HUGE mistake in clinical.... - page 2

pt. was 90, total care with dysphagia and recently admitted after recovering from aspirational pnuemonia. i took care of him yesterday with no problem. today, i was told we had to make sure we... Read More

  1. by   MassED
    Quote from mattiesmama
    pt. was 90, total care with dysphagia and recently admitted after recovering from aspirational pnuemonia. i took care of him yesterday with no problem. today, i was told we had to make sure we brushed his teeth after breakfast. i had a brief tutorial on brushing teeth and other aspects of basic pt. care in ns, but i had only done denture care in clinicals up to that point...but i figured it couldn't be too hard, i'd seen the cna's do it on other pt's before so i gave it a shot. i dipped the brush in a little bit of water and put a tiny dab of toothpaste on and brushed...when it came time to spit, i gave the pt. the emesis basin and instructed him to do so. he spit out a tiny amount but there was still a lot in his mouth and i could tell he was having difficulty spitting it out because it was a thick consistancy and sticking to his mouth. he started to swallow some of it...and i started to freak out thinking "oh god he's going to swallow a big chunk of that and it will become lodged in his airway", so i took the cup of water which had a tiny amount left in it (literally about a centimeter) and gave it to him and told him to swish and spit. as soon as i did it, i realized what a monumental mistake i had just made...he’s an aspiration risk on thickened liquids. ****. i leaned him forward and helped him to spit it out, which he did but he started coughing like crazy and struggling for air (which is a pretty common occurrence with him but it is always scary when it happens) i had my partner go get the rn while i tried to help him get all of it out. she came in and made sure his airway was clear, and he ended up being fine, thank god. she asked me what happened and i was honest...i got lectured for it (i knew i would) but she was pretty understanding since this is our first clinical rotation.

    my instructor was a different story...she took me into the post-conference room and proceeded to ream me out, telling me that i wasn't taking this seriously and that i needed to remember that i was dealing with a human life, that this man could be my grandfather and i was acting without empathy

    then, she called a special class meeting…she didn’t name me by name or state exactly what happened, but i’m sure everyone knew she was talking about me because i was the only one crying. she launched into a lecture, again, about the fact that these are human beings and that people can die from our mistakes, and how maybe some of us (meaning me, i'm sure) are just not meant to be nurses, and are “in it for the money” and really didn’t care about being a good nurse or caring for their patients. part of me felt like crawling under a rock and dying, and part of me wanted to scream at her. i know that it is her license on the line, and i know she has to address concerns with patient safety…but she has no idea what she is talking about when it comes to my empathy or how serious i take this. i was up until 1am last night researching this man’s medical conditions and learning how to ask him questions in his native language just so i could communicate with him better-why would i bother doing that if i didn’t care? if i didn’t take this seriously, why did i get the nurse right away? why would i tell her what i did? like i mentioned the coughing spells aren’t unusual for him so i could have easily gotten away with it, but i didn’t even think twice about it. it was a mistake-a bad one, yes, but it was not made because i didn't have empathy or just didn't give a crap about this man's well being...it wasn't even that i didn't know aspiration precautions, i was just so afraid of him choking that i momentarily forgot.

    the truth is no matter how bad she made me feel, it's nothing compared to the butt-kicking i did to myself. i held it together the best i could but as soon as i got into the car i broke down crying and had to pull over because i couldn't drive. i watched my grandfather succumb to aspirational pneumonia, i remember vividly what it was like to watch him struggle to breathe and the look of terror on his face when he couldn't. the idea that a stupid mistake like that could potentially cause someone to go through that pain is really heartbreaking and makes me wonder if i can really handle this career
    that, unfortunately, is how you learn. that's what nursing school is all about - you won't make that mistake again. don't beat yourself up over it - how else does he brush his teeth? if he has a trickle of water, it will likely make him sputter and gag. my suggestion might be, if it's possible where you're doing this clinical rotation, is to have suction set up to immediately suction out the water and paste while brushing - like at the dentist. he has to have brushed teeth and mouth, anyway. don't worry about it. live and learn. nursing school is difficult. if you beat yourself up too much over this (probably more the humilitation by the instructor) then how will you handle bigger teaching moments?
  2. by   MassED
    Quote from SrnD
    Just to let you and the other poster who said that we as students practice under our intrustors license....that's not true. i believe i heard a clinical instructor say this before also BUT in the very first nursing class we ever had at our school (the really basic intro to issues in nursing) we were taught that students DO NOT practice under their clinical instructor's license. the only person who can practice under a license is the person it belongs to. and i don't see how this could differ from school to school as it's such an important issue.
    I recall paying liability insurance while in nursing school, with the college, which was a requirement to carry. I would imagine that as a nursing school, there are certain requirements for students to perform clinical skills, such as supervision from a licensed RN. I'm sure this varies from state to state as far as stringency as well.
  3. by   shann106
    Yes it was a mistake, but truly it was a small one in the scheme of things. You owned up to it, got help, a lot of students would have tried to cover it up.
    I think the instructor handled it competley wrong, possibly because she will get in trouble too. She should have just used this as an example that even something like oral care that seems so simple can be dangerous and left it at that. Implying you were only in this for the money was totally inappropriate.
  4. by   sissiesmama
    I agree with some of the other posters, don't beat yourself up because you weren't the first one to have this trouble at clinical, and you won't be the last for sure. That happened to me not long after I started working as an LPN on a busy med surg unit and I panicked completely. My charge nurse was very nice about it and helped me.

    I always try to have a suction set up, a Yankeur (spelling?) at the bedside, you can use it for clearing secretions from the mouth when performing hygeine. Might not help 100 percent of the time, but can usually help.

