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).
In every nursing program in which I've been a student or a faculty member, it is the responsibility of the student to come to clinical prepared to safely and appropriately administer the medications the client has ordered. If you approached the client without knowing which port you were supposed to use, or how to disconnect the IV, IMO, that's unprepared. That's something you should have researched and verified prior to actually giving the medication and, IMO, the clinical warning was appropriate.
It's not "bias" on the part of your clinical instructor if you keep having performance issues in clinical -- that's just the clinical instructor doing her/his job.
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).
You still don't get it....you demonstrated that you didn't know what you were doing during medication administration-freezing up was enough evidence that you were unaware of the procedural process of medication administration-even not knowing how to connect is an error on your part. Think about it...in order to effectively administer medications, you need to know procedurally how to do it; your hesitation on even how to connect or disconnect it would look like you missed the right route.
I went through PN school, which was one year and clinicals changed faster than I could change my underwear; and an Accelerated BSN program-everything was fast paced, and I utilized the resources that was available to me-suggested YouTube links, nursing lab, and my clinical instructor-before I did any procedure I was prepared to do it, and voiced it was my first time, what I knew FIRST, then expressed what I knew and what I needed help with beforehand.
And besides, a clinical warning for not properly administering medication in this case is STILL valid.
Specializes in Complex pedi to LTC/SA & now a manager.
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).
Well you were wrong. This isn't a "near miss" or "medication error" so the 'non putative medication error' does not apply. This is you for the third time, not being prepared for clinical. You deserved the third warning whether you agree with licensed nurses telling you do or not. Messing up the 6 rights would have been a medication error not an unprepared clinical warning. You did not know what to disconnect or where to connect the IV medication. You risked your clinical placement by not being prepared yet a third time. That patient had no confidence in you and could have complained to the hospital which could have been even more devastating for you than a clinical warning.
You are focusing on the wrong issue. You were not targeted. You made the error of not being prepared to administer an IV piggy back infusion. You admit you froze. You admit you did not know what to do = not prepared for safe & efficient medication administration on your assigned day. I doubt this was a STAT order sprung on you at the last second.
You need to set yourself up to be better prepared moving forward. If you elect to appeal this deserved clinical warning it likely won't turn out the way you hope. You will have to explain why you were not prepared, why you did not know what to do, why your actions reduced patient confidence in clinical staff. Do you want to go down that doubt? And you may be asked to create a clinical improvement plan for yourself to ensure you don't repeat.
You would have been dismissed from my program's clinical and failed for appearing on site unprepared. Out of uniform without a pen you'd have been sent home the first day.
Specializes in Cath/EP lab, CCU, Cardiac stepdown.
If you did not know what you were doing then you needed to ask questions or state that before it ever got to the point where you're right next to the patient about to do it. It is your responsibility to be prepared beforehand as you knew you were going to be giving meds. If you didn't know, then it was your responsibility to let your instructor know that you are unsure. You do not just stand there and wing it, which I'm sure was what the patient and instructor felt.
From your posts you are making too many excuses and this will impair your improvement. If you can't even admit to where you went wrong how are you going to improve?
You've stated that you're unfamiliar with it and that everything is going fast and it will be your first time administering it this semester. So why didn't you research and ask questions and practice in lab prior?
You said that you felt like no harm was done, well the whole point of clinicals is to develop safe practices and to correct the action BEFORE harm is done. If there were harm to the patient it would have been likely you would've been dismissed from the program, so a warning is more than fair. And are you providing safe care if you go up there not knowing how to do something and you don't even speak up?
Now you also say you felt like the instructor is biased against you. Now if you had a student who has demonstrated incompetence twice already, wouldn't a prudent person be more vigilant when that person is about to administer direct patient care? That is their job, if you already messed up they gotta watch you even more carefully because you've already shown that you are unprepared not once but twice. Now add to the third time that you've been unprepared as you failed to research and practice beforehand. Not to mention you failed to disclose your lack of knowledge and confidence.
If you are serious about nursing you really gotta do some serious reflection. Nursing is not just something we do on a whim. We are in a career where people's lives are in our hands. There's a difference in not knowing how to use a fax machine and not knowing how to properly administer a medication (especially IVP). So far your mistakes have been small but do you really want to wait until you have a big mistake. At that point you may be causing adverse effects on the patient. So really how serious are you about nursing and are you going to choose to take this lesson as it wasn't my fault or I learned from this and will never have this mistake again?
It sounds like you just need more practice at this skill. But, I still would not discount that this instructor is out to get you. I have seen this in one of my clinical. A judge, that was a friend of the students father, actually said this instructor was "guilty" of bulling. The other students didn't want to defend this particular student because it was close to graduations and didn't want to get involved. The Department Chairperson went to clinical and saw what was going on. The student was a very good nurse and luckily for her, she was a strong person to defend herself. It could have turned out much worse.
It's only unreasonable if you've already been taught how to and have been able to practice and master disconnecting a line and hanging a new bag or giving a push through a port. If you haven't, then it's totally unreasonable. If you have (which, tellingly, you haven't mentioned), then it's reasonable.
It seems like she was right to give you all three warnings because you were not prepared. At my school, coming unprepared or not knowing a procedure was cause for a write-up, two of those and we failed clinical. I suggest you attend skills lab to practice the different types of medication administration so that you are prepared when you attend clinical and not freeze up.
OP- stop playing the blame game, get over this 'it's not fair' childishness, and get to work perfecting your skills. The amount of time you've wasted posting and telling US we are wrong/ unfair could be put to more productive use.
Specializes in Cardiac (adult), CC, Peds, MH/Substance.
