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."
® AV shunt is the reason behind not taking the BP on the right. 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.
I agree with you that if the reading on the arm is high, it would also be on the leg; however, in this case, the patient is morbidly obese (weighs over 350 lbs.) and I would wonder if many health care facilities would actually have cuffs that would fit the leg. Sometimes the large cuffs aren't big enough to go around the arm. BP readings can be affected if the cuff is the inappropriate size, so my concern would be that a BP taken on the leg---if the cuff did not fit----might not be as accurate as one taken on the arm. In that respect, unless the previous nurses had been taking the BP on the leg and had an appropriately sized cuff, I don't see that the OP did anything wrong in taking the BP on the left side. I honestly believe the instructor overreacted to the student's actions and was thinking back to the old days in which radical mastectomies were the norm and one never, ever, ever took BP on the affected side for any reason. I think it's imperative that instructors keep current with evidence-based practice and not just look back to what they learned in school.
It's also imperative that nurse educators admit what they don't know and I've never done cardiac, would not want to teach cardiac, and have had no experience with an AV shunt, which is why I asked. Thanks for the information---I appreciate it!
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
Hey, Tait---you might want to check out the OP's other thread; I agree that it isn't possible to see everything on a post on the Internet but I don't think she's holding back anything about her experience.
Specializes in Acute Care Cardiac, Education, Prof Practice.
Hey, Tait---you might want to check out the OP's other thread; I agree that it isn't possible to see everything on a post on the Internet but I don't think she's holding back anything about her experience.
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
I achieved A's and A-'s on my previous clinicals. This is a re-take clinical and this time, I failed it because she deemed me unsafe with the BP and call light incident.
first off, i would not have called you unsafe. what i would call your instructor however, is overly harsh and non forthcoming with rationales. if i were in a position to give an evaluation on her, i would put her on probation. she's failing you over something that is not generally taught to student nurses as a clinical alternative.
the ankle brachial arterial pressure index is about 1:1, meaning that on the average person, the ankle and brachial blood pressure is almost exactly the same. did anyone ever teach this is nursing school? no. so should nursing students be faulted for not knowing of this alternative? no. if one faults the student, then one must also fault the faculty for their failure in teaching this little nugget from that nursing body of knowledge.
interaction with the public while in school is a learning process, and not an examination process. the idea is to use such "mistakes" to instruct and to teach, not to find fault and then fail, because even the best student will eventually make a mistake or two.
my assessment? go to your school's ombudsman or talk with a dean of student within the nursing division. the failure of a promising student over something as simple as a clinical disagreement over blood pressure (secondary to risk of lymphedema, which is a rather weak clinical argument in the first place) is akin to throwing out the baby with the bath water.
first off, i would not have called you unsafe. what i would call your instructor however, is overly harsh and non forthcoming with rationales. if i were in a position to give an evaluation on her, i would put her on probation. she's failing you over something that is not generally taught to student nurses as a clinical alternative.
the ankle brachial arterial pressure index is about 1:1, meaning that on the average person, the ankle and brachial blood pressure is almost exactly the same. did anyone ever teach this is nursing school? no. so should nursing students be faulted for not knowing of this alternative? no. if one faults the student, then one must also fault the faculty for their failure in teaching this little nugget from that nursing body of knowledge.
interaction with the public while in school is a learning process, and not an examination process. the idea is to use such "mistakes" to instruct and to teach, not to find fault and then fail, because even the best student will eventually make a mistake or two.
my assessment? go to your school's ombudsman or talk with a dean of student within the nursing division. the failure of a promising student over something as simple as a clinical disagreement over blood pressure (secondary to risk of lymphedema, which is a rather weak clinical argument in the first place) is akin to throwing out the baby with the bath water.
you need to fight this.
"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." word for word comments/evaluation of my instructor
I had a couple of instructors who made Nurse Ratchet look cuddly. I recently had a experience with an instructor who flunked a student for giving a patient a pill by mouth rather than through the dobbhoff. An unfortunate mistake, yes, but the instructor sat there and watched it so why wasn't she kicked out too? (The patient passed a swallow two hours later, btw.)
If you've done well in previous clinicals then consider the source. Don't less this experience define you or make you think less of yourself. I wish you all the best.
I agree that you have been treated very unfairly based on your post.
The RN in charge of the patient really made the decision to leave the call light disconnected-not you. As a student you did the right thing by informing them it was disconnected as per the family request and the RN made the decision to leave it not connected. I don't see how the student can be at fault here.
Instructions were made not to take the BP on the right, only on the left and you followed the hospitals instructions. It might help your case if you can find orders from a doctor or senior nurse in the patients care plan where to take the blood pressure. If you can present this to you school (make sure patients confidentiality is maintained) to prove that you were only doing what you were instructed then this may show your instructor is in the wrong.
I agree you need to fight this. You have been kicked out of nursing school so you have nothing to lose and everything to gain.
Wow, I'm sorry! I wish you the best after this stressful situation.
It sounds to me like there was internal confusion about which side was the safe side and it's not your fault you didn't know.
My Mom had a mastectomy on her right side 10 years ago, and when she was recently in the Cleveland Clinic, they had a sign up not to take BP on the right side ... I know her doctor said don't hang a purse on that arm or wear a watch, so it is a danger -- but it's not YOUR fault THEY were confused about what side!
I may be way off here BUT it sounds like maybe the staff nurse caring for the patient sort of set you up for the fall as well, because KNOWING you were the student under her caring for her patient under your instructors guidance then maybe SHE should have been spoken to, or reprimanded herself............Not knowing both sides of this story it's hard to make an accurate judgement, but I would definetly go over the instructors head on this one.......some instructors have an attitude like students should know everything already......if they did, then they wouldn't have had to go through school to learn...........I think maybe I would go talk to whomever you need to......are there other issues you've had before with clinicals? I saw how you said this was a retake and you're only allowed one retake and that's it..........well, if you get into another program just ask , ask, ask and don't just do whatever the nurse tells you WITHOUT going to the instructor 1st so they know what's going on.....and don't just do what the staff tells you without clearing it with the instructor either.........that way your butt is covered.......if anything chalk this up as a learning experience and move on......good luck with whatever you end up doing....
Moogie
1 Article; 1,796 Posts
I agree with you that if the reading on the arm is high, it would also be on the leg; however, in this case, the patient is morbidly obese (weighs over 350 lbs.) and I would wonder if many health care facilities would actually have cuffs that would fit the leg. Sometimes the large cuffs aren't big enough to go around the arm. BP readings can be affected if the cuff is the inappropriate size, so my concern would be that a BP taken on the leg---if the cuff did not fit----might not be as accurate as one taken on the arm. In that respect, unless the previous nurses had been taking the BP on the leg and had an appropriately sized cuff, I don't see that the OP did anything wrong in taking the BP on the left side. I honestly believe the instructor overreacted to the student's actions and was thinking back to the old days in which radical mastectomies were the norm and one never, ever, ever took BP on the affected side for any reason. I think it's imperative that instructors keep current with evidence-based practice and not just look back to what they learned in school.
It's also imperative that nurse educators admit what they don't know and I've never done cardiac, would not want to teach cardiac, and have had no experience with an AV shunt, which is why I asked. Thanks for the information---I appreciate it!