    Anne, RNC
  5. by   MassED
    Quote from shann106
    Yes it was a mistake, but truly it was a small one in the scheme of things. You owned up to it, got help, a lot of students would have tried to cover it up.
    I think the instructor handled it competley wrong, possibly because she will get in trouble too. She should have just used this as an example that even something like oral care that seems so simple can be dangerous and left it at that. Implying you were only in this for the money was totally inappropriate.
    isn't that just an incentive for the poster to not fess up next time?? Really, it makes it seem that her being honest was met with punishment, rather than understanding from the monster of a nursing instructor. I had a nursing instructor (director of the program) on my tail from day 1, so I understand. The instructor SHOULD have been understanding of a mistake, though firm, but still approachable for the student for potential future mistakes. Geesh! No wonder nurses turn to drugs!! haaaa just kidding.
  6. by   sissiesmama
    I just went back and re read your first posting when the thread got started. Your instructor said WHAT???? You didn't have any empathy??? I wasn't there, but it seems to me when reading this that you were very concerned about the patient, and that what happened was just a mistake. It could have been worse, but thank goodness it all worked out ok, and I'd be willing to bet this is something you will remember for quite a while.

    I'm sorry your instructor handled it that way. Seems like she could have handled it differntly and still have made it a learning experience.

    I still just can't see the lack of empathy there. In fact, if I am in the hospital, I wouldn't have a problem with you taking care of me.

    Anne, RNC
  7. by   goodstudentnowRN
    Mattiesmamma,

    You have admitted to your mistakes and have taken responsibility, now it is time to move on. As we go along, we do better. I have seen worst than this happens to students and they have graduated and are very good nurses. I am not here to judge you. I wish you all the best.
  8. by   Agrippa
    Screw your instructor. You're a nursing student and a human being - you will make mistakes. She sounds like the one who can't empathize.
  9. by   Jolie
    One line of discussion on this thread concerns me. That is the "debate" over whether or not a student "practices on his/her instructor's license."

    If this is something that has not been adequately discussed or explained in your nursing education program, please ask your instructor to do so.

    There are some legal principles that provide the answer to this question. One is the legal requirement in all states that individuals hold licenses to engage in the practice of nursing. An exception is made to this requirement for nursing students, as it is recognized that without the opportunity to learn skills and interact with patients one can not possibly be prepared to practice the profession of nursing. All states allow students to engage in professional nursing practice under the supervision of a clinical instructor and/or preceptor. Either the clinical instructor, preceptor, or both are responsible for determining the skill level and knowledge base of the student and determining the degree of supervision required for each particular task (vital signs, bathing, toileting, dressing, feeding, passing meds, managing IVs, sterile procedures, etc.) Without such an evaluation of the students' abilities and the physical presence of either the instructor or preceptor, the student nurse may not engage in practice.


    So in this sense, a student does indeed, practice on the license of the instructor, preceptor, or both. There is no such thing as "practicing against a future license," because there is no presumption that a student will someday have a license. If a student is determined to be incompetent and is dropped from a nursing program, that is typically an academic matter, not a licensing matter. Unless a student is dropped from a nursing program for fraudulent, illegal or wantonly reckless activity, his/her status will not be reported to the BON, so no action is taken against a "future license."

    The second concept is respondeat superior, or the legal principle that the superior is responsible for the actions of the underling. This applies to instructors/preceptors and students, charge nurses and their staff, as well as nurse managers and their staff. The superior is responsible for making assignments within the scope of practice and ability level of the underling and is also responsible for supervising performance and addressing errors made by the underling that impact patient safety and care. Failure of the superior to do so can result in the superior being held legally accountable for the errors of the underling. Courts of law have determined that nursing students are to be held to the same standard of care as practicing nurses. That is the professional standard of what the "reasonable nurse would have done in the same situation," not the lower standard of what the "reasonable person" would have done. Student nurses can and have been sued for negligence in practice, and in cases where a student nurse is named, you can expect the instructor/preceptor to be named as well, under the concept of respondeat superior.

    Please don't underestimate the legal liability taken on by nursing instructors and preceptors.
  10. by   FireStarterRN
    She could have only reacted so strongly if she, herself, felt some guilt for what happened. I remember doing that with my children before. She's projecting her own sense of responsibility on to you as a psychological defense mechanism. People do this all the time.

    She's probably feeling overwhelmed with the job of overseeing several inexperienced nursing students all at once. She, herself, is not doing the best job in organizing her work and clarifying expectations. She also feels a loss of control that scares her.

    You are an easy target for her emotionally immature response, just like a mother can easily yell at her impulsive child who makes a mistake.
  11. by   Jolie
    I agree, FS.

    The responsibility for this error and the harm it may have caused the patient is shared by the student and the instructor.

    I don't mean to beat anyone over the head, but I don't think that some of the posters here recognize the serious implications this episode may have had for this elderly patient. The instructor does, hence her reaction, which wasn't the best, either.

    I would recommend a private conversation between the OP and the instructor so that the OP may express her understanding of the potential harm and reassure the instructor that nothing similar will happen in the future.
  12. by   mt3
    I wish they would make a sticky about student nurse mistakes because I'm sure EVERYONE makes them. I will be starting clinicals in the fall and I have learned so much from reading these types of posts. Thank you for sharing your story and rest assured that you are not the only one making them. Your instructor should have thanked you for being honest and used it as a teaching tool instead of reaming you.
  13. by   ErinJane
    I think that your instructor handled the situation improperly. Yes you made a potentialy serious mistake, but reaming you about it and making presumptions about your strength of character based on one mistake is overkill. But whatever you do, don't try to convince her otherwise. Just go through clinicals and keep your head down.

    Don't beat yourself up about it. I've made mistakes, every single nursing student is going to make one big whoops and some of them may not even catch themselves doing it. At least you knew your mistake and you owned up to it.

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