I am so upset! I am going into my 3rd semester, and I have never had to worry about how I did in clinicals, and have always gotten positive evaluations.
Well, 2 days before the end of this last semester (dec. 2010), I was working with my clinical instructor in pediatrics and I had a patient that had a lot going on. She had a central and peripheral line, was on a tubefeeding and G-tube. I have never had the oportunity to start a tubefeeding or give meds through a g-tube. so, while I was giving meds through the tube, I asked how much normal saline I should flush with?; Then, I had to start a tubefeeding, which I have never done and told her this, and she had to walk me through it; I have never dealt with a central line, so I again asked her if we flush it with heparin or normal saline? I was very upfront with her and told her I had never done these skills before. The next day, I had the same patient and did everything on my own without asking a single question. The next morning after class, she said she wanted to go over my evaluation with me! She said, "I was going to tell you to go home and fail you this semester, but since you improved the next day, I am doing you a favor and olnly putting you on probation.:crying2: I asked why, and she said I should know all of my skills by second semster and she should only have to supervise me. What makes me so upset, is that the majority of the students only had to give out pain meds to their patient! I told her this too, and she said "well that is the luck of the draw!" My heart absolutely dropped. I pleaded with her not to do this, but of course she doesn't care.
I am so damn upset. In all of my clinical rotations, if we told our instructor that we had not had the opportunity to do a procedure on a patient, they would walk us through it. I always thought that people who got put on probation in their clinicals, were doing something that could endanger the patient ie. not washing their hands, leaving bedrails down, faliling to stay with the patient until they take all of their meds!!
I am just bummed, because my new clinical instructors will know I am on probation, and I feel like I will be walking on eggshells! I feel devastated!!!!
I asked why, and she said I should know all of my skills by second semster and she should only have to supervise me. What makes me so upset, is that the majority of the students only had to give out pain meds to their patient! I told her this too, and she said "well that is the luck of the draw!"
This is not being mean or rude in any way..but you should have been happy to get the opportunity to do all these skills. Your classmates were stuck doing the boring things. Some students complain they get boring patients and never do anything fun, well you had that fun chance. And the fact that your patient had all this stuff to be done, if you knew in your mind that you had never done these things...why didn't you brush up on the skills book regarding those certain skills? I know many instructors who would have sent you home for being unprepared. And it's not being mean, but if they say you should be competent and confident in something, and you're not..then what? And like they said, if you had done well before, they expect you do continue that trend. If you drop below your own bar, they won't just let it slide. The reason you shouldn't be upset is because they could have failed you, but didn't. Learn from it and carry on.
My advice is this: if you know your patient will have something going on and you're not familiar with it, brush up on it before you go do it. When I graduated and was going through orientation, things came up that I hadn't done in a while, were done differently, etc. and we have this big book of skills stuff on the floor to reference. I've glanced at it a few times to remind myself how things should be done for those skills you don't do often.
Is there a written list by hospital or program about what the expectations are for skills by semester or hospital? There are always people about others, though you risk being called a trouble-maker if you rock too hard. Would a polite meeting with the instructor and DON to ask about these issues help at all? Maybe everyone just needs to be on the same page. Are other students having problems with her?
If nothing else, you should have the opportunity to evaluate the instructor. Doing so in specific, non-attaching words will be most helpful.
Did you learn these skills at school first? And had check offs?
What is your reason for asking how much NS to use, and what to flush with? Did they not tell you the answers at school, so you had to ask to the instructor? If there was another classmate of yours having to do these, would they also ask? self criticism.
Did you learn these skills at school first? And had check offs?
What is your reason for asking how much NS to use, and what to flush with? Did they not tell you the answers at school, so you had to ask to the instructor? If there was another classmate of yours having to do these, would they also ask? self criticism.
I totally disagree with this statement. Learning how to give po meds or do a simple dressing is one thing but accessing a central line or g-tube should (in my opinion) always be a "learn it - see it - do it" opportunity. No student nurse should be expected to do these things without having the opportunity to see it being done first. As stated previously, this is what nursing school is for. If students are frightened into not asking questions there will be an inevitable decline in the quality and confidence of graduating nurses.
I think if it was first semester clinical, you would have a point. Not third though.
The information the student needed should have been on the MAR and if not, should have been addressed during prep. By the third semester, we should know enough to get our questions cleared up before going into the patient's room.
I'm guessing it was the "NS flush" through the g-tube question that got the student in hot water.
Sorry that happened. Hopefully it was a good lesson learned.
