clinical instructor problem or is it me?

[studentnurse162484]

I am in my third semester of nursing school. This incident occurred the 4th week of my medsurg clinical rotation. Up to this point, I had received all satisfactories on my clinical evaluation and no negative comments. I have always received outstanding reviews from my previous CIs.

Ok so to the problem, it was my first and only turn to pass meds this rotation. I would like to add this was my first time doing an IV flush/push or using a needless syringe in general. The patients RN pulled all the meds and my CI placed them in a black pencil holder. We went over the meds in the holder and compared them to the MAR in the hallway. MY patient had an IV med that I needed to draw up. My teacher told me to draw up the med in the hallway so I did, then I removed the needle from the syringe. I carried the black pencil holder with meds inside in one hand and the needless syringe in the other.

I lay the bag down next to the computer. (The MAR was already pulled up from before we left the room.) My CI pulls the meds out of the holder(most were PO, one was subcut, and then a NS and Heparin flush). I lay the needless syringe we had drawn up next to the meds. My teacher proclaims "What is this?!" I point to the now empty vile we used to fill it up in the hallway. she stated, "you never ever do this. this is a huge no no. YOu cannot do this..." I immediately felt awful but honestly I was unsure of what I did wrong. I almost felt that since she said "what is this" she had forgotten we drew it up in the hallway together. So I thought I should have labeled it because I remembered reading/learning in class to label syringes you draw up. That is all I thought I did wrong. Then we scan the drugs laying on the countertop in no particular order. My teacher was going so fast I wasn't really able to make sure we had scanned everything. It's like she knew what she was scanning, and didn't want to wait for me to read the drug name and make sure it was there. I honestly felt like she was doing it all and was just going to let me administer them. Then she checks the blood return and lets me admin the normal saline...she stands behind me at the computer and hands everything to me over my shoulder. We finish that procedure and she says next I would give the subcut then do the PO and she leaves the room with the bag and I complete their meds. It all felt very rushed. I left thinking what just happened?! (in regards to the IV push) The whole time she was just handing me stuff and I didn't have time to stop and think what I was really doing. I wouldn't have known if she had given me the wrong med it was happening so fast. A few hours later she walks in to the room holding the black pencil pouch and asks if the patient was on ibuprofen. I say yes. She checks the MAR and comes back and says you forgot to give this so I immediately give it. So that was my day...

Now fastforward to my clinical evaluation ticket. She gave me one S and the rest were S- which technically she can't even do its either an S or U. Her comment stated that I failed to cap or label a syringe. I forgot to give a med at the schedule time and I didn't finish charting before I left for lunch. She stated that I was halfway through my rotation and needed to step it up to meet basic requirements. I really took it personally because if we are almost done with the rotation why is she jut now saying I need to step it up. Why didn't she say anything to me previously?

I was at a loss for words. I went home and cried. I spoke with some of the other students in my clinical who had done IV meds and they said they didn't label the syringe. THey also stated they didn't usually chart the assessment until after lunch. This was the first week I hadn't completely charted my assessment before lunch. I didn't think it was a necessity to cap the syringe if I was immediately going to give it to the patient.I didn't even realize I should have done it until she wrote it in my evaluation. Being my first time doing anything with needless syringes, why didn't she walk me through the procedure slower? Why didn't she tell me in the hallway to cap it and label it as a reminder? I honestly feel like she was setting me up for failure. Why did she wait til after to reprimand me instead of reminding me while I was preparing the syringe to teach me the importance of these things. As far as the medication admin error, I didn't get to check the black bag to see if I left anything out. Witht previous CI, we would go down the MAR one by one. I didn't even pull the meds out of the bag. I believe I had a part in not noticing I did not give one med but I feel like she was also to blame and should have taken some of the responsibility. The reason she was in the room and scanning the meds with me was to make sure I gave meds in their entirety and correctly.

To make matters worse, at lunch in front of thte rest of my class, she stated that I was just not with it and my head was off today. We have one more week and this week I will have two patients. I am just terrified to ask her for any direction or questions. I hope and pray I get a helpful RN and easy patients, because I don't want to have to do a skill I hven't performed before in fear of getting unsatisfactories. I just feel like she is very inconsistent. How can we know what we shouldn't do if she doesn't walk us through it.

Honest opinions would really help. This has been bothering me all week and I just can't get it off my mind.

[klone, MSN, RN]

I'm sorry that happened.

