Failed clinical because...

Published

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.

Specializes in Pediatrics.
In a perfect world the clinical instructor watches over us every minute and every skill is taught before we ever hit the clinical floor. In reality, my clinical instructor had twelve of us.

I was waiting for someone to bring this up. Since it is not a perfect world, and the CI only has one set of eyes, and this was the final semester, the CI made that judgment call that this student could be left alone with a tube. It wasn't like the student was hanging a med, emptying the tube (or at least it's not mentioned in the OP), she just radomly tied it during her care for the pt.

I may be wrong, but it sounds like this girl had not been taught about the care of a nephrostomy and so when she observed the RN tie it to the bedrail she did not know that it was the wrong thing to do. Some of you say it is critical thinking, but there are a lot of things that nurses do in a way that wouldn't make sense to non medical people
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Okay, we're no talking about an ET tube here, it's a nephrostomy. There's not much to know about. Just like any other tube (NG, IV, JP, and all the rest), you want it to be free flowing, non obstruced, and hanging in a way that is not putting the patient in any harm, and you want it to stay intact!! And at this point, a senior nursing student is not a "non-medical person".

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I think the punishment is just. I have never worked with such a tube but do wonder why an RN would tie it to a rail. Can't really blame the student totally for doing it if she did see an RN do it but, as someone pointed out earlier, students are expected to prepare for clinicals, not practice on patients without preparation. Of course, where was the Instructor? What teaching had she done on such tubes? Had she quizzed the student about tube care prior to clinical?

As a former Instructor, I hated it when students did not prepare the night before. They gave lots of excuses - I work, I have kids, I would have to travel too far, drive too much, hard to park. None of it moved me. My rule was Come late, get sent home. Come unprepared, get sent home. Clearly, clearly, both verbally and in syllabus, explained this and the rationale for it in very first meeting.

I could not afford for students to mess us on my license, insured or not. As another person pointed out, students are held to the same standard as RN's. One student went over my head to the Dean, who asked me to be lenient. I expected her to take the student's side so the student wouldn't raise a huge fuss, but I just could not, mainly because it was not the first time this particular student arrived late.

She was habitually late, which meant she missed pre-conference, I had to repeat stuff, she disrupted the class. Not fair to me, other students, or even to her. And then she'd spend most of clinical time reading her books, instead of being out with her patient. Unprepared in my book.

I know she had it hard - single mom of a pre-schooler, babysitter woes, travel woes, working. Not my problem, no matter how sorry I felt for her and admired her desire to get ahead. I could not take the risk that she'd mess up. I told both her and the dean all of this and still required her to repeat the Clinical day.

The boss was upset with me but I kept my license and believe the student was better served, ultimately.

Again, punishment was just, OP.

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Specializes in Cardiac.
Sorry that many on here are jumping all over her by saying she deserves to fail,and yes I'm a student as well. I could almost bet that many on this topic have done far worse, they may not admit here, but we all make mistakes. Better punishment would have been a paper on proper procedures, not an out right boot out the door.

Seriously?

A paper as punishment? Wow!

If she doens't have common sense by now---especially as it relates to pt SAFETY, then writing a stupid paper on it won't fix it.

She's SOOOooooo lucky that she's allowed back into the program. I'd want her expelled.

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We had a case a few weeks ago where a student helped an RN with a foley. The student did not inform the instructor what they were doing, and we are all well aware that the instructor MUST be with us if we are performing a skill not yet signed off. Well, long story short, the student put 25cc of saline in a 10cc balloon AT THE PROSTATE! The RN he/she was with supposedly said that the resistence was the bladder and placement was ok. Supposedly she said to use 25cc to inflate the balloon. The punishment? Write a paper. We have been practicing foleys for weeks in sim lab and have been discussing the proper insertion for just as long. There was no excuse for this mistake to have been made and no reason for this student to have been allowed back in to the clinical setting. :nono:

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Specializes in 5th Semester - Graduation Dec '09!.
Supposedly she said to use 25cc to inflate the balloon. The punishment? Write a paper. We have been practicing foleys for weeks in sim lab and have been discussing the proper insertion for just as long.

In my experience, I have had pts where they inflate the balloon to 20-25 cc's because of leaking around the catheter at the urethra, but that was after the foley was inserted and flowing. And it is not something that students should be practicing anyway--I would never inflate a foley with more water than it calls for.

Every foley kit that I have seen comes with the 10cc syringe w/ sterile water. Never the less, she should have known 10ccs of water even if she had to draw it up herself. The port says 10cc's.

I just think that it is such fundamental knowledge. If this person doesn't know how to put in a foleys even though he/she has been practicing in the lab, it makes me wonder what else they don't know.

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Seriously?

A paper as punishment? Wow!

If she doens't have common sense by now---especially as it relates to pt SAFETY, then writing a stupid paper on it won't fix it.

She's SOOOooooo lucky that she's allowed back into the program. I'd want her expelled.

Sorry that I sided on a fellow student nurses side!! Yes it was a very bad error, that lacked very bad judgment. Maybe this student does deserve to fail, and maybe not, we all here don't truly know this student and this students potential. Maybe its the military experience coming out in me, but I prefer to stick up for people on my side and not just throw them to the wolves,especially not knowing the whole story. And yes, maybe a paper would not suffice,maybe more hands on training, and yes possibly a career change. I hope this student is doing well.

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Specializes in Cardiac.
Sorry that I sided on a fellow student nurses side!! .

You should be siding on the pts side...

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You should be siding on the pts side...

That is true as well!!

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Sorry that I sided on a fellow student nurses side!! Yes it was a very bad error, that lacked very bad judgment. Maybe this student does deserve to fail, and maybe not, we all here don't truly know this student and this students potential. Maybe its the military experience coming out in me, but I prefer to stick up for people on my side and not just throw them to the wolves,especially not knowing the whole story. And yes, maybe a paper would not suffice,maybe more hands on training, and yes possibly a career change. I hope this student is doing well.

I hope she is doing well too, but she made a horrible error, doesn't matter what her potential was up to that point, the fact is she made an error and she did it while performing basic nursing care and as a 2nd year student certainly did not require the instructor being there. We have been told countless times that we are held to a certain standard and are reminded constantly that "student" isint the only word in our title, "nurse" is there too. What whole story do we need? We are talking about patient safety..#1 priority.

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Specializes in Acute Mental Health.

I'm sorry your friend has to repeat. I hope this will make her a better nurse. I bet she will never again tie anything to the rail. It's a hard lesson to learn for a moment of bad judgement, but its a lesson hopefully learned. I'm glad she didn't get kicked out of the program all together. Believe me when I tell you that as humans, we all will make tons of mistakes in our lives. A friend had a baby in the PICU at Children's and she started flipping through the medical chart (11yrs ago), and she came across a note stating someone had bumped a pump in surgery and the baby had gotten a bolus of narcotics! The infant was in for open heart surgery and someone bumped a pump!!!?? He made it, but it was scarey! I don't think that person got the boot.

I sure will be very aware of lines and tubes even more now then before reading this thread. I wish her the best of luck.

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