So I failed out of my last class, my senior practicum, preceptorship. I'm just looking for a little perspective. I'm gonna try and make it brief as possible so bare with me.
I love psych but also like ER and all the medical side of things. I decided to go for psych because I thought I would enjoy it over med-surg. I discussed this with my clinical director and we decided on gero psych. I ended up an inpatient, drug rehab facility. It's a nice facility that incoporates detox and a longer stay unit. I thought what the hell, It's not my first choice but I'll make the best of it.
My first day was very slow. They couldn't get me in the computer system to chart or give meds so all I did was take BP and HR. I was getting along good with the patients but I knew RIGHT away that choosing psych to start was a mistake. Weirdly enough, one of the first patient interactions was someone with pneumonia. Right then, I knew I needed the medical background first but I didn't mention this this to anyone and I carried on. I had only 7 shifts left and I wanted to stick it out.
Finally I got to pass meds. I think the second person I gave meds to had like 13 meds. I immediately felt overwhelmed. I got his vitals first. I saw that he was taking dig so my preceptor said make sure to get an apical pulse. I went to the med room first though to start collecting his meds. While I was in there she said get an apical pulse. I thought she was just reminding me but I think she meant like NOW. Finally she goes, "for the third time, get an apical pulse". I said ok...do you want me to get go do it now? She said no, just finish getting the pills. I got his apical pulse before giving the dig. It was 85. I gave him all his meds. This was one incident that was brought up at evaluation. I would have known next time to check the apical BEFORE grabbing the pill but I didn't get another chance to do that persons meds.
Another incident was someone who had cirrhosis and major fluid overload but no respiratory symptoms like crackles or SOB. My preceptor was doing his meds and asked me to get a O2 sat for him. I put it on him and it read 91% so I told her. She said to leave it on longer and have him take a deep breathe and sit down. It went up to like 93, 94. I was supposed to know to leave it on longer. But again, didn't get a chance to do O2 on a critical patient. Or critical for that unit I should say.
My preceptor wasn't around and a patient came up complaining of anxiety. I looked at his chart and gave him PRN 1mg ativan. I told my preceptor what I did when she got back. She asked me if I got his BP first. I didn't. I forgot or was thinking that we took his morning vitals and that was all we needed. I said, damn, I was just about to and I didnt. I told her I would check it next time I saw him, just to be safe. She said don't bother it's over, now you know, you won't do it again. That was the first and last PRN narc I gave.
I asked her sometime last week for feedback. She said I was good with groups, good with the patients, a big talker. Nothing negative.
But last night, the second to last of my shifts at the end of my shift, I got my "mid-term eval". She started going over some incidents but that I could do better on my last shift but that she would never do anything to jeopardize me not graduating. She mentioned those previous incidents but also something about not taking the pulse ox on the side of a BP cuff inflating. She said it can cut off circulation and change the reading. I said ok. She also said I have poor body language and no "eagerness" to do vitals when a patient needs it.
On my last shift today, right when I was supposed to shine and improve, I messed up big. Preceptor told me to count pills for a discharge and note it. She put the meds down and said go fast b/c we were busy with discharges. Well she put the meds right down next to an insulin vial someone left out, probably from night shift. Before though, the patient had lisinopril that wasn't on the sheet that listed his meds. I asked my nurse about it and she said it was added later, go ahead and add it. Well, I applied the same logic to the insulin vial. The patient doesn't take insulin. I gave her the whole bag and said I was done. She said...what's this insulin doin in here?? Opps. I still can't believe I did that. I'm sure there were other mistakes that I made but that is what was brought up. I don't think I did any other "major" mistakes.
