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).
Specializes in primary care, holistic health, integrated medicine.
I could be wrong, but I don't think you are supposed to IV push Pantoprazole. It is irritating to the veins... I suppose it depends on the dosage, but I have always seen it mixed in a bag of saline. You are supposed to give 80mg over 15 minutes. In reality, that is a long time, so usually it is mixed. So I would not consider this an IV "push". But for the OP, look up EVERY drug you could possibly be giving and make sure you know the most important administration details, side effects, possible contraindications, etc. If you have an open skills lab, go in and practice with IV administration sets. Every hospital has slightly different equipment, but, the more you touch it the more comfortable you will be with it. Always look at the IV site and make sure it looks healthy before you inject anything. If it is covered with anything, remove it and assess the site no matter what. And I HATE the term "med pass". Medical technicians "pass meds". Nurses administer medications. I think there is a huge difference.
I could be wrong, but I don't think you are supposed to IV push Pantoprazole. It is irritating to the veins... I suppose it depends on the dosage, but I have always seen it mixed in a bag of saline. You are supposed to give 80mg over 15 minutes. In reality, that is a long time, so usually it is mixed. So I would not consider this an IV "push". But for the OP, look up EVERY drug you could possibly be giving and make sure you know the most important administration details, side effects, possible contraindications, etc. If you have an open skills lab, go in and practice with IV administration sets. Every hospital has slightly different equipment, but, the more you touch it the more comfortable you will be with it. Always look at the IV site and make sure it looks healthy before you inject anything. If it is covered with anything, remove it and assess the site no matter what. And I HATE the term "med pass". Medical technicians "pass meds". Nurses administer medications. I think there is a huge difference.
I work on a floor where i regularly give iv push pantoprazole. Rather than vein irritation i try to push it slow because it can cause tinnitus when pushed too fast. Depends on the doctor i suppose. :)
I could be wrong, but I don't think you are supposed to IV push Pantoprazole. It is irritating to the veins... I suppose it depends on the dosage, but I have always seen it mixed in a bag of saline. You are supposed to give 80mg over 15 minutes. In reality, that is a long time, so usually it is mixed. So I would not consider this an IV "push". But for the OP, look up EVERY drug you could possibly be giving and make sure you know the most important administration details, side effects, possible contraindications, etc. If you have an open skills lab, go in and practice with IV administration sets. Every hospital has slightly different equipment, but, the more you touch it the more comfortable you will be with it. Always look at the IV site and make sure it looks healthy before you inject anything. If it is covered with anything, remove it and assess the site no matter what. And I HATE the term "med pass". Medical technicians "pass meds". Nurses administer medications. I think there is a huge difference.
We do 40mg push in 10ml in the ED. At minimum a 2 minute push.
Specializes in Nsg. Ed, Infusion, Pediatrics, LTC.
I'm sure there would obviously have consequences if something happened that put the patient at risk... Buy that never happened from what I know. Our program , like many other bsn programs, focused mainly on theory rather than clinical experience. We didn't have skill test outs, etc.
Eek. How would you show competency for even the most basic nursing tasks? Was there even a high fidelity simulation lab so the students had some sort of clinical experience with competencies?
Specializes in Cardiac (adult), CC, Peds, MH/Substance.
My school's conduct guidelines specifically state that if you feel unprepared for a task, you need to speak up, and that not doing so may result in expulsion if patient safety is endangered as a result. They, basically, expect a mature response to the situation.
Did you read the part where the patient was scared and nervous? Do you think that it is appropriate or therapeutic to let a fumbling student nurse to continue to fumble around a scared patient who clearly has lost confidence in the student? Can you imagine how this reflects on the school and hospital? While students are there to learn, they are not there to learn at the expense of patient care.
And please read carefully where it was stated many times that the last warning was more likely due to the fact the student was unprepared, again, and that she did not speak up about being unprepared prior to reaching the patient. You do not stand up at center stage and then fumble around. You speak up and say, professor, do you think you can walk me through this part or show me?
Specializes in Cardiac (adult), CC, Peds, MH/Substance.
You can push it. I'm not aware of any med reference that states otherwise. Med pass versus administration is semantics. I've seen both used to describe nurses administering chemicals at over 20 facilities and in two nursing schools.
I could be wrong, but I don't think you are supposed to IV push Pantoprazole. It is irritating to the veins... I suppose it depends on the dosage, but I have always seen it mixed in a bag of saline. You are supposed to give 80mg over 15 minutes. In reality, that is a long time, so usually it is mixed. So I would not consider this an IV "push". But for the OP, look up EVERY drug you could possibly be giving and make sure you know the most important administration details, side effects, possible contraindications, etc. If you have an open skills lab, go in and practice with IV administration sets. Every hospital has slightly different equipment, but, the more you touch it the more comfortable you will be with it. Always look at the IV site and make sure it looks healthy before you inject anything. If it is covered with anything, remove it and assess the site no matter what. And I HATE the term "med pass". Medical technicians "pass meds". Nurses administer medications. I think there is a huge difference.
I have to break it to you, gently I hope, that coming across as a person who doesn't prepare is the #1 thing that will make life impossible in nursing school. Your instructors will not be motivated to help you, and may (as I think might be happening in your case) be more inclined to grade you harshly because they feel you haven't done your end of the work. I speak as someone who has been on the receiving end of this kind of smackdown. This is why communication is so vital. Email an instructor to clarify assignment instructions, make sure you review what you expect to be doing the night before clinical, have backup supplies in your car, memorize that syllabus, admit when you are fuzzy on how to do something, show humility.
Your recourse is to do whatever you need to in order to show instructors that you are prepared and motivated to do well. Sometimes you have a rough clinical, a rough semester, or a poor instructor fit... get up and do better :)
mystcnurse, MSN, APRN, NP
115 Posts
I could be wrong, but I don't think you are supposed to IV push Pantoprazole. It is irritating to the veins... I suppose it depends on the dosage, but I have always seen it mixed in a bag of saline. You are supposed to give 80mg over 15 minutes. In reality, that is a long time, so usually it is mixed. So I would not consider this an IV "push". But for the OP, look up EVERY drug you could possibly be giving and make sure you know the most important administration details, side effects, possible contraindications, etc. If you have an open skills lab, go in and practice with IV administration sets. Every hospital has slightly different equipment, but, the more you touch it the more comfortable you will be with it. Always look at the IV site and make sure it looks healthy before you inject anything. If it is covered with anything, remove it and assess the site no matter what. And I HATE the term "med pass". Medical technicians "pass meds". Nurses administer medications. I think there is a huge difference.