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).
As a recent graduate of nursing school (Dec. 2015) I'm not far removed from the nervousness of performing tasks in front of instructors who are watching your every move. The key, though, is preparedness. Just about every person who has responded to your post has mentioned that word.
If you aren't sure about a procedure, don't go in and try to fake the funk. If you know you are scheduled to perform a task that day, review the steps the night before and the morning of. Even before you go into the room with your instructor, run through the procedure and ask for feedback. That's what they are there for. The worst thing you can do, besides physically harm the patient, is to lack confidence and have it show in front of the patient.
I think your warnings were totally justified because you were unprepared. YOU did not do the things you needed to do prior to arriving at clinical. You also seem to have an excuse for everything. You have to take responsibility for your actions because as a nurse, you will have peoples lives in your hands and excuses for harming them are not acceptable.
Do your best to prepare for each clinical day. These are limited opportunities to practice those things that we read about in our texts. Most students don't even get to experience a vast variety of situations in clinical so you have to make the most of each opportunity by being ready to participate.
I hope you take all the advice you have received and give it some real thought and consider what you can do differently. I hope that the rest of your clinicals go smoothly. Best of luck to you.
(P.S. please consider breaking up your sentences as they are way too long and difficult to read)
When I would have an instructor watching me do something, heck or even the nurse if I was doing something with them and not my instructor, I would always review the procedure with them before going in. Even if it was something I had done before. It was for 2 reasons. One was to show I prepared and learned the procedure. The second was so that in case I forgot a step or was nervous and went blank, it would happen outside the room where it could be corrected before ever touching a patient. Because of that, I never fumbled through a procedure. And if it was a first time for a certain procedure, I would let whoever was monitoring me know so that if I was slow, I wouldn't get docked for not being prepared.
You are defensive because you did not get the answer you wanted. You got the truth. You were wrong in all 3 instances and all 3 warnings were for being unprepared in some form or another. Just own it. You will never move and never learn if all you want to do is argue your wrong doing. Suck it up. Move on. Do better next time.
And just some advice, if ever you go blank on a procedure in front of a patient just smile and let them know you want to double check you're doing it right with the instructor. Then ask the instructor what to do next in a calm manner. Half of this warning was probably purely for how you acted and made the patient feel. Never make the patient lack confidence in you. They will respect you more and be more confident if you admit you are stuck and need some help. They will appreciate that you are making sure it's done correctly. But freezing and scarin them will make them apprehensive with you and probably other future students.
If you are looking for someone to tell you that you are right, you are wrong. All of the warnings that you received were indicated. SAFETY is primordial in any and every situation involving a patient. With SAFETY comes PREPAREDNESS. You already knew that it would be an IV injection, your responsibility was to familiarize yourself with the tubing prior to administration. As a student, every time that you walk into a patients room, you might find something that you not have seen before. Always ask questions. Lack of knowledge is not an excuse for wrongdoing. Hope that these become learning experiences for you. You seem to have a lot of energy and focus on learning about "Clinical Warnings", use that same eagerness to learn about how to come prepared to clinicals. Best of luck to you!
As said before you started out as a problem student and the instructor knows that. You disregarded the rules and expected a free break. The instructors at my school got rid of the people they did not feel would make good Nurses. Out of a class of 48, only 23 graduated. The rest either dropped out on their own due to stress, or were kicked out of the Nursing class for infractions. I hope once the Instructor gave you the warning she explained how the procedure should have been preformed. Good luck to you in the future. Talk to a trusted friend or Advisor and make sure you are prepared for each and every class.
As an Instructor, I have a few questions....Were you aware that you had to give meds prior to your arrival? If so, were you given time to research the medications prior to administration? When was the last time that you administered a medication IV? Have you ever done a piggy-back administration? Had you reviewed this prior to your arrival, if you knew you were giving meds? These are things that I would ask one of my own students. It is not only our job to train you but it is also your job to be prepared for each clinical day. I would tell my students to be prepared to administer medication via any route, as we cannot predict the type of patient that you may have or what their mediation may be.
I cannot speak to the policy regarding the reduction in your grade re: medication administration. I would say if it's not in the policy, it probably would not stand. I will say that from here on out, if you choose to dispute the warning, you need to be 100% prepared for each and every possibility. Go to the lab and practice, enlist other students to help. Ask for information and clarify the expectation of the clinical instructor before the first day. It would seem to me that her expectations should have been covered in orientation, if everyone else had it done, you may have missed her saying that.
Best of luck to you. Do not let this discourage you. We all make mistakes...the patient was NOT harmed!!!
I think people are too fast in judging this young lady. I agree she should have got a warning on the first two occasions. On the third occurrence, however, she needs to go look at her clinical sheet. Did she miss an essential step or not. What did the syllabus say she would be graded against? What were the written clinical expectations? What is the policy of the school regarding deduction of points in case of clinical warning?
Was she made familiar with the equipment, meaning tubing before she was assessed in its use? This case to me looks like the student was hesitant because she did not want to harm the patient. Patient tubing can come in different shapes and sizes, depending on which unit they are coming from. Was she prewarned which port to flush or disconnect at?