My evaluation today was that I'm not safe. A lot of the nurses don't want to work with me because of safety, I have poor critical thinking, poor assessment, and I dont' apply knowledge that I know. I'm probably going to appeal but I think I'm going to lose. I did a lot of things good but the workflow is so slow, I don't think there was enough to prove myself, only enough to make mistakes, which are my fault, I know. I was so bored there. It was supposed to be my preceptorship and me "being the nurse" but it just wasn't like that. On average, I probably did about 1 or 2 hours of actual work, if that. The rest was sitting around doing nothing or walking around aimlessly. And trust me, there was NOTHING to do.
I feel like I was set up to fail for sure. Why wasn't this stuff brought up to me earlier? But I also get soo anxious, especially if I make mistakes. I live in them. If I don't do good at first, I sometimes get anxiety to the point where I can't think at all. It's like I can feel my IQ just plummet. So here I am, wondering where the hell to go from here.
Geeze no one is taking my side! lol This is all good stuff guys thank you. I'm going to have to appeal this and I appreciate the perspective. I also want to learn from this. I know I'm accountable and responsible.
There were times in the morning when it wasn't slow. From about 7:30-9, before the clients had morning group. It was also hectic during that particular morning, there was like 5 discharges on top of meds. My nurse said that there was no point to train me on the discharges because it was mostly just computer stuff. I said ok and I just got vitals for all three of the nurses. She then called me into the med room to count the patients' meds. I don't know why it happened, it just did. I wasn't paying enough attention I suppose, I was trying to count 1000 pills with people cramed all around me. I got super anxious. I should just grabbed his meds, found a clearer spot to work, took a deep breathe and been more careful. It was bad and unsafe.
Like I said, I could have found more things to do. I get it. But again, my mindset was centered around "being the nurse" and "doing what the nurses do" And a lot of the times, they weren't doing anything and were just talking and waiting to give meds. Thats why I pushed so hard the first day to get computer access.
I talked to a lot of the patients. When I got a chance to lead group, afterwards we started a volleyball game. I got to interact and talk with a lot of them. Once I walked outside where they were smoking and just checked in on people. I heard their stories and asked people how they were.
But whenever I left, I was thinking I should be back at the nurses station, being with the nurses.
OP, that really does sound like a not-very-good unit for a preceptorship like that, after reading your most recent comment. I didn't mean to be overly harsh, but I think you were correct in your earlier comment that a lot of students read these posts looking for tips they can use to be successful. It also helps me as an educator to better support our students in their learning experience because "you don't know what you don't know."
I hope you find a better learning experience after your appeal.
OP - my personal opinion is that mental health is not the best setting to shine as a senior clinical participant.
Most of the learning in nursing school is more med/surg based and mental health nursing can be very different unless it is a unit with some kind of acuity to it like units with psychotic patients.
My mental health clinical was not a senior preceptorship, it was in my second year. It was in a psych facility and the floor I was assigned was garden variety mental health problems. It was very slow and boring. Literally, the day would not go by. In the morning I had to wake up patients and try to get them to shower and so on - mission impossible. After that walking to the dining hall where one of the longterm patients would get "fits" and throw herself backwards with a chair or just let herself fall to the floor. After breakfast they had team meeting with the psychiatrist to discuss the cases. After that I was bored until lunch because the meds were all given by one person. Because I had to do something I would play board games for example. After lunch we would take a small group and go for a walk. It was terribly boring and I wished to the whole time - every day. Well - one day we did a movie "night", which was in the early afternoon.Picking a movie was a total long process because the movie had to get approved by the psychiatrist who had objections to almost all movies. I forgot what it was we watched in the end.
By the way - people learn best when they have some form of "tension" and are not too relaxed. People do not learn well and tend to make more mistakes when they are too comfortable or too relaxed. Perhaps because the mind wanders off or what not.
I wish you good luck with the next place - pick something that is a better place and more structured.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
I am a senior nursing student in my leadership clinical in an emergency room.
For what it's worth, I do not think you should have failed. It sounds like there were some communication errors. The nurse who asked you to get an apical pulse meant for you to stop what you were doing, put the meds back and get the apical pulse first. That wasn't clear to you. It was a communication failure, not a personal failure.
