Failed Clinical Med Surge 3

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Welp, today it happened, I was failed by my clinical instructor.Im going to be speaking with my dean on the situation as I and other students feel the situation is wrong. Heres the background: On friday, At LAC+USC I was doing a make up clinical day because I missed my regular day due to being sick. On my make up day I was with a different instructor, this instructor teachs the lecture part of the course. It was 1100am and insulins were coming up, My RN did the FS and b/s was below coverage as ordered by doctor, so the pt. had a maintenance dose of 5units ac. The clinical instructor asked if I had given insulin, I said yes confidently, as I've given insulin since my first semester in my first year. I told the instructor it had been a while since april/may this year i'd given insulin so she then asked me to just draw up the 5 units of air and show her. This is where the I encountered the problem/confusion on my behalf, the insulin syringe I used all my first year was the 1/2 cc for 50 units or less. My first year med surge instructor had us only use this syringe the whole first year and never were we familiarized with the others. At county they only use 1cc 100 unit syringe. I looked at the syringe confused at first because it did not seem familiar to me, however I drew up what I thought in air was the 5 units and made the mistake of drawing in 50 units air. My instructor said am I sure thats 5 units, and still I wasnt totally sure but said yea, and my instructor had me show my RN per protocol when working with insulin only it was (AIR). the RN laughed and said no it wasnt 5 units. I then re-examined the U-100 and noticed my error and fixed it. The instructor then told me I just engaged in unsafe practices that harmed a patient, but then told me to go ahead and draw up the 5units fast acting insulin. I drew it, and with my instructor administered it without incident. Afterward the instructor talked to me and asked me if I was oriented to the syringe and what I did and asked if it would happen again, and I said yes i understand and no it wont happen.the day carrys on and nothing happened all day.

12/06 comes around and im in my reg clinical day at USC+LAC with my normal instructor. Immediatly she pulls me to the side to have me explain to her what happened on friday, I begin to tell her that there was some confusion on friday with the syringe. I told her that the syringe i had been used caused me a bit confusion, she then sent me on a goose chase throughout the whole hospital to search for the 50 unit 1/2 cc which that hospital does not carry. With no luck I return and she dismissed my defense and nothing else happened. At end of shift she pulls me aside and tells me the situation isnt good and she doesnt know what is going to happen to me, tells me to go home sleep and dont worry and for me not to even try to build a case in my defense.

12/07 I meet with my instructor on campus for her final decision, she then tells me she is failing me because insulin is very serious with incidence of high mortalitys. I told her I understand that side of it, but yet still even though it was air and we were at bed side, and the whole situation happened at the nursing station, I was failed for reason #1 being the 5units air. #2 being that I didnt finish my charting, having not completed a 2nd assessment and end of shift summation on the computerized charting system. Mind you, in regard to #2 I had never been to county before, I have no county ID badge, instead I use a temp. I never have been trained or received material from my instructor on how to chart nor was I given a login by her to chart. On the first or second week of clinical with my instructor, she asked who was new to county and who never used the system. I raised my hand, and she said she would show me. That very day, lunch came around, I approached and asked if she would show me and she said no, dont worry about it, goto lunch. Thus I was never shown. I then missed a clinical day, and on due to tahnksgiving we never had a clinical that sunday during holiday. On the day of the syringe incident, it was finally THAT instructor that created me a login, and vaguely showed me how to use the system.

Point being, I never knew the system, nor was instructed in it, my normal instructor is a big CYA type instructor and will always contradict herself and cover her own ass in everything! so she gave me #2 for me having not asked that day on how to use it, despite my efforts to try and use it based on what the other instructor showed me. And even though I didnt chart at the end because I didnt know how to start a second assessment, I went to my RN and told her the situation with me and the computer charting system and I gave her a verbal report for all changes noted on the second half of my shift.

So after having spoken with my first year med surge instructor who agrees with me, and believes that the instructor shouldnt have failed and should have orientented me to the differences in the syringes at county and aboard. I feel having then if the instructor did that and I did the same thing again then it would be fair, cuz then that would be full competency. How then does my normal instructor fail me for something she was never there to see, and how then is she being so harsh? why is she being so defense in telling me to go home and not make a case because I have none? what is she afraid of? and why is she dinging me for #2 when I made efforts to seek her instruction and she never tended to them nor did her part? this is ********.

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This is where the I encountered the problem/confusion on my behalf, the insulin syringe I used all my first year was the 1/2 cc for 50 units or less. My first year med surge instructor had us only use this syringe the whole first year and never were we familiarized with the others. At county they only use 1cc 100 unit syringe. I looked at the syringe confused at first because it did not seem familiar to me, however I drew up what I thought in air was the 5 units and made the mistake of drawing in 50 units air.