But yes, if you're giving more than one medication (and technically, even if you're only giving one), you need to label them. Otherwise, how can you be sure of what you've just given?

And yeah, it's a big no-no to remove a needle from a syringe and not IMMEDIATELY replace it with a sterile cap or another needle. At the very least, you can slide the protector over the needle and leave the old needle on to protect sterility until you can put a new needle on it.

[caliotter3]

Does your program have a retention coordinator or a separate advisor? I would speak to your advisor or another faculty member to get advice on this situation. If for no other reason you will have brought this to a third party's attention prior to any adverse action. That could work in your favor.

[Stephalump]

I forgot to label a med in clinical once.

Technically, my preceptor drew it up while I watched and then left it for me to give with my instructor - common practice where I was.

All hell broke loose when my instructor came in and I tried to give an unlabeled med that someone else drew up. It threw me for such a loop, and made me so anxious, I couldn't function and I ended up being sent home for the day with a big, fat F.

Ah, memories ?. Just remember...eventually all this will be a distant memory.

As other people have pointed out, yes, you have to label meds, and YES, you have to be responsible for your patient, even if your instructor is pushy and gets in your way. I know I struggled with really being "in control" and taking full responsibility when I was in clinical (too many irons in the fire, not enough time for me to process without other people jumping in), but it's something to work on.

Don't beat yourself up. You're there to learn, and lots of lessons are leaned by making mistakes.

As far as her behavior, it was totally inappropriate to talk to you like that in front of your peers, and you're right...she could've took the time to educate you, vs whatever she did. I had an instructor like that in my 3rd semester. I burned her effigy in our graduation bonfire.

[windsurfer8, BSN, RN]

You cried..now move on and get back to it. It really is a waste of time to even blame anyone. You have a tough instructor and that is good. Most are fairly hardcore...for a REASON. If you made a med error you can kill someone. Not to mention law suits...losing your nursing license...all of it. So yes...this isn't like working at wal-mart. What matters is humility and doing what your instructor tells you to do. Period. Learn from it and move forward.

[NICUmiiki, DNP, NP]

I don't know if it would be acceptable where you are, but we tape the empty vial to the syringe. That way, it is labeled, and we are able to scan the med in the room in one fairly simple and quick step. After you draw up the med, engage the needle safety, and leave it on until you are about to give the med.

[mrsboots87]

Technically, this is entire situation is your fault and your responsibility. WHen you are an RN you will get pushy coworkers and patients, and you need to be able to keep your head on straight and complete the task at hand. Also, when unsure of what to do, dont just do it in hope you will be corrected. Knowing you would be doing an IV push with a needles system, if you didnt know exactly what to do you should have looked it up or asked your RN or CI before started. When you go to the med pass when she rushed you through, you could have rechecked your meds against the MAR before giving them. You said the instructor passed everything to you after scanning and then left the room. That didnt mean you had to just give them. You could have looked at the MAR to match your meds, and you would have seen the missing ibuprofin at that time.

With all that said, you are a student. And you will make mistakes. I am a student too and have made a mistake before. It happens. dont beat yourself up over it. Just learn from the experience and move on and do better next time. If you get offered a new procedure tomorrow that you havent done before. Dont just shy away from it out of fear. Look up the procedure before doing it. Ask your nurse or CI questions before. Then when you get to the procedure, you will know what to do and will not get graded negatively for it. GL

[mrsboots87]

Also, for the uncapped syringe. You put the syringe on the table. What about any germs on that table? The outer edge is now contaminated. Even if you plan to hold the syringe in your hand until you attach it the needle-less system, it is still best practice to either leave the caped needle connected to it or to recap with a sterile cap. This is just in case you need to put the syringe in your pocket for an emergency, or you put it down on a table, or you accidentally brush it on something. The cap or the needle keeps the syringe tip from getting contaminated and then you injecting whatever germs got on that syringe tip directly into a patients vein. IV catheter infections cause 10-20% of hospital acquired infections. Granted that includes all types of IV catheters, but contaminated injections are one way to introduce that infection.

[labordude, BSN, RN]

Now fastforward to my clinical evaluation ticket. She gave me one S and the rest were S- which technically she can't even do its either an S or U. Her comment stated that I failed to cap or label a syringe. I forgot to give a med at the schedule time and I didn't finish charting before I left for lunch. She stated that I was halfway through my rotation and needed to step it up to meet basic requirements. I really took it personally because if we are almost done with the rotation why is she jut now saying I need to step it up. Why didn't she say anything to me previously?

