Failed clinical because...

[Rebel_Kitty]

My very good friend got pulled out of clinical yesterday and now has to wait a year to get back into the program (we're third year doing the BSN) because she tied a nephrostomy tube to the bed railing and when she put down the bedrailing, she forgot she tied it there in the first place; well it popped out of the patient. It was a big deal in our ward with everyone including patient care coordinator, family, rn, drs yelling at the instructor and student...It was a very ugly scene...

Do you guys agree with the fail she got? We are nursing students and we are there to learn are we not? I believe this is her first incident report.

[NRSKarenRN, BSN, RN]

Often 3rd year of BSN program students are in only in their first or second clinical rotation. Patient safety and needing to think about the potential negative outcomes that may happen as a result of ones actions just starting to sink in as part of critical thinking.....can't teach common sense.

Often we learn more from our mistakes than we do from our successes. This student has just helped educate hundreds persons who will read this post.

[CNAinNeb]

I think this is the result of SON's admitting students by GPA. Many (not all) of the students with the 4.0's required to get in are so focused on book knowledge, that they are completely lacking in common sense. How do you measure common sense for admission though? Darn near impossible.

[MB37]

I think it says in all of my books that you're not supposed to tie anything coming out a patient to the bed rail! Good grades and common sense are not mutually exclusive, we also have no idea what the admissions process is at the OP's school.

[sneakymom2011]

We were taught in Fundamentals not to tie restraints to the bed rail. We were then told that NOTHING gets tied on any part of the bed that moves.

In our school, if you do something like that (leave bed rail down and walk away from the pt etc) you can be dismissed from the program. Period. That's not being a safe nurse.

[autumn_raine]

First day, first semester: My instructor stands before the class and announces the first rule of nursing, "Do no harm". If this means asking questions throughout the whole clinical day then so be it. Students are not there as the sole caregiver for the patient (that remains the nurse's responsibility) we are there to learn. It sounds as if this student was so involved in finishing a task that she didn't stop to think about what my current instructor likes to ask before discussing any clinical interventions "what's the worst that could happen?". In this case the worst that could happen actually happened. This does serve as a learning experience for all of us.

[future L&Dnurse]

I remember learning in my very first skills class that you NEVER tie anything to any part of the bed that moves. Not restraints, not foleys, not vent tubing, nothing. Isn't that a really basic rule?

I hope that she takes her year off to really think about what it means to be a nurse and how big the responsibility is, so when she comes back she remembers to stop and think about what she's doing before she does it, and hopefully will never cause that kind of needless pain and complication to a patient again. We all make mistakes, this is a big one, and I hope she learns from this one and is successful when she tries again.

[santhony44, MSN, RN, NP]

Figuring out what will happen if you tie something to a side rail and then lower the rail isn't rocket science. This student is getting a second chance, but no one is left in doubt about how seriously the school takes patient safety.

It pays to be cautious before lowering a side rail, anyway. Things that aren't attached also have a tendency to get in the way, so make a habit of looking for things like IV tubing, chest tubes, Foley catheters, body parts, and so forth before lowering a rail.

[manofcare]

I read that the reason she tied the tubing off on the rail was because she saw an RN doing the same thing. One thing you will learn about the clincal setting is that there is the school way and the real world ways of doing clincal procedures. The school always teaches as close to perfect as possible and the real world generally compomises some steps for speed. I am not advocating a break in sterile procedure, nor anything that would compromise pt safety. Here's the rub. She saw another person (an RN!) do something foolish, and she did the same thing. This is absolutely one of my biggest beefs with nursing school. Students are hounded to death by instructors to be an advocate for their pt, but schools absolutely hate people with a backbone. I can not even start to tell you how many times I have heard instuctors throw "professionlism" in the face of a student for disagreeing with them. I really believe schools beat the ability to confront mistakes or errors out on their students. How can a nurse be an effective advocate if they are not willing to ruffle some Doctor's feathers occasionally?

[UM Review RN, ASN, RN]

I read that the reason she tied the tubing off on the rail was because she saw an RN doing the same thing. One thing you will learn about the clincal setting is that there is the school way and the real world ways of doing clincal procedures. The school always teaches as close to perfect as possible and the real world generally compomises some steps for speed. I am not advocating a break in sterile procedure, nor anything that would compromise pt safety. Here's the rub. She saw another person (an RN!) do something foolish, and she did the same thing. This is absolutely one of my biggest beefs with nursing school. Students are hounded to death by instructors to be an advocate for their pt, but schools absolutely hate people with a backbone. I can not even start to tell you how many times I have heard instuctors throw "professionlism" in the face of a student for disagreeing with them. I really believe schools beat the ability to confront mistakes or errors out on their students. How can a nurse be an effective advocate if they are not willing to ruffle some Doctor's feathers occasionally?

I understand what you are saying, it's just that this was a little too obvious a situation -- tie something to the bedrail, forget, let bed rail down, yank big fluted tube-with stitches-out of a vital organ...

So we have a painful, dangerous accident with potential for infection, potential for lawsuit against the hospital, the school, and the student, and potential for increased chances for a bad outcome to a patient's medical problem.

I'm sorry, but no matter how you twist it, it's still the student's fault. Patients need to be protected. The student could've taken a proactive stance by simply NOT tying the tubing to the railing, untying it when the RN left the room, or when she saw the RN doing it, she might've said, "Gee, what will happen when the patient turns or suppose someone who isn't aware that the tubing is tied to the bed rail comes in and drops the bed rail?" We have CNAs who drop bed rails all the time and really, they don't expect that vital tubings or lines are connected to moveable parts of the bed.

If all else fails, this is why students are ultimately supervised by their instructors. She could've asked her instructor, who might've simply come in and unhooked the tubing from the bed rail or actually confronted the RN for the student.

It all goes back to the fact that the problem was that the student did not understand that it was wrong, so she didn't ask for her instructor's input on how to handle the situation.

I have to ask how it is possible that the student did not know better -- in treatment of the nephrostomy patient, almost every resource you check out will tell you that care must be taken not to dislodge the tube. Not "common sense" at all, it's right there in black and white. If she'd taken the time and effort to look it up. IMO, this student was not prepared to care for this type of patient and didn't have a clue.

Not having a clue means that the student came to clinical unprepared - this is utter disrespect for the power that the nurse has when caring for patients.

Being a patient advocate is all about taking responsibility. Being a good nurse is all about taking responsibility--responsibility to educate onself about the appropriate care for a patient's condition, responsibility to the patient to protect the patient from sloppy practices that can harm him.

I imagine that nephro doc's feathers were quite ruffled when he found out about the incident - and justifiably so.

[elizabells, BSN, RN]

The other thing to think about is that it is REALLY hard for nursing schools to get clinical placements - I had my OB rotation changed because the hospital "fired" our school due to a mistake made by a student in the rotation before mine. Kicking that student out may have been the only way your school could keep its placement on that unit.

Even aside from that, add my voice to the chorus saying that at my school, she wouldn't be getting that second chance next year. There's being unprepared, and then there's just not thinking.

[kcochrane]

Unfortunately you can't teach common sense, which is a major part of nursing. For someone at that level of nursing, common sense should have kicked in. Now mind you, it could have been a momentary loss, but it was a big loss in my mind. As others have stated, at least she is getting a 2nd chance. MOST schools I know of would not give her another chance.

[ORRocksRN]

I read that the reason she tied the tubing off on the rail was because she saw an RN doing the same thing. One thing you will learn about the clincal setting is that there is the school way and the real world ways of doing clincal procedures. The school always teaches as close to perfect as possible and the real world generally compomises some steps for speed. I am not advocating a break in sterile procedure, nor anything that would compromise pt safety. Here's the rub. She saw another person (an RN!) do something foolish, and she did the same thing. This is absolutely one of my biggest beefs with nursing school. Students are hounded to death by instructors to be an advocate for their pt, but schools absolutely hate people with a backbone. I can not even start to tell you how many times I have heard instuctors throw "professionlism" in the face of a student for disagreeing with them. I really believe schools beat the ability to confront mistakes or errors out on their students. How can a nurse be an effective advocate if they are not willing to ruffle some Doctor's feathers occasionally?

wow, does this sound familiar. I got in trouble for being late (one time!), and the head of dept is late for every single thing she does!! Is she "modelling professional behavior"?? If you try to speak up and "clarify" when they accuse you of something you didin't do, you get in trouble for "talking back." How are they teaching you to be able to stand up and advocate for your patients, when you aren't even allowed to advocate for yourself????