liability. If indeed, manual vital signs were never taught or the CNA skills were not required before matriculating, the student can note that in an appeal to the school. (the appeals process should be in the student handbook)

Please do not feel that I am pushing the blame on you. I sincerely hope that you can resume your studies.

Glycerine82, LPN · Apr 15

Would it hurt?

maybe not you but it could hurt someone!

LlamaLlamaMamaJamaac · May 13

Wow... assuming that there's not more to the story WOW. If your skills are subpar it's kinda the instructor's job to remediate you. Im sorry that happened

Majie RN · May 20

Is that your first time to take blood pressure or heart rate manually?

akulahawkRN, ADN, RN, EMT-P · May 21

I'm going to surmise that this nursing school is not in the United States. So I'm going to use "obs" instead of "vital signs" to make it easier for the OP to understand. That being said, if this is your 2nd year, you should have been taught how to take manual obs correctly before you were sent out to your clinical sites as it is known that NIBP obs machines can fail or even read incorrectly at times. Doing these really is NOT that difficult but it can be stressful for students who have rarely been required to do manual obs. Over the years, I have (literally) done thousands of manual measurements and it's only since I became an RN that I began frequently using NIBP obs machines. I do know their limitations, but I have a well-accustomed ear for manual blood pressures, and I can be VERY quick at obtaining manual obs, sometimes faster than the machines I use.

Clinical instructors can be very unforgiving and can decide that you've failed their rotation because you don't measure up to whatever standard exists in their mind for students. Universities usually back up that instructor and will usually go along with the instructor's recommendation. I had a clinical instructor that was known for targeting "a" student who was usually male and would be exceptionally focused on that student's performance and anything less than perfect would result in being placed on a performance plan or getting removed from a clinical site. Everyone else got to skate on by as they weren't being focused on. Guess who didn't pass that term... I, somehow, managed to earn a place back in school and did quite well, and I have been a licensed nurse for nearly 10 years as I write this response.

I don't know what recourse you, OP, have relative to your progress through your program but I suspect that you may be required to show that you are able to take manual obs correctly or be retrained to do them correctly and demonstrate this skill acceptably to program staff. In the short-term, you very well could be removed from the program and be required to repeat an entire term, which would move your graduation date similarly back. Worst case is you may be removed and disallowed to return, forcing you to go to another program entirely.

I hope the best for you.

FullGlass, BSN, MSN, NP · May 21

akulahawkRN said:

Clinical instructors can be very unforgiving and can decide that you've failed their rotation because you don't measure up to whatever standard exists in their mind for students. Universities usually back up that instructor and will usually go along with the instructor's recommendation.

I don't know what recourse you, OP, have relative to your progress through your program but I suspect that you may be required to show that you are able to take manual obs correctly or be retrained to do them correctly and demonstrate this skill acceptably to program staff. In the short-term, you very well could be removed from the program and be required to repeat an entire term, which would move your graduation date similarly back. Worst case is you may be removed and disallowed to return, forcing you to go to another program entirely.

I hope the best for you.

I find this unbelievable. It is the school's job to teach their students and advocate for them. It looks bad for the school to have students not graduate and so on.

I had a clinical placement in my NP Program and when my school clinical advisor came to the site to check on me, the clinical instructor from the facility tried to get me failed or something When my advisor pressed her on what exactly are the issues she is concerned about, the clinical instructor said I didn't know the meaning of basic terms like "xyz" (I forget the term she mentioned). My advisor (fantastic NP w/30 years of experience) just looked at her and said "I don't know what that is, either." Turns out the term was specific to that site not something that would be taught in any standard NP curriculum!

Any school that does not stand up for their students is just plain a crappy school. Students do get nervous, that is understandable. They just have advisors and professors that can help them and advocate for them. The OP needs to escalate this up the food chain at her school. I was really nervous about lots of things as a student! Once I began practice, everything "clicked" and the more I did something, the easier it gets.

The rule of thumb is it takes 5,000 hours to achieve mastery. That is the equivalent of 2.5 years of FT work!

akulahawkRN, ADN, RN, EMT-P · May 25

FullGlass said:

I find this unbelievable. It is the school's job to teach their students and advocate for them. It looks bad for the school to have students not graduate and so on.

I had a clinical placement in my NP Program and when my school clinical advisor came to the site to check on me, the clinical instructor from the facility tried to get me failed or something When my advisor pressed her on what exactly are the issues she is concerned about, the clinical instructor said I didn't know the meaning of basic terms like "xyz" (I forget the term she mentioned). My advisor (fantastic NP w/30 years of experience) just looked at her and said "I don't know what that is, either." Turns out the term was specific to that site not something that would be taught in any standard NP curriculum!

Any school that does not stand up for their students is just plain a crappy school. Students do get nervous, that is understandable. They just have advisors and professors that can help them and advocate for them. The OP needs to escalate this up the food chain at her school. I was really nervous about lots of things as a student! Once I began practice, everything "clicked" and the more I did something, the easier it gets.

The rule of thumb is it takes 5,000 hours to achieve mastery. That is the equivalent of 2.5 years of FT work!

I agree. When I was the one under the microscope and ultimately was failed for that semester, I was hoping that I would have been allowed to continue as this happened at the end of the clinical portion of that semester. In your case, your school stood up for you as their clinical advisor actually investigated what the facility's instructor was doing. In this case, the facility instructor wasn't an employee of the school, my clinical instructor was. That being said, that particular instructor didn't return to teaching at my school that following semester and I was offered a seat immediately in a repeat semester. I didn't see that clinical instructor at the school afterward and I suspect that after an investigation, that clinical instructor was removed from teaching. Unfortunately that didn't help me stay with my original cohort as I couldn't progress to the next semester.

I'm hoping for the OP that something similar to what happened to you will happen... but I suspect that something similar to what happened to me will be what transpires. Students should have a good grasp of the basics but if they've never done healthcare stuff, they will not have mastery of it. I hope that the OP's school remembers this fact.