Deemed unsafe

[mimi225]

as a student nurse, I was assigned to a confuse pt and started pulling, pressing and biting the call light. the family was at the bedside and asked to unplugged the call light bec. she may get electrocuted so I did after I talked to the primary care nurse about the situation and she was find w/ the idea. Also,r instructed family to notify the staff when they leave. then the next issue was, I had a 350 lbs pt w/ R AV shunt and L Mastectomy 5 yrs ago. she has a Left anterior chest wall perma cath and Left IV inserted in the hand. phebotomist was drawing blood on the L arm as well. there was a note posted on the wall " Do not take BP on the R arm". So the staffs had been taking BP on the Left and so I did too since no signs of edema on that arm..then the instructor deemed me unsafe for taking the BP on the L bec. of the risk of lymphedema. the instructor said I should be taking BP on the leg

the pt was on anti-hypertensive meds. with Hx of DVT and Clot and hypertension is leg the best place to get an accurate BP prior to medicating? So........... I was deemed clinically unsafe.... thats my :twocents:story:mad:

Evaluation/comment by the instructor

"This information is based on the Fundamental level of nursing and information that you should know. My concern at this time is that you have forgotten basic nursing knowledge that affects patient safety.

This is information that I am not truly responsible for teaching a 5th term student. Your knowledge base regarding the basics concerns me and I am responsible for the safety of the patients as well as myself.You should ask yourself, How would I feel if a nurse disconnected my husband's call light and left the room?How would you feel if your mother had a mastectomy and the nurse decided that she could take her blood pressure on that arm when she should have known not to?

At this time it is unfortunate but you made these decisions. These decisions were detrimental within the profession of nursing and could cost the patient as well as myself. Your decisions are not based on my approval. I am unable to confidently say that you are able to provide safe and competent care as a Registered Nurse.

This lack of knowledge will require your understanding of the Fundamentals of nursing."

[CaLLaCoDe, BSN, RN]

I hope you weren't kicked out because of this incident! I agree with the instructor that your action was unsafe, however to remove you from school because of it would be a little too harsh IMHO.

[mimi225]

unfortunately, they did....

[Moogie]

I was going to post this on the other thread but just saw that you started a new one.

Regarding the call light situation, I should think the institution would have had some sort of substitute for the traditional call light if the patient was confused, pulling it out and biting it. I think you know that it isn't appropriate to just remove the call light unless there is some sort of substitute; however, the staff nurse should have given you some guidance on the institution's policy regarding a substitute. If I were your instructor, I would have wanted to talk with you about the situation but I don't think I would have considered you to be unsafe.

I was curious about the BP/mastectomy situation so I looked at Mayo.com for some guidelines. I'm old and remember the days when all mastectomies were radical---removing lymph nodes as well as breast tissue. It used to be that one never, ever, ever, took BP on the affected side after a radical mastectomy due to the possibility of lymphedema. However, because most mastectomies now are NOT radical and do NOT involve removal of all lymph nodes (only those closest to the cancer), the possibility of lymphedema is greatly decreased with modified radical mastectomies. If lymphadema does occur, usually it is short-term and occurs within a year of the surgery. Mayo encourages staff to take BP and blood draws on the unaffected side if necessary.

I would think, since the patient was five years post-mastectomy, you should have been safe taking her BP on that arm, particularly since staff has been doing it themselves. I think you are correct in that taking it on the leg would have made for a very different reading. What did your staff nurse say about this? (Why did they say no BPs on the right arm? Was the staff confused about which side the mastectomy was or was there another reason?)

Dang. I am sorry this happened to you. I honestly do not agree with your instructor but, unfortunately, that isn't going to be much help to you in this situation (unless you can find some evidence to prove your point---more than just what you're going to get here on AN---I mean evidence based research and hospital policies) and try to appeal the instructor's decision.) Good luck and gentle hugs to you.

[Tait, MSN, RN]

As always with the internet, we receive only a small snapshot of the situation.

I would be curious to know if there were other incidences of misjudgment before this specific situation to warrant being removed from the program?

Tait

[CaLLaCoDe, BSN, RN]

Re Moogie's post:

(L) AV shunt is the reason behind not taking the BP on theLeft. I disagree regarding an entirely different reading would have been read if the BP were taken on the leg. Usually a hypertensive reading on the arm is reflected as well on the leg.

[mimi225]

this is a re-take class, at my school, students are not allowed to re-take same class more than once.

[SuesquatchRN, BSN, RN]

I'm sorry, Mimi.

[mimi225]

me too.... ... I started looking into other school..... to get my degree even if I have to start all over again....

[Lucky0220]

this is a re-take class, at my school, students are not allowed to re-take same class more than once.

If this was your last semester, had you not taken clinicals in the past semesters? Had you had experience on the floor in those hospitals? What was so different about this last clinical that made it so difficult? Failing just because you would not know exactly where to place a BP cuff just doesn't seem realistic? How did you do throughout the semester on other clinical days? What about your care plans and all the other things you had to do for this semester's clinical? I would think that your grade would depend upon your performance during all the days you had clinicals, not just this one day. Were there other incidents on other days? I do wish you luck and maybe you can find out what it is exactly you need to focus on to be successful. :redbeathe

[mimi225]

I had A grade on my previous clinical and C+ in theory. 2nd time around, I have A- in theory and F for clinical...B- (84%) is the cut off

[CFitzRN, ADN]

It sounds like there may be other issues, such as not passing the one component of med-surg, that contributed to their decision. ?