I'm very sorry for your frustration over the situation but this ^^ is a pretty huge error.

It doesn't matter whether it it a 1/2 cc or 1 cc insulin syringe the unit markings are printed on the barrel. As a second year student I'd expect you to be able to rationalize it out, recognize they are different but the same or SPEAK UP.

I know it screws up your 'plans' and will cost you extra in tuition but perhaps repeating this clinical is not a bad thing.

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I agree to that. Umm...fair yah. But to problem #2.....that I would argue isnt my responsibility to teach myself a computer system even when I mentioned to my instructor I needed the instruction weeks ago and it was never given. When I think about it, Perhaps I didnt think long enough about what I was looking at in terms of the syringe, I did feel confused, However, I felt so confident having done it so many times successfully. What a ****** situation yea, yes this mistake wont be made again, but damn I dont get a second time to fail clinical or anything for that matter as I've been told.

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Specializes in SNU/SNF/MedSurg, SPCU Ortho/Neuro/Spine.
I agree to that. Umm...fair yah. But to problem #2.....that I would argue isnt my responsibility to teach myself a computer system even when I mentioned to my instructor I needed the instruction weeks ago and it was never given. When I think about it, Perhaps I didnt think long enough about what I was looking at in terms of the syringe, I did feel confused, However, I felt so confident having done it so many times successfully. What a ****** situation yea, yes this mistake wont be made again, but damn I dont get a second time to fail clinical or anything for that matter as I've been told.

-I see that you seem stressed right now,

here are a couple of things that I learned from nursing school so far

1- even though i practiced things in the lab, and got checked off, i always perform a skill on the first time with my instructor, whom i kindly ask guidance (so if I make a mistake she can teach me other then fail me)

2- whenever i am going to touch any material other then a termometer or a bp cuff, (specially invasive ones such as cath, trach, syringe, and what not) i do it alone like a dork on the supply room, i read it, i look at it and if i haven't seen one of those before i ask for my instructor to possibly open one of those packs and show me so i can become familiar with it.

3- any time that i draw insulin, or anything else, i kinda do it a couple of times before showing my instructor (like a dork) so that when i turn around i am sure of what I am doing...

4... you can never know enough, and when you become ... used to something that is when mistakes happen!!!

got to see a student fighting with several syringe pumps, saying that they were not working, they were choosing monoject syringes out of the setting because that is what it was used often, guess what, they did not noticed that the farmacy had sent them a BD syringe, (that is after testing about 6 or seven syringe pumps)...

I feel like I have to do everything as if it was the first time i was doing it, so for i can pay attention to the details.. other wise i might feel comfortable and leave room for dumb errors to happen!

... my take on the charting, if she went just briefly with you, and you had questions about it, you should ask and make notes, if she was too busy then and there, right down your assessment, and then ask her to come and guide you through charting since you are not comfortable with it giving the circumstances! if she said she could not, then i would let my nurse chart every thing and take measures to cover my back!

... just take a deep breath, and tomorrow is another day....

any ways, i am glad that now, you will pay attention to every syringe in your life time, and every time you pick up a syringe, foley, whatever... just think of those 50 units, and that will alert you to check and recheck everything!!!

although I think she was kind of harsh... we are students, we make mistakes, and we learn with them(hopefully) plus you did not administered that... (but would you have done so?)

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I feel it was harsh, thing is after I told her it had been awhile kindly, and told her I felt a bit rusty having it been 6 months since I gave insulin, and having us not given it during psych. Thats why she told me to draw up the 5units "air" for practice and show her first to see If I knew what I was doing, and that is also why with insulin you always verify with another nurse to avoid errors. The RN verified and denied it to be correct, then my instructor handed it back to me to correct, which I did, and then she allowed me to draw 5units insulin and administer SQ without incident in front of her. What I think is happening here as I spoke with my first year instructor and she agrees and spoke with my instructor about it. Is that the instructor with whom the incident this happened, for my instructor to fail me based on what is word of mouth and her not really hearing the whole story or seeing it and having been there how is this? Thats what my first instructor talked to my current instructor about, is how is she going to go on the simple fact that I made an error without all the facts, like #1 I was tested first to see if I knew after 6months #2 I corrected the problem #3 why then was I still allowed to administer the med ? this all is not rational.

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Specializes in 5th Semester - Graduation Dec '09!.

People rant about failing all the time and most of the time I understand why the instructor did it. Your situation on the other hand is really not very fair situation.

It is pretty serious.... but it was just air!

It's pretty likely you will NEVER make another insulin mistake again in your life-- you will probably take extra special care drawing it up and probably check it 10 times! A great lesson was learned by you and your classmates about how careful you must always be! No medication was drawn. No one was harmed.

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Honestly i feel like the whole situation was unfair for the student. And i feel you guys are being a little too harsh on the student. Seriously, it hurts to come this far, the semester is almost over, and then you find out you failed. Shouldn't a student's performance be judged cumulatively? In other words, one should not fail medsurg or any class for that matter for just one mistake. In this situation the insulin error should not carry so much weight; after all we are students and we are continually learning and making mistakes, that's why we have our clinical instructors to guide us and help us be "COMPETENT AND PRUDENT NURSES!!!" If the student had done relatively well throughout the semester, then he/she should be judged based on that. Of course the insulin mistake is a very serious one, but that should not overshadow the student's overall performance throughout the semester. It is unfair!

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Honestly i feel like the whole situation was unfair for the student. And i feel you guys are being a little too harsh on the student. Seriously, it hurts to come this far, the semester is almost over, and then you find out you failed. Shouldn't a student's performance be judged cumulatively? In other words, one should not fail medsurg or any class for that matter for just one mistake. In this situation the insulin error should not carry so much weight; after all we are students and we are continually learning and making mistakes, that's why we have our clinical instructors to guide us and help us be "COMPETENT AND PRUDENT NURSES!!!" If the student had done relatively well throughout the semester, then he/she should be judged based on that. Of course the insulin mistake is a very serious one, but that should not overshadow the student's overall performance throughout the semester. It is unfair!

A license isn't measured cumulatively....an unsafe action is an unsafe action. How many times should someone in their second year be unsafe before there's a consequence?

Almost giving 10X the dose of insulin is an unsafe action. It doesn't matter at what point in the term it is. The only reason the student made the error with air instead of insulin is because the instructor asked to pull up air instead of insulin. I think it's unlikely from what was written that if there was insulin in the syringe the student would have noticed the error faster.

The student agrees with this in the third post (and then goes on to talk about the charting...which I don't understand. It's not like the first thing didn't happen and it's only the second charting issue to deal with).

To the OP: I'm really sorry this happened, I can only imagine how frustrated and upset with yourself you are. How long will you have to wait to repeat the class?

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Specializes in ob/gyn med /surg.

i think the instructor was right in the incident with the insulin,, that's a big error and if it was given the pt could possibly of died... it's her license you are working under .. i would feel the same way if it were my license.. pt safety is top priority... that's reason for dismissal right there... i'm sorry if you feel it was unfair , but this was a human life and it could of been a major error.... about the charting .. that was a bit harsh.. i think your major issue is the insulin ...

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Specializes in 5th Semester - Graduation Dec '09!.
i think the instructor was right in the incident with the insulin,, that's a big error and if it was given the pt could possibly of died... it's her license you are working under .. i would feel the same way if it were my license.. pt safety is top priority... that's reason for dismissal right there... i'm sorry if you feel it was unfair , but this was a human life and it could of been a major error.... about the charting .. that was a bit harsh.. i think your major issue is the insulin ...

I can totally appreciate what your stance.

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I understand how upset you are, having to retake 2 courses due to grades myself ( psych and clin pharm) , look at it as a learning exper. and take a deep breath.

What I am having trouble with is that you gave the insulin right? Then had to show the instructor how you did it ect, when your regular instuctor heard about it she sent you looking for a syringe that you were used to using and that hospital didnt have one all they had were the 1cc type not the 1/2 cc.

I think they were trying to tell you something here and yes it was a learning mistake, if you were not used to the 1 cc syringe to begin with what did you use for the first shot you gave??

In your first year nursing you would have had the foundation course, I know they had you look, feel, and see the difference between the 2 then test on it ( at least they did me) I am not being a hard butt about this but it still has me wondering about that syringe. How abo0ut anyone else

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Specializes in Telemetry.

hmmm...that was a dangerous dose, however, you explained to the instructor that you were not very sure about this from the start she should have taken this in consideration. No one is perfect and as students we are there to learn. This is a learning experience. You would not have given the medication without her present and you would have done your 10 rights before giving the medication. I have seen worst mistake than this and students were put on probation and still pass the course. This is very hard to swallow but as I said in other posts, you will always be at the mercy of the clinical instructor...When I was in Med/Surg III, my instructor told me that I was too cautious. Hell yes I have to be! I take pains to do things her way so that she will not have to reprimand me. What is wrong with that? At the end of the semester she told me that I will make a good nurse. Thank you ma'am!

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