The insulin mistake was an honest mistake. It would not have happened had night shift cleaned up. It would not have happened had you been on your a-game, and you weren't because you are brand spanking new and not even a nurse yet. The nurse caught it. No one was harmed.
Sometimes preceptors don't want the job, but they get pushed it into it for a variety of reasons. Most of the time they don't really know what you learn in school. Nursing school has changed a lot, and for some of these preceptors school was much more about tasks then it is now. They don't have any frame of reference for understanding what you should know and how you are being trained. You might really look like an F student to them, even if you work hard and do really well, for this reason.
Schools are in a difficult position, because their clinical sites are very important to them. They don't want to lose the relationship or credibility.
I think your school needs to investigate this further. Take the appeal seriously. If you were the first student placed here, this is a flag for the school, that it probably isn't just you. Clinical instructors may need to have a more active role, preceptors may need more guidance on what students are expected to know and what constitutes failure, and this site may just not be a good fit for the senior clinical. Do not be accusatory or defensive in your appeal. Show a willingness to improve and grow from the situation.
In my school, you would not have failed for this. Not many people fail clinical, but when they do it is because of intentional behavior, not because of mistakes. They are people who were warned by faculty not to repeat a certain behavior and did it anyway. For example, a student failed for repeatedly visiting his girlfriend who worked on another floor in the hospital. Another student failed for multiple dress code violations; fake nails, hair not pinned back, after having been warned. It is rare that students behave this way. No one fails for not knowing how to do something, or not being as good as the nurse.
I wish you luck with your appeal. Hugs and love, it is very hard to be a student right now, perhaps it always was, but it is difficult for different reasons now.
OP, reading over the thread, one of the things that leaps out at me is that you keep harping on not having "tasks" to do, and that you are more comfortable keeping busy on a med-surg floor. Well, yeah, there aren't a lot of "tasks" to do on psychiatric units -- but nursing isn't really about doing "tasks." (That's something that is often a challenge for nursing students.) It's about the higher level thinking. Anyone can be trained to do "tasks." Interventions in psychiatric nursing, apart from actually giving out meds, are based on assessment, communication, and therapeutic use of self -- which is something you could be doing at any point in the day, with anyone. Totally apart from the medication errors, a student who was making an effort in the preceptorship would have been staying busy and showing initiative during the day by learning about diagnoses/disorders and individual clients' histories, interactions with clients, honing your therapeutic communication and psychiatric intervention skills, etc. Regardless of how active and invested the staff nurses may or may not have been, there is always something to do on a psychiatric unit, esp. for a student.
OP, reading over the thread, one of the things that leaps out at me is that you keep harping on not having "tasks" to do, and that you are more comfortable keeping busy on a med-surg floor. Well, yeah, there aren't a lot of "tasks" to do on psychiatric units -- but nursing isn't really about doing "tasks." (That's something that is often a challenge for nursing students.) It's about the higher level thinking. Anyone can be trained to do "tasks." Interventions in psychiatric nursing, apart from actually giving out meds, are based on assessment, communication, and therapeutic use of self -- which is something you could be doing at any point in the day, with anyone. Totally apart from the medication errors, a student who was making an effort in the preceptorship would have been staying busy and showing initiative during the day by learning about diagnoses/disorders and individual clients' histories, interactions with clients, honing your therapeutic communication and psychiatric intervention skills, etc. Regardless of how active and invested the staff nurses may or may not have been, there is always something to do on a psychiatric unit, esp. for a student.
It's ironic that you and the poster directly prior to you posted within a minute of each other, yet, one as a nursing student and one a seasoned nurse, have such different takes on the situation. If there was a "love" option, I would've loved your post instead of just liking it; it is so dead-on. But the student just prior to you (not knowing what s/he doesn't know) was sympathetic with the OP and felt he was treated wrongly. This is the struggle that the OP has to come to terms with at this point; he had different expectations of himself and his preceptorship than his preceptors, clinical instructor, and school had for him. That's where I'd begin in revisiting how to achieve success in a preceptorship the second time around; *what is expected of me?* (not what *I expect* from the experience).
