HUGE mistake in clinical.... - page 3

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   cursedandblessed
    i guess i'm lucky, as i have almost always had suction by my patients bedside, and never thought of not using it during oral hygiene. most of my patients have been either fairly critical needing total care (i had one who just loved to bite down on the glycerin swab and the suction like a vice) or are able to do their oral hygiene themselves.

    sorry your instructor was unprofessional. i'm glad your patient was okay, though.
  2. by   MattiesMama
    I am not sure exactly how it works, but we were told that both the student nurse and the instructor are liable in clinicals...and we are held to the same standards as a practicing nurse would be. To be honest, the more I think about it, the more I'm having a hard time understanding why, that being the case, we were given the responsibility to care for a patient who was that medically fragile under such limited supervision. Aside from the liability aspect, I feel like it is putting the patient in danger...I mean, I consider myself a reasonably intelligent person but there is just no way, after only 5 weeks of instruction, that I can develop the clinical judgement needed to provide safe and effective patient care to someone who is that high risk. Especially when we have such minimal time doing hands-on stuff in the lab...I mean seriously, I don't need someone to hold my hand and lead me through this stuff, but reading a step by step explaination for how to cathaterize a patient and then being expected to "practice" it on a living breathing human being seems unreasonable to me...Is this what it is like in every school, or am I just in a crappy program?

    ETA-we also have not even studied anything about aspiration precautions yet...let alone caring for patients with any of the litany of medical problems that our clinical patients have. We don't even know in advance who are patients are, so we don't have a chance to do our own independent research.
    Last edit by MattiesMama on May 9, '09 : Reason: q
  3. by   CRBRNCPHT
    Your instructor is ridiculous. Yes, you made a mistake. Yes, she needed to discuss it with you and help you understand where you went wrong. But all that crap about lecturing the whole class and yelling and saying you didnt care about your patient? Seriously? That's just stupid.

    She should have applauded you for how you handled the situation...you got the RN, helped the patient, and fessed up. That takes alot of guts. It would have been easy to just not tell anyone what happened. Admitting to and taking responsibility for your mistakes tells me that you DO care and that you DO have the makings of a good nurse. Don't listen to your instructor...she's way out of line.
  4. by   CRBRNCPHT
    I am not sure exactly how it works, but we were told that both the student nurse and the instructor are liable in clinicals...and we are held to the same standards as a practicing nurse would be.

    This is so untrue. Even licensed nurses who are brought before the State Board of Nursing are only held to the standard of what a reasonable prudent practitioner with the same level of experience and education would have done in the same situation. You will learn this when you take Leadership and Management. You cannot be expected to know everything that a practicing nurse would....that's why you're in school!

    At my school we did not go to clinical until out 10th week and even then we went to a nursing home where the patients were not acutely ill. We also had a partner, "picked up" our patient the day before so we could prepare, and we weren't allowed to do ANYTHING without discussing the proper procedure with our instructor first.
    Last edit by CRBRNCPHT on May 9, '09
  5. by   fiveofpeep
    your teacher sounds like a total WITCH. I hate how some people feel the need to pass judgment on who is in it for the money and who is meant to be a nurse. Its so harsh and they dont know you and how you really feel so it's very presumptuous coming from them.

    That wasnt a huge mistake but its good because now you will always know to be prepared for complications and have suction at the ready. I agree that you probably shouldnt have been doing oral care anyways since in first semester you cant suction, but I do remember that my first semester I was on a rehab floor with lots of dysphagia patients and we did the oral care too.
  6. by   Blueorchid
    If he's at risk for aspiration and on thickened liquids I'm wondering why they've only provided you with regular toothpaste and a toothbrush to clean dentures in his mouth... I just finished my first clinicals and my patient was initially on a trach with nectar thick liquids-but we had a suction toothbrush and a cath ready to use at the bedside. Granted he's not a trach patient, but all the beds on our unit had suction-which by the way we could do...Our instructor had to be present because it was an invasive procedure but we were perfectly within our rights as students. So for the people saying you can't suction...I'm not really sure if that's entirely true.

    I don't think your nursing instructor should have reamed you out for not caring enough about your patient though...that's just unprofessional. She sounds a bit more concerned about her own license than how others are learning. And that's the whole point of clinicals...to learn. We're all going to make embarrassing mistakes and we better get used to it.

    So don't let a "near miss" like that make you doubt wanting to be a nurse. Part of clinicals is learning to deal with the people in the hospital as well as the skills too
  7. by   Jolie
    Quote from crbrncpht
    i am not sure exactly how it works, but we were told that both the student nurse and the instructor are liable in clinicals...and we are held to the same standards as a practicing nurse would be.

    this is so untrue. even licensed nurses who are brought before the state board of nursing are only held to the standard of what a reasonable prudent practitioner with the same level of experience and education would have done in the same situation. you will learn this when you take leadership and management. you cannot be expected to know everything that a practicing nurse would....that's why you're in school!
    i'm not sure where you are getting your information from, but i would urge you to consult with your school's nursing leadership instructor or a health care attorney.

    there have been cases in which courts have held student nurses to the level of professional negligence, (for failing to act as a prudent nurse would act) not ordinary negligence (for failing to act as an ordinary person would act).

    the following summarizes the findings of one such case: a student nurse administered oral nystatin by the intravenous route. the patient subsequently died. the family sued. the court ruled that the student was be held to the standards of a professional nurse. failure of a student nurse to read, understand and implement a physician’s order
    is professional malpractice, not ordinary negligence.
    the reasons why a nystatin suspension must be
    given orally and not intravenously are not within the common understanding of lay persons.
    court of appeals of michigan
    september 29, 2005

    a student nurse is required to exercise professional nursing judgment when administering medications. a student nurse
    is expected to understand the importance of correctly reading and following physicians orders and must also understand and follow safety considerations when administering medications to patients.

    full article: legal eagle eye newsletter for the nursing profession november 2005 page 7
  8. by   Natingale
    oh wow i didnt even mean for it to get out of hand ...i have this one clinical professor that reamed on students for not having their bed in 45 degrees, and we all chalked it up to "shes like that because of her license" thanks for the info, i'll be sure to pass it on to other classmates


    as for the OP ...again, i still believe youre going to be a fantastic nurse and you learned something here.

    As for the professor, who are we to call her a witch? were we there? I think we should refrain from stoning the individual and name calling, regardless if she was right or wrong its unprofessional

    as for the patient, yeah I agree ...im glad theyre ok
  9. by   NurseLoveJoy88
    I'm sorry I didn't read all the post but I'm sure others have said what I'm about to say.
    First of all you must forgive yourself and try to move on. We all make mistakes.
    Secondly, when ever I'm doing mouth care on a pt. who is on aspiration risks I use a toothette and I dab some mouth wash on it. This way the pt. don't have to worry about spitting out anything and its safe.
    Good luck.

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