Clinical instructor keeps handing out clinical warnings?

[lilfayfay]

I'm in my 2nd quarter of nursing and in only just 4 weeks of clinicals my instructor gave me 3 clinical warnings.

The 1st one was reasonable because I didn't have my hair up nor had a pen and didn't bring my papers to orientation.

The 2nd one was because I forgot to do the Pathophysiology assignment for my patient (last quarter my clinical instructor didn't require it to be done on the day of care for your patient until turning in the assignment, only your plan of care for your patient and face sheet, but was reasonable because she said I was the only one that didn't do that).

But I don't agree with this recent clinical warning she gave me today which was because I didn't know how to give an IV bolus to my patient which was Pantoprazole (Protonix).

We have 2 times in successfully passing medications to our patients the whole day in clinical (which is 9 hours) and today was my first schedule to give out meds. to my patient with a pass or fail mark. I administered 2 medications today: Insulin and Pantoprazole. She passed me when I gave insulin SUBQ in the abdomen in my patient but didn't pass me when I gave Pantoprazole IV (I froze in the part where I had to disconnect the IV from my patient, I paused because I didn't want to hurt the patient and didn't know which port to disconnect it from which made me and my patient nervous/scared so my clinical instructor grabbed the medications out of my hand and administered them herself).

After that she told me to go talk to her post-conference alone and that's when she said she was going to give me another clinical warning because I didn't know what to do (even though I have 1 more chance to give meds. with a pass/fail grade in 4 weeks from now and that's why I pleaded with her to give me 1 more chance since my next/last chance in giving out meds. to redeem myself is in 4 weeks from now but she said that it was my responsibility to practice this/be prepared in knowing what I should do when my schedule for passing out meds. was today so I asked her if I can object to this clinical warning and she told me that I can see the head instructor of my clinical class and talk with both of them about it).

So my question is, is my clinical instructor set out to fail me from the course because in the first 2 weeks that I had her, I had already gotten 2 clinical warnings?

Is she biased towards me because of that?

I asked her if the others passed giving out meds. so far and she had said yes (but I think she's being a little more hard on me although she could've sent me home for not bringing my Patho sheet from the 2nd clinical warning).

It's too late now to withdraw from the class because last day from dropping classes was this week on Monday so is that why she's being more hard on me or am I just being paranoid)?

Any comments/advices/constructive criticism is greatly appreciated! I really can't sleep/study and I've been crying/worried since this evening today because I feel like this clinical warning is the last straw (in the 2nd clinical warning I already had a 10% reduction in my grade so I'm scared/worried that for this 3rd one she's going to do another -10% reduction in my grade again which I don't think is fair).

[springchick1, ADN, RN]

I don't think your instructor is out to get you. Everything you've been given a warning for has been earned. You didn't show up to clinicals prepared on two separate occasions. You're lucky you weren't kicked out of the program because at my school, you would have been.

Take the extra opportunity you have been give and practice. Ask a friend or another instructor that you like to help you find your areas of weakness.

[lilfayfay]

I understand that but do you think this last/recent clinical warning was fair? I agree that the first 2 were understandable

[IVRUS, BSN, RN]

I administered 2 medications today: Insulin and Pantoprazole. She passed me when I gave insulin IV in the abdomen in my patient but didn't pass me when I gave Pantoprazole IV (I froze in the part where I had to disconnect the IV from my patient, I paused because I didn't want to hurt the patient and didn't know which port to disconnect it from which made me and my patient nervous/scared so my clinical instructor grabbed the medications out of my hand and administered them herself). After that she told me to go talk to her post-conference alone and that's when she said she was going to give me another clinical warning because I didn't know what to do (even though I have 1 more chance to give meds. with a pass/fail grade in 4 weeks from now and that's why I pleaded with her to give me 1 more chance since my next/last chance in giving out meds. to redeem myself is in 4 weeks from now but she said that it was my responsibility to practice this/be prepared in knowing what I should do when my schedule for passing out meds. was today so I asked her if I can object to this clinical warning and she told me that I can see the head instructor of my clinical class and talk with both of them about it). So my question is, is my clinical instructor set out to fail me from the course because in the first 2 weeks that I had her, I had already gotten 2 clinical warnings? Is she biased towards me because of that? I asked her if the others passed giving out meds. so far and she had said yes (but I think she's being a little more hard on me although she could've sent me home for not bringing my Patho sheet from the 2nd clinical warning). It's too late now to withdraw from the class because last day from dropping classes was this week on Monday so is that why she's being more hard on me or am I just being paranoid)? Any comments/advices/constructive criticism is greatly appreciated! I really can't sleep/study and I've been crying/worried since this evening today because I feel like this clinical warning is the last straw (in the 2nd clinical warning I already had a 10% reduction in my grade so I'm scared/worried that for this 3rd one she's going to do another -10% reduction in my grade again which I don't think is fair).

First of all, Are you saying that your instructor "passed" you on giving a SQ medication (Insulin) injection? But you're calling it an IV injection???? I get the nervous part... all nurses can say, "been there, done that", But you are telling us that you weren't prepared.. You missed assignments, and you didn't clarify what you were about to do and you froze up because of it in front of the patient!. Many patients don't mind students working on them, but when a student blatantly is clueless, that reflects bad on the student and the instructor. I am sorry, but I too would have giving you another warning. My advice to you is to never be UNPREPARED. It sounds to me like that is the crux of your problem.

