Failed second attempt at final practicum

[rariel]

In January I made my first attempt at my final practicum. I had 3 month old twins and wasn't getting enough sleep. That combined with hypothyroidism and the stress of full time clinical work ended up with me suffering from postpartum depression. The whole practicum experience kind of snowballed from there. I ended up dropping about halfway through after struggling and being put on a learning contract. I was given the option to continue, but I just wasn't in a good place.

Fast forward to September and my second attempt at my final practicum. I felt like I had everything sorted out and was in a good place to be successful. My learning contract carried forward, which sucked but I had high hopes to get off it. My preceptor was a newer nurse (1 1/2 years out of school) and seemed ok. We soon ran into issues when it became apparent they acted as charge on all night shifts and sometimes for day shifts. In all of 15 shifts I was actually observed by them for 4 (one of which was following them around for charge duties). In all I had 5 different nurses pick up duties as my preceptor.

My first shift with them was my 6th shift. It didn't go great but we addressed the issues and I learned from it. There were several situations where my preceptor did not act in a professional manner e.g. doing my midterm evaluation in front of 3 other nurses. In general I just seemed to rub them the wrong way or did something at some point to offend them. I don't feel like they were out to get me or anything, but it does feel like there was a personality conflict that resulted in them judging me more harshly than they would another student.The final circumstances that resulted in my failure were: Vancomycin running at the wrong rate, not reassessing a patients pain (an issue that came from my preceptor not the actual nurses I was working with), coming back early from breaks, lack of following up over a missed Warfarin dose.

Apparently the Vancomycin I hung was found to have run dry running at a rate of 667 mL/hr. What doesn't make sense is that it was hung at 0040, but the LPN (who really didn't like me) found it beeping at 03:30. If it had been running at that rate it would have been done in less than an hour. The pain reassessment was charted in the nurse notes as I was told to do by the RN I was following. In regards to the coming back early from breaks, I was accused of administering medications without RN supervision (different shift same LPN who doesn't like me). What actually happened was I sat to chart some vitals I forgot and another time I was flagging my 0600 medications. At no time did I have patient contact or perform skills/administer medications. The Warfarin dose (if it actually was that) was about a pill I found in a patients room (a known drug user) when they called me in to help clean up a spill. I didn't know what to do with it, so I brought it to the attention of the RN I was following. It had gotten wet and was dissolving. We couldn't identify it so she said to throw it in the sharps container and chart in the nurse notes. There was a whole situation that the other nurse was not informed because the two nurses don't like each other so weren't communicating (I wasn't around until after the other nurse found out). Anyway, my preceptor used this as evidence of a reason to fail me. Some other things were that I lack initiative (not sure what else I could have done to show more initiative), I did not question a wrongly reported lab value given in report when admitting a patient from ER (I went through their lab work after they came up), and the final issues was that I volunteered to do a care plan (I offered do to it with the RN's help).

My preceptor never gave me a chance to even attempt to explain anything and recommended I fail. It was very disheartening for me because I don't think I should have failed. I was improving and other nurses I had worked with did not report any issues. Although I have appealed the grade, I only have my notes, my faculty resource persons notes, clinical evaluation checklists, and my preceptors notes to go on. I can't ask for statements from the other nurses on the unit, copy nurse notes, or the MAR as evidence. Given that clinical grades are entirely subjective I highly doubt the appeal will be in my favor.

I'm kind of struggling with what to do now. In my school 2 attempts at one class is all you can have. It's the only class I need to graduate with my BSN. I've looked into the other nursing school here, but you have to give them a clinical reference form. I'm guessing that will preclude me from getting in. Does anyone know if any provinces in Canada will let you take the LPN licensure examination with RN education credits? The other thing I've looked into is appealing the dean for a third and final attempt at the practicum. Does anyone have any suggestions for how to word the letter?

[jadelpn, LPN, EMT-B]

Before you step into clinicals, all students are given malpractice insurance. Have this conversation with them. They will help you sort through this mess.

The vancomycin--sometimes it is a 2 hour time period, other times more like 3-4 hours....patient depending. So I am unclear on what was wrong. It ran over 3 hours.....and unless someone cleared the history of the machine, can be proven.

Warfarin would not be in my mind a drug of choice for a drug addict. Even so, that you found a pill on the floor is not something that I would see as being your issue.

An LPN should not be directing your clinical work. It is the one constant in most every state's scope of practice for LPN's.

IT at the facility can in fact see that you were flagging meds--you leave a footprint every time you are on a computer. So a bit difficult to be in a room and on the computer at the same time....unless you were on a WOW, and even then, it is a little far fetched--along with the medication administration unit. If you were not getting meds out, not sure how you would get them.

All of this sounds like tremendous mis-communication issues. Most of which can be proved by the machinery that you used. And I get a little perplexed at the lengths some schools will go through to have someone re-take and pay more tuition for foolishness.

I would think hard about where to go from here. Talk to the malpractice carrier. Talk to your academic advisor. At that point, I would think about switching schools if what you are hearing from the school sounds crazy to you. In thinking about new schools, go and talk with them. DO NOT trash the clinical experience, just that it was not in line with how you envision your future practice to be. Ask what are transferrable credits.

And a completely off the cuff--some states allow a nursing student after their first _____ years to sit for the LPN NCLEX-PN. If LPN's are hired in hospitals in your area, and that is where you want to be, maybe go that route, and do an LPN to RN bridge. Especially since you already have the general education portion of your degree done.

Wishing you the best.

[rariel]

I'm in Canada so most everything is paper based. I can't access the MAR or nurse notes to provide evidence that I didn't do what I'm accused of. The Vancomycin was hung up at 0040 but the LPN found it beeping at around 0330. She said it had run dry and was going at a rate of 667 mL/hr. It was a 500 mL bag + 85 mL solution added. That's why I said it makes no sense. It couldn't have been running at 667 mL/hr because it would have finished in less than an hour not 3 hours. I brought up the patient was a drug user because we couldn't identify what the pill was beyond that it was round and orange. It had gotten wet so was very dissolved. They had been previously found hooking things up to their PICC, burnt spoons in the room, used syringes, etc.

Thanks for answering. It kind of sucks because I can't back on the unit. This means I can't ask for other nurses I've worked with to provide a statement of my performance or to show that no medications were administered. I'm not the perfect student, but I've been improving and had received favourable feedback from the other nurses I had worked with.

Do you happen to know if states that allow nursing students to take the LPN exam will let Canadian students take it? I've been trying to find out, but the only state I've found so far is Florida and it isn't really clear on whether it would be considered equivalent.

[I like cats]

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