Specializes in Psychiatry, Community, Nurse Manager, hospice.
It's ironic that you and the poster directly prior to you posted within a minute of each other, yet, one as a nursing student and one a seasoned nurse, have such different takes on the situation. If there was a "love" option, I would've loved your post instead of just liking it; it is so dead-on. But the student just prior to you (not knowing what s/he doesn't know) was sympathetic with the OP and felt he was treated wrongly. This is the struggle that the OP has to come to terms with at this point; he had different expectations of himself and his preceptorship than his preceptors, clinical instructor, and school had for him. That's where I'd begin in revisiting how to achieve success in a preceptorship the second time around; *what is expected of me?* (not what *I expect* from the experience).
I am not sure what you mean when you say I don't know what I don't know. If you can clarify that, I would like to hear it.
I also would like to be clear that I agree that there is always something to do in clinical. I learned to know my patient inside and out from my first med-surg clinical. I was quizzed on every detail. I had to come up with nursing diagnoses and explain interventions and expected outcomes.
My leadership clinical is the same way, we have a conference midday, and we are quizzed, not just on our own patients, but on each other's patients. We have to come up with on the spot nursing diagnoses and interventions for each other's patients. It can be painful, but we do our best. You can be sure that we are spending a lot of time looking through charts and labs trying to make sure we understand the big picture, so we can answer whatever we might be quizzed on that day.
When we haven't collected adequate information, we are told what we need to follow up with and we do it, that same day, we head back to the floors.
There is no failing at this, because we receive a lot of guidance. The expectation is clear. If you were unable to give a report on one of your patients the first day at lunchtime, you would be very clearly guided on how to correct that for the afternoon. It would not happen again.
But these are not the things the OP thinks he failed for. Maybe he is wrong. But then how did he get through almost the whole experience of nursing school without understanding that he is to research pathophysiology of at least one patient per clinical (and as a senior, many more), identify nursing diagnoses, interventions and expected outcomes? If that happened, someone else failed here, not just the OP.
I think I'm saying this for the third time now but yes, I agree with all you seasoned experienced nurses, I should have been more creative in finding tasks to do. But there's nothing on my evaluation from about "creative task finding". If I was told this during my time there by either my preceptor or faculty to go find more tasks and do more research, I absolutely would have. But at this point, I'm done playing the blame game and I'm moving on, learning from this and looking towards solutions, not problems.
Also, I retract my comment about "being set up to fail". This is a victim, egotistical statement and I was upset at the time and still in victim mode. I love what someone just said about having the mindset of, what do they expect from me? Other than, what do I expect from them? That's good stuff and I will carry that with me.
At this point, I'm not even claiming I should have passed or failed. I'm not appealing the grade, I'm actually going through a different process and requesting that I am able to walk after next weeks ATI review, work with my clinical director to find me a new preceptorship, get evaluated properly via the proper university guidelines, pass and receive my degree. I'm fairly confident they will allow this. If they don't, I will deal with it then.
Thank you all for your comments and feedback. Without the experienced nurses who are willing to give feedback and help us newbies, we would suffer and our patients would suffer. I think I'm going to be a great nurse because I'm willing to mess up and move on. And most importantly because I do genuinely care about the welfare of those under my care.
Wish me luck on my next preceptorship, or don't, I think I will be fine. Thanks for those who encouraged me and those who gave me constructive feedback. Maybe I will come back and post about how my next preceptorship goes.
" I got super anxious. I should just grabbed his meds, found a clearer spot to work, took a deep breathe and been more careful. It was bad and unsafe."
It sounds like you have great self awareness and you learned from your mistakes. I wish you great luck with your next perceptorship!