[lilfayfay]

Sorry it was a typo. I fixed it now. I just looked on my nursing class website and my teacher just post an announcement

[h=3]Medication Safety Forms and clinical reminders[/h]

N264 students. We talked about the use of medication error/near miss occurence forms, but neglected to post them on Blackboard. They are posted under 'Forms' then "medication Safety'. I have included the policy so that you know how to complete the form. This is a new practice, so while your clinical instructor should prompt you to complete the occurence form, IF you have a medication error or a near miss medication error you should complete the form and turn it in to your clinical instructor. These are not intended to be punitive, but are intended to help you develop a reflective practice (ie. really think about what you are doing) and to reduce the number of medication errors that you commit.

This was my first time handing out medications. We have 1 more chance to redeem ourselves in giving out meds. to our patients with a passing grade. So unless I don't pass the 2nd/last time I don't think it's reasonable to give me a clinical warning, I didn't hurt the patient (I didn't know where to disconnect the IV line) and so that's why I paused to do anything else to not hurt my patient.

[springchick1, ADN, RN]

I think that by your second quarter and your fourth clinical, you should know how to unhook an IV. If you had any questions or concerns, they should have been addressed before you went into the room with the patient.

[lilfayfay]

Our quarters go by 10 weeks, but based on the announcement my head clinical instructor posted she said "IF you have a medication error or a near miss medication error you should complete the form and turn it in to your clinical instructor. These are not intended to be punitive but are intended to help you develop a reflective practice (ie. really think about what you are doing) and to reduce the number of medication errors that you commit." They neglected to post this until today so I really don't think the clinical warning was necessary.

[springchick1, ADN, RN]

OP, obviously you aren't going to get what you are looking for here. I'm not going to tell you that your instructor is being unfair because she isn't. Most places you would have failed after not showing up prepared twice. YOU need to take responsibility for your actions and stop trying to shift the blame.

[NurseGirl525, ASN, RN]

What is a clinical warning exactly? Every school is different with the way they do things. We don't have warnings, which sounds to me you really aren't being disciplined so much but being told to don't do it again.

Is this a for profit school? I just ask because it seems a little odd the way they do things. We are not graded pass/fail in a clinical setting like that but I have heard of that occurring at for profit schools.

To to me it is impossible to remember everything. Now if you had said you messed up on the 6 rights of med administration I would say yeah, you deserve that, but an iv push on second quarter? That may be a little harsh depending on what you did first quarter and if this is a skill you can practice in sum lab and become proficient with. I always get confused on hanging the bags and what line goes where. I know when I do it over and over I will be fine, but I only hung my second one ever last week and I was all thumbs. But we are not graded on that stuff. We are graded on how much we progress in the semester. Like I said each school is different.

But you are showing up unprepared. You need to fix that, like now. Not having your hair pulled up, come on, you know that needs to be done. You need to thoroughly read your syllabus and see what is expected of you from each instructor. They are all very different.

I would stufy real hard for the next med pass. These are important concepts to know. Good luck!!

[JustBeachyNurse, LPN]

I understand that but do you think this last/recent clinical warning was fair? I agree that the first 2 were understandable

Yes. You were not prepared. You did not know what to do and in your panic diminished patient confidence in your ability. Absolutely deserved. It wasn't a surprise that you had a med pass scheduled. The onus was on YOU to be ready

[LadyFree28, BSN, LPN, RN]

Our quarters go by 10 weeks, but based on the announcement my head clinical instructor posted she said "IF you have a medication error or a near miss medication error you should complete the form and turn it in to your clinical instructor. These are not intended to be punitive but are intended to help you develop a reflective practice (ie. really think about what you are doing) and to reduce the number of medication errors that you commit." They neglected to post this until today so I really don't think the clinical warning was necessary.

But you didn't have a near miss medication error-you demonstrated that you were NOT PREPARED to effective administer medications.

Nursing school is about effectively preparing yourself to effectively advocate for your nursing practice and your patients; once you saw that you had to administer an IV med, you could've alerted your instructor that you have not administered an IV med and need assistance reviewing it or time to research how to do it.

There are going to be many procedures that you may not do in a regular basis as a nurse-it is up to seek assistance or research before we do a procedure in order to be provide safety and minimize discomfort for the pt. Based on what you explained, you did neither, and it seems as though you don't understand what type of error you demonstrated-another red flag.

Your best bet is to correct your mistakes, be prepared, and seek out resources for procedures you didn't know if you want to correct this, no matter what the outcome of this event.

Best wishes.

[lilfayfay]

I asked and a clinical warning is to make sure you don't commit the offense again (which I haven't). It seems to me that based on my 3 clinical warnings so far it's based on something different (my first 2 were reasonable but I don't agree with this 3rd one). Clinical warnings can also result in a -10% reduction of the grade. And I go to a public CSU university.

I didn't mess up on the 6 rights of medication but when it came time to unplug the IV to put in my medication IV push, I froze and my clinical instructor took the medications and did it for me. This is our first quarter actually giving out medications/IV by hand. I did fine giving out the shots (we practiced a lot on administering shots first quarter) but not the IVs (this is a 10 week quarter so everything goes fast and it's hard to keep up so that's why we're given 2 chances of having a pass/fail at administering medications).