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."
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!
there wasnt any confusion. The R arm has an AV shunt so I can't take BP on that side. So the left was the safer side to take BP compared to the R. the other option was take it on the leg but the concern was how accurate the reading is? the patient is obese and no cuff size that fit.
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....
I repeated this clinical because I failed my theory (got 82%) the passing grade is 84%. they both go hand and hand. I passed this clinical before with an A. If I fail one and pass the other I still have to retake both....
thanks and It is a great lesson for me. next time i will validate it with my instructor rather than the primary care nurse.
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:
mimi225
Maybe because you're emotional, you made this oversite but in your oringinal post, the pt had R AV shunt. You just posted it the other way around so maybe there was some confusion concerning what side was appropiate for the BP reading.
there wasnt any confusion. The left arm has an AV shunt so I can't take BP on that side. So the Right was the safer side to take BP compared to the Left. the other option was take it on the leg but the concern was how accurate the reading is? the patient is obese and no cuff size that fit.
:igtsyt: In your oringinal post you gave your reasoning for taking it in the R arm as being because you saw the phlebotomist taking blood as well as other staff members taking BP readings from that arm. It was only after Moogie posted clarifying information concerning BP cuff size that you are now including it in your reasoning. Maybe it was after the fact that you realized the sign over the bed as well. I hope that you are still able to reach your goals regardless. I know that this will undoubtly be a learning experience for you so I do wish you well.
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:
mimi225
Maybe because you're emotional, you made this oversite but in your oringinal post, the pt had R AV shunt. You just posted it the other way around so maybe there was some confusion concerning what side was appropiate for the BP reading.
there is a Right AV shunt on the right Arm. and L mastectomy 5 yrs post op. Neither arm are appropriate for BP so leg is the last option but with hx of DVT/ hardening of arteries and legs are 10% to 20 % higher reading in systolic. also with 350 lbs weight.
Wow, your instructor was pretty harsh! I just don't understand how we are not allowed to make mistakes, that don't put the patient in serious jeopardy, without being overly punished for it. We learn from our mistakes, it's common sense. You didn't make a med error or abandon your patient, those are serious errors. With the information you had available you did the right things. Some instructors just would rather fail you , rather than I don't know...teach!!!!
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:
mimi225
Maybe because you're emotional, you made this oversite but in your oringinal post, the pt had R AV shunt. You just posted it the other way around so maybe there was some confusion concerning what side was appropiate for the BP reading.
OMG... I think we went to the same school.... I ,too, was deemed UNSAFE and failed during my 3rd semster, even though I was passing. After three hellish semesters of this evil program, I chose not to go back, but instead to take my LPN license and complete my RN online with Excelsior while working. It was the best decision I could have made. It took me 2 years to get my confidence back and my RN license.... but I would put my knowledge up against most anyone....especially those that completed the program I failed. This isn't the end, unless you chose to let them win!
So sorry this has happened to you. Some of us have certainly had instructors that were like this. But, as I reread your post, this thought came to me. If you do decide to appeal to the administration of your nursing school, do you think that it was wise to post "word for word", your instructor's comments from your evaluation? This could possibly be a disadvantage on your part. There are way too many nurses that read AN posts.
:igtsyt: In your oringinal post you gave your reasoning for taking it in the R arm as being because you saw the phlebotomist taking blood as well as other staff members taking BP readings from that arm. It was only after Moogie posted clarifying information concerning BP cuff size that you are now including it in your reasoning. Maybe it was after the fact that you realized the sign over the bed as well. I hope that you are still able to reach your goals regardless. I know that this will undoubtly be a learning experience for you so I do wish you well.
Thank you! I was thinking that too -- I was scratching my head trying to figure out what I had missed??
mimi225
24 Posts
there wasnt any confusion. The R arm has an AV shunt so I can't take BP on that side. So the left was the safer side to take BP compared to the R. the other option was take it on the leg but the concern was how accurate the reading is? the patient is obese and no cuff size that fit.