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.
4boysmama
273 Posts
I'm curious how passing meds was still a new process in your capstone experience? That seems like a red flag on your program...