I will attempt to offer a little perspective. As a lifelong student and teacher, I believe I have fairly broad experience holding a clipboard while watching people do tasks and having people watch me while holding a clipboard. I've been a Soldier, medic, instructor, noncom, commissioned officer, project manager, operations manager, service manager, vice president, student at many schools, and so on. I'm now a BSN student who wears a PVC superhero costume and jumps across buildings in his ample spare time.
When early on in a clinical instructor - clinical student relationship, the student shows blatant disregard for very basic standards, it is remembered. Do not forget your name badge or pen on the first day. Do not fail to put your hair up because you didn't feel like it. And before there is a statement about not remembering to put hair up: We remember to do what is important to us. Do not fail to turn in your first, second, third, or fifth assignment. If you come unprepared on the 13th day, most instructors will either give you a break, or treat you in accordance with the syllabus (grade reduction, et cetera), but you will not be marked for potential execution. If you show up unprepared on the first day, you aren't marked, but you're noticed for certain. First impressions are impossible to recreate. If after being noticed (in a negative way) you are noticed again, you are no longer just noticed. You have graduated from being noticed to being a potential problem student. Once you have been marked as a potential problem student, instructors will generally be much more stringent with you on standards. You only get so many freebies. Never use them during the first week, because you'll probably need them later. And as mentioned already, if you use them early, instructors will make the (usually valid) assumption that you need additional monitoring.
So, the first point is: What you did this time, don't do it again, ever. Suck your lumps up and learn from it. Show up in uniform to the next clinical with your homework done, your hair and uniform pristine, all your reading done, your practice skill sets done, and ready to ask LOTS of questions if you have them before you enter a room (not after).
My observation of your word choice is this: Stop doing that, yesterday. If you want to be successful in your program, choose words that combine into sentences such as, "I really screwed up by being totally unprepared repeatedly and my instructor is giving me more attention than I want now. I'm worried that it will result in me not passing the course. You know, it's that kind of attention. What can I do to build the instructor's confidence that I won't kill anyone if she turns around for five seconds?" Those are more productive words, and it's a more productive attitude.
You've harmed the instructor's confidence in you by, excuse my *#$@'s, but by clearly not giving a #$@& on the first two times you received warnings. Those were not the result of making a mistake or forgetfulness, and your instructor probably realized that. The third warning - maybe it was harsh, maybe it wasn't. None of us were there watching you. But something we can form an opinion on is that after two warnings not just for being unprepared, but for being unprepared in a way that clearly indicates you were not taking things seriously, you are more likely to be looked at very closely for every patient interaction after that.
I truly believe that you need to look inward. Try doing some meditation, clearing your mind, then reading your own posts as if you were an instructor or experienced nurse reading them, then try to play the role of that person reading your writing and offer yourself advice. Pretend they aren't your own posts, but someone else's who needs help. I have a feeling that if you approach this activity with honesty, your guard down, and an open mind, it will be productive.
My question is: why would you need to "unhook the IV" to administer the IV pantoprazole? It is compatible with most continuous fluids. You would simply pause the infusion, do a flush in the Y-port nearest the patient, then administer the med in the Y-port with a follow up flush to make sure it all went in the tubing. Then you re-start the infusion. No need to unhook all the tubing from the patient.
We were taught not to unhook the tubing unless there's no compatibility at all with the meds/fluids. A quick check in Lexicomp using the IV Compatibility tool will tell you if it's safe to administer in the same tubing.
Now, the next question is: what did you do wrong when you tried to disconnect the IV tubing that would make your instructor fail you? Did you forget to lock the tubing and blood starting backing up in to the tubing? Did you accidentally unhook the positive pressure cap instead of the actual tubing? These things are very important to know.
I don't think your instructor has it in for you. Put yourself in his/her shoes. She's already given you 2 warnings, so she's going to be very vigilant with you to ensure you're not headed towards a clinical failure. She also has to ensure patient safety. The school's reputation is on the line when students are on the floor.
I would take the advice you've been given from your instructor and strive as hard as you can to be prepared in advance for your clinicals and to know your meds. If you don't know them, look them up so you're 100% sure how to properly administer them. Review technique if you feel like you blank under pressure. You haven't failed out, which is the good news for you. Not sure if your program gives an actual grade for clinicals. Ours were simply pass or fail. We only received a grade in the classroom course. Clinicals were "attached" to the course.
A classmate of mine was failed for the entire semester, in our last clinical rotation of the entire program (before the internship). Her offense: she and the instructor went into the room for her to set up the pt's tubefeeding, and she didn't know what to do.
If clinical warnings can cause a 10% deduction and you've gotten three, you should be thanking your school for not having failed you already. Assuming you had a 100% going in the class, 3 10% deductions takes you to failing (because 70% is generally an F in nursing school.)
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).
What is your point with this? That you didn't repeat one mistake--just made repeated mistakes? Actually I would argue that the 3rd is the most serious. It takes 2 seconds to tie up hair and find a pen. Assignments can be handed in late if the instructor is willing to accept them; usually you're docked points, but the learning still happens when you complete the assignment. Not knowing how to give an IVP med before touching that pt is a whole different story. Did you not learn them in lab? And if not, why would you not ask the instructor for help BEFORE fumbling with that pt?
You asked for thoughts, but immediately argue with anyone who says your instructor had a point. Heck you've engaged in a back-and-forth with springchick, which tells me that you did not come here seeking to understand; you came seeking validation that isn't being given...so you are defensive. That is not a teachable attitude.
In a student or novice RN, defensiveness and an unteachable attitude is a very scary thing. Those are the ones who are dangerous.
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Dacatster, ADN
97 Posts
Sorry you were unprepared in every case, first or tenth clinical, it doesnt matter.