Clinical teaching is moving away from bouncing quarters on beds and punitive actions that result in student anxiety. Students go to clinicals to learn and should be treated as novices not experts.
The written announcement negates the action that was taken by the instructor, or the practice of passing failing people based on one action. The school I taught at, did not even assess medication admn on site. We did that in the lab in house.
My suggestion to the student is, to take it easy. Worrying will not help. It will rather hinder you. You need to go talk to your clinical instructor and ask for detailed steps expected for a student to pass, preferably, a sheet spelling out all the steps. If you are giving IV meds, go into the patient's room and familarize yourself with the equipment first. Practice, practice, practice.
If you do all that and still fail, then appeal the decision to the department chair. Produce your written proof, or the absence of it. If they did not tell you all the expected steps in writing on a clinical sheet, that is evidence, because you had no way to know what to do. Everybody doing something is not evidence enough. They all might have been wrong.
I don't mean to bash you when you are down, but showing up for clinical with your hair down and no pen is completely your doing. I am pretty sure that the "rules" were already given to you before the first day of clinical. If they weren't then I guess you have a valid argument. As far as the medication incident, we had lots of simulations prior to the real deal. When it was our time to give medications, we had very supportive, helpful instructors who wanted us to succeed. Quite frankly, your's seems harsh but I don't know the whole story as I wasn't there. One thing I do know...............you are very lucky to still have your spot so take these things as a big learning experience and don't let it happen again.
Specializes in Cath/EP lab, CCU, Cardiac stepdown.
I think the majority of nurses here find issue with her trying to wing it. You do not wing anything in nursing. It's one thing to be unprepared, speak up before you get to the patient. The instructor might be displeased that you weren't prepared but they will mainly understand if you're not familiar with it. At this point they usually will guide you through it. But to go up there in front of the patient and not say anything until the instructor notices, then that is an issue. The patient has lost confidence in the student, the instructor, heck probably the other nurses too.
Borrow a pen. Steal a pen. Never show up to a clinical without a pen and why in the world would you go to clinical with your hair down. It's just gross for you and the patients.
At my school you're out after one clinical warning. Clinical is a big deal. Yes you are there to learn, but act like you want to learn. Read up on stuff, watch videos, spend time in a skills lab...don't be unprepared. And ask questions before you go in a room.
Well my dear, let's say that you started on the wrong foot. If you Really want this career you will have to make every effort to redeem yourself. Come early to clinical; ask to be assign difficult cases; ask your professor for guidance; be available to do Anything on the floor. That is what your professor is waiting for right now... she wants you to show her that you really want to be an RN ! Good Luck, it's not too late... do not fight this!
As a "head instructor" I would want to know, is this a skill/medication you were supposed to know? If so, and you weren't prepared, it would warrant a warning at minimum. My advice would be to hit that skills lab and those books extra hard and knock out that next medication administration opportunity!
So far, I have to agree with the majority of the comments. It may be hard to keep up, because it's an intense semester etc. and that's true, but if you knew in advance, you are responsible for being prepared to give medication.
When you get your patient assignment, it's a good idea to take a minute and look up medications you're giving (be it with a drug book, micromedex etc.) and know the basics of what you're doing. No one is asking you to know it all. Your instructor is a resource. If you aren't comfortable with it or feel 100%, ask her to go over with it briefly with you, while you explain how you plan on proceeding.
Mistakes happen, licensed nurses make mistakes, but they have to step up, take responsibility, and be proactive in making sure it doesn't happen again. In your case, spending time practicing things would probably be beneficial.
I really hope this helps, and I'm sorry if it comes off a little harsh, it's hard to convey feelings in a comment thread.
Jaykalkyn, BSN, RN
144 Posts
As a recent graduate of nursing school (Dec. 2015) I'm not far removed from the nervousness of performing tasks in front of instructors who are watching your every move. The key, though, is preparedness. Just about every person who has responded to your post has mentioned that word.
If you aren't sure about a procedure, don't go in and try to fake the funk. If you know you are scheduled to perform a task that day, review the steps the night before and the morning of. Even before you go into the room with your instructor, run through the procedure and ask for feedback. That's what they are there for. The worst thing you can do, besides physically harm the patient, is to lack confidence and have it show in front of the patient.
I think your warnings were totally justified because you were unprepared. YOU did not do the things you needed to do prior to arriving at clinical. You also seem to have an excuse for everything. You have to take responsibility for your actions because as a nurse, you will have peoples lives in your hands and excuses for harming them are not acceptable.
Do your best to prepare for each clinical day. These are limited opportunities to practice those things that we read about in our texts. Most students don't even get to experience a vast variety of situations in clinical so you have to make the most of each opportunity by being ready to participate.
I hope you take all the advice you have received and give it some real thought and consider what you can do differently. I hope that the rest of your clinicals go smoothly. Best of luck to you.
(P.S. please consider breaking up your sentences as they are way too long and difficult to read)