Help! Dig error, accused of lying?

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Hi there,

God, I don't even know where to start. I am a senior level nursing student in an ADN program at a community college. I will be graduating in May of '09. Yesterday part of my paperwork was incomplete at the beginning of clinical, and my instructor sent me to another floor of the hospital to speak to the other more senior instructor and show her my care plan. (my fault that certain parts were incomplete). This senior instructor sat me down, humiliated me, told me that certain parts of my labs were missing. The long and short of it is that my clinical instructor was requiring different things in her care plans than this senior level nursing instructor was, so I tried to explain, when I could get a word in, that yes I took responsibility for the parts that were incomplete, but the labs were not due till a later date and this was even stated on the website/clinical requirements. She got in my face, wouldn't let me talk, and said "well, then are you calling Mrs. ... a liar? Is that what your'e saying, that she's lying?" in a very aggressive tone. It all got sorted out and she went to the college website, saw that I was right and gave me a very short apology and sent me back down to my clinical floor to my regular instructor.

This was in the morning, first thing, and I was devastated. I really look up to both these instructors, and am one of the best students in the class. I work so hard, I have given up my house, my care, my whole style of living to make it through this program and they are aware that I am willing to do whatever it takes to succeed. I never argue with them, never complain, and to be accused of calling my instructor a liar just hurt me very deeply. I was so anxious that the end result was I forgot to check a pt. apical pulse before giving dig. I forgot to even check his name band. I had it in my mind all morning, since I had never given dig before, check the apical pulse, and told my instructor as she was drawing meds out of the pyxis, wait, I still need to get that apical pulse before I can give the dig. She followed me into the room and started hammering with questions about the meds, which I had already answered correctly for her in the med room when we pulled the drugs! I got so distracted trying to answer her questions and give the drugs at the same time, it just all spiraled downward from there. I had to put a nitro patch on, give a heparin injection, hang an antibiotic, and give pills. I trying to organize my meds in the room and give everything correctly but she was asking me questions like "now are you sure you want to do this?" and "are you sure you want to do that", when I was doing the right things, but she wanted to "test" me.

Anyway, I am now in danger of being asked to leave the program. I have a meeting with them on Monday. Of course, they view it as a med error because had she not reminded me, I would have given the dig. without checking the apical pulse first. I just feel they need to take some responsibility for the way they talk to students and basically treat them in a way that verges on harassment, sometimes. Any advice would be greately appreciated. I am just devasted, I've been crying for 2 days, I'm in shock that this happened. I have never done anything like this before.:sniff:

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Hey QueenJane,

I am a student, too, so this really isn't 'advice' per se...but as soon as I read your post I reviewed my Student Policy Handbook to see what it said about med errors. First and foremost, the book emphasized the definition of a med error.

In our school, violation of one of the six rights prior to administration constitutes a med error, and one of them would be checking the pts name band.

Peppering you with multiple questions just prior, to me, seems not to be conducive to the task at hand. The time for that is in the med room. I can see how that was very distracting especially since you had answered all the questions at the appropriate time in the med room. Our clinical instructor does the same thing in the med room, and on our way down the hallway to the pts room, we review the most important pre-administration assessments. Once we are in the room, no more questions, no more interruptions.

I am sorry this happened to you. During your meeting, I would raise these points and certainly bring up the inappropriate interaction between you and the senior instructor, which was belligerent at best.

Don't be defensive, and always behave professionally (even when others do not).

I'm sure you will get much better advice from working nurses and those with more experience. Be sure to review your school's definitions and protocols for following through on med errors to ensure your fair treatment.

Good luck

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Hey QueenJane,

I am a student, too, so this really isn't 'advice' per se...but as soon as I read your post I reviewed my Student Policy Handbook to see what it said about med errors. First and foremost, the book emphasized the definition of a med error.

In our school, violation of one of the six rights prior to administration constitutes a med error, and one of them would be checking the pts name band.

Peppering you with multiple questions just prior, to me, seems not to be conducive to the task at hand. The time for that is in the med room. I can see how that was very distracting especially since you had answered all the questions at the appropriate time in the med room. Our clinical instructor does the same thing in the med room, and on our way down the hallway to the pts room, we review the most important pre-administration assessments. Once we are in the room, no more questions, no more interruptions.

I am sorry this happened to you. During your meeting, I would raise these points and certainly bring up the inappropriate interaction between you and the senior instructor, which was belligerent at best.

Don't be defensive, and always behave professionally (even when others do not).

I'm sure you will get much better advice from working nurses and those with more experience. Be sure to review your school's definitions and protocols for following through on med errors to ensure your fair treatment.

Good luck

Thanks for your advice, it helps a lot. I am just afraid that even admitting my responsibility and also expressing why I goofed up that they still will not give me another chance. I feel like they are targeting me for some reason. I've never violated any of the 6 rights before, ever! That's why it got me so flustered that she started all over with the questions when we got in the pt. room, I mean she actually sat down in a chair and started writing down everything I was doing! It just totally freaked me out, I'm thinking, we just went over all of this, it was all okay 5 minutes ago, what is going on? I went to hang the piggyback antibiotic at the rate I had just told her I was going to set the pump at 5 minutes ago in the med room, and she had said, yes, that's correct, etc. Then as I start to program the pump, she says "now are you sure you want to run that in at that rate?" She was trying to mess me up. So, of course, I doubted myself, I thought God forbid I run this in at the wrong rate, so I stopped what I was doing, had to get out a pen and paper and yes, I was correct. She then proceeded to hammer me about the heparin injection, and it just went all downhill from there. She had me so nervous I couldn't even think straight.:confused:

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I wish I could help more. Has this instructor ever done anything like this before? It does seem rather odd that she is behaving this way. I do not understand why some feel it is okay to badger and be of so little actual 'help' when it comes to med administration. My instructor is so supportive, and when we're nervous or whatever, she helps us through the whole thing. I never take her for granted.

I'll give you a little personal story. I am a paramedic, and trust me, when it comes to working in the field, it is absolutely brutal. I have been beat down to the point where there are no more tears to shed. One of the things I had to learn was that I knew what I was doing, and I had to refuse to let anyone treat me otherwise.

On one particular call, we had a CHF-er who was so close to requiring intubation it wasn't even funny. As soon as I saw him, I thought, 'Oh God, he's going to die in my truck.' We had him on the stretcher, hooked up to the monitor, high-flow O2, and on