For what it's worth, my psych clinical was my worst. I was young, task oriented and pretty clueless about the role and function of any type of behavioral nursing. I was confident and self motivated to learn any task but in my psych clincal I experienced the same aimlessness after the few if any tasks were done. They would direct me to observe a group or start a therapeutic discussion with an individual patient and I didn't know what that looked like let alone had any sort of experience to build upon.
Years of nursing and life experience later I could but as successful as I've been in my field, I was a complete duck out of water in psych clinicals.
It might sound crazy but if I had more things to do, like being on a med-surg or ER floor, I would have been WAY more focused and more energetic. When I get bored I tend to get uneasy and zone out.
Just a piece of advice: this tendency is something that you need to work to improve. I work in an ICU and occasionally have a slow shift. I might have one floor boarder and an admit bed but no admissions, and the nurses adjacent to me also have patients who are stable. It doesn't happen often, but it does happen. However it's not an excuse to zone out, and we can't zone out because at any moment things can change. And as you've found the hard way, zoning out can lead to huge safety issues for the patients.
This sounds a lot like my clinical psych rotation. I have been a working RN for awhile now in med-surg and I am well-liked and hard working. I make good clinical decisions and I pass a very high volume of meds, including many narcotics.
What I remember from my psych rotation as a student was what you described: Lots of downtime, clinical chores few and far between, and none of the regular RNs were very good at explaining things. Once they blew through their tasks they would hole up and talk amongst themselves. As a student, I did not have the context and experience to make the kind of decisions I now make several times a shift. Some of my fellow-students were LVNs and had solid work experience and we STILL were unable to find tasks to keep busy. Mostly the staff and patients did not want to be bothered. In between tasks we mostly walked laps of the unit (nowhere to sit) and quizzed each other to pass the time. The highlight for everyone was when we lined everyone up for the patient's smoke break and took everyone outside.
Sure, you made some mistakes but it does not sound like your preceptorship was well organized and well taught. Don't dwell on it. All you can do, like most times, is learn from the experience and do whatever it takes to move on.
Also, my actual preceptorship was a joke. My RN was very new and would not delegate. She was swamped with charting and it was a very slow unit. There was literally NOTHING for me to do for hours on end and I started going through every binder in the unit (policies and procedures) and interviewing everyone I could find. I learned a lot from RTs by following them around. Same with phlebotomists. I helped CNAs, who were initially suspicious of me for cheerfully getting bedpans and emptying foleys several times a night. If a patient took a sip of water I would run and chart it. Coma patients are a great opportunity because you can assess them over and over without getting on their nerves.
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Spurse32
45 Posts
Geeze no one is taking my side! lol This is all good stuff guys thank you. I'm going to have to appeal this and I appreciate the perspective. I also want to learn from this. I know I'm accountable and responsible.
There were times in the morning when it wasn't slow. From about 7:30-9, before the clients had morning group. It was also hectic during that particular morning, there was like 5 discharges on top of meds. My nurse said that there was no point to train me on the discharges because it was mostly just computer stuff. I said ok and I just got vitals for all three of the nurses. She then called me into the med room to count the patients' meds. I don't know why it happened, it just did. I wasn't paying enough attention I suppose, I was trying to count 1000 pills with people cramed all around me. I got super anxious. I should just grabbed his meds, found a clearer spot to work, took a deep breathe and been more careful. It was bad and unsafe.
Like I said, I could have found more things to do. I get it. But again, my mindset was centered around "being the nurse" and "doing what the nurses do" And a lot of the times, they weren't doing anything and were just talking and waiting to give meds. Thats why I pushed so hard the first day to get computer access.
I talked to a lot of the patients. When I got a chance to lead group, afterwards we started a volleyball game. I got to interact and talk with a lot of them. Once I walked outside where they were smoking and just checked in on people. I heard their stories and asked people how they were.
But whenever I left, I was thinking I should be back at the nurses station, being with the nurses.