I was at a loss for words. I went home and cried. I spoke with some of the other students in my clinical who had done IV meds and they said they didn't label the syringe. THey also stated they didn't usually chart the assessment until after lunch. This was the first week I hadn't completely charted my assessment before lunch. I didn't think it was a necessity to cap the syringe if I was immediately going to give it to the patient.I didn't even realize I should have done it until she wrote it in my evaluation. Being my first time doing anything with needless syringes, why didn't she walk me through the procedure slower? Why didn't she tell me in the hallway to cap it and label it as a reminder? I honestly feel like she was setting me up for failure. Why did she wait til after to reprimand me instead of reminding me while I was preparing the syringe to teach me the importance of these things. As far as the medication admin error, I didn't get to check the black bag to see if I left anything out. Witht previous CI, we would go down the MAR one by one. I didn't even pull the meds out of the bag. I believe I had a part in not noticing I did not give one med but I feel like she was also to blame and should have taken some of the responsibility. The reason she was in the room and scanning the meds with me was to make sure I gave meds in their entirety and correctly.

To make matters worse, at lunch in front of thte rest of my class, she stated that I was just not with it and my head was off today. We have one more week and this week I will have two patients. I am just terrified to ask her for any direction or questions. I hope and pray I get a helpful RN and easy patients, because I don't want to have to do a skill I hven't performed before in fear of getting unsatisfactories. I just feel like she is very inconsistent. How can we know what we shouldn't do if she doesn't walk us through it.

Honest opinions would really help. This has been bothering me all week and I just can't get it off my mind.

I promise you honesty. You made a few errors. The bright side of this is that you are a student and you were being observed by someone who noticed them because you don't have the experience to always notice them yourself. I believe your instructor did you a favor by giving you the S- rather than a U. She was under no obligation to do that. I bolded and underlined something you said and hope that I can change your mind on this. You will learn little to nothing from "helpful RNs and easy patients." Do not hide away and try to pass by the skin of your teeth, you will be woefully unprepared to transition into professional nursing. Seek out those patients that make you squirm and learn from the nurses taking care of them. You are clearly in a teaching hospital, but you do have to be active in seeking out learning opportunities. This is one of the things I look for when I hire people. Do not be afraid to ask questions or ask for directions, it's worse when you need help and don't ask!

As for the behavior of the instructor, I'm not addressing that as it doesn't change anything (you wanted honesty, here it comes) and the way it's presented here really seems like you want sympathy. I empathize with you, I do not sympathize with you.

Everyone makes a mistake at some point. It's what you learn and take from it that makes you better at what you do and helps you move forward.

[rob4546, ADN, BSN, MSN]

I think that the 'S-' was given because she does have faith in you and didn't want to sink you with a 'U'. Get back on the horse and do this. Later in your career you will look back on this and laugh because it was a learning moment.

Someone might think differently but, I always tape the vial to the syringe after drawing up medication. Then I know what the syringe contains and I have the bar code to scan later. Oh, and recap the syringe. Pretty basic but now you know. Keep on moving on.

[Karou]

In the future I would say to this instructor, "I need you to slow down, this is too fast and I am not comfortable. I need to review these medications fully in order to be safe." When using words like "safe" you let your instructor know that you are aware and care about patient safety. It is always okay to slow down and double/triple check. Never let someone rush you into a mistake! It happens all the time as a nurse and sometimes we just have to slow it down. No shame in that.

As other posters pointed out, you are supposed to always label a syringe after drawing up a medication. Does this always happen in practice? No. But in nursing school, and on the NCLEX, yes!

Capping a syringe is important because of contamination.

And now you know. Don't let this get you down, just learn from it and move on.

[kgh31386, BSN, MSN, RN]

Let's turn this into a positive. Your instructor is hard on you, that's a good thing. The reason she's on hard on you is probably because you set the bar very high. You said you had done very well with all prior things...if your head isn't in it, that's not up to par with how you normally perform. Also, other students may not be performing as well as you are, so the instructor may be focusing on the very basic things with them. If their assessments aren't charted until later, it's because they are with the instructor doing something else...so you can't compare how you're treated to the way they are, especially if you're ahead of them with your performance. Back when I was in nursing school, I got sent home from clinical one day because I didn't have EVERY med on the MAR ready and forgot what one of them was for(this was first semester). She said she sent me home because I usually perform very highly and that I wasn't up to my potential that day. Don't go reporting this or anything, but instead just meet with your instructor and get some feedback.