I see what you guys are saying. Really I do. But are you guys saying that she shouldn't have asked any questions, even if she did happen to know what to do? I know that when I know how to do a skill, I always double check with my instructor. Yes, everyone has a bad day but is that worth wanting to fail a student instead of simply re-educating them? And since she was the only one blessed to have the chance to perform these skills, couldn't this have been used as a learning experience for her as well as her clinical group? I'm sure she wouldn't have been the only one without questions. But OP now that is going to be a hard situation to be in... fail if you ask questions if you aren't completely sure about something or fail if you attempt to do it yourself and possibly hurt the patient. Like I said before, just stick with the RN in charge of the patient.
Did you guys attend a school this strict? I guess I don't understand how someone can be so unforgiving about something like this. My school expects you to come prepared as well, but they aren't expecting a student to be an expert clinician either; they appreciate questions. Even the "dumb" ones on occasion. I just think that this way isn't the most constructive for her, her confidence, and self esteem. Its just sad to know that capable students are being failed everyday due to things like this.
Question how is this fair because I learn by doing things not by just reading it so they are saying if you learn things hands on you are just going to fail I mean some things you have to do to understand how to do them I had a central line and a pt with a lot going on and my instuctor was like wow you have a lot to do and walked me through everything you did great just being able to do everything the next day
But are you guys saying that she shouldn't have asked any questions, even if she did happen to know what to do?
Did you guys attend a school this strict?
Its just sad to know that capable students are being failed everyday due to things like this.
No one is saying the student shouldn't ask questions. Here is the part you may be missing: The OP stated, "while I was giving meds through the tube, I asked how much normal saline I should flush with?"
Yikes. This is a very very bad time to realize you don't know what you are doing on a basic med admin skill.
Yes, my school is this strict. By our third semeser we are expected to know all about the meds we are to administer before we even pull them.
A capable student in the third clinical doesn't ask about how to perform a med administration in the middle of the procedure. A capable student gets their questions cleared up beforehand.
The OP made a mistake, and a pretty bad one at that. They appear to have a chance to make up for it, but instructors are certainly justified in applying consequences when a student goes into the room to do treatments and doesn't know what they are doing.
fail if you ask questions if you aren't completely sure about something or fail if you attempt to do it yourself and possibly hurt the patient. Like I said before, just stick with the RN in charge of the patient.
My school expects you to come prepared as well, but they aren't expecting a student to be an expert clinician either; they appreciate questions. Even the "dumb" ones on occasion. I just think that this way isn't the most constructive for her, her confidence, and self esteem. Its just sad to know that capable students are being failed everyday due to things like this.
Again, it's not about asking questions...you can ask 100 questions and be the most proficient student. But you can just ask questions to clarify, re-iterate, guide yourself and your instructor through your process.........or you can be shaky, unsure, not proficient at all and ask one BIG bad question that throws a red flag. Really it may have been about the way the OP came off in the situation.
I can empathize with your situation of feeling like you were singled out. My 1st clinical almost did me in as the instructor had me do a myriad of skills which were only a day or 2 fresh from skills practice - I was honest about what I knew and didn't know - many in my clinical later revealed being relieved that it wasn't them - she did pass me but I spent a semester under a microscope and in constant fear. The situation was a bit unrealistic (monumental understatement) - and I am only lucky after so much criticism that I decided to push on and wound up with a wonderful clinical instructor the next semester. I don't know why we can't be a little less harsh with each other - and treat school as a bit more of a setting to encourage learning.
Wow, that really sucks. I can understand that you are expected to know your stuff but our instructors encourage us to ALWAYS ask about ANYTHING we're not sure about.
:crying2: I asked why, and she said I should know all of my skills by second semster and she should only have to supervise me. What makes me so upset, is that the majority of the students only had to give out pain meds to their patient! I told her this too, and she said "well that is the luck of the draw!" My heart absolutely dropped. I pleaded with her not to do this, but of course she doesn't care. 
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kgh31386, BSN, MSN, RN
815 Posts
This is not being mean or rude in any way..but you should have been happy to get the opportunity to do all these skills. Your classmates were stuck doing the boring things. Some students complain they get boring patients and never do anything fun, well you had that fun chance. And the fact that your patient had all this stuff to be done, if you knew in your mind that you had never done these things...why didn't you brush up on the skills book regarding those certain skills? I know many instructors who would have sent you home for being unprepared. And it's not being mean, but if they say you should be competent and confident in something, and you're not..then what? And like they said, if you had done well before, they expect you do continue that trend. If you drop below your own bar, they won't just let it slide. The reason you shouldn't be upset is because they could have failed you, but didn't. Learn from it and carry on.
My advice is this: if you know your patient will have something going on and you're not familiar with it, brush up on it before you go do it. When I graduated and was going through orientation, things came up that I hadn't done in a while, were done differently, etc. and we have this big book of skills stuff on the floor to reference. I've glanced at it a few times to remind myself how things should be done for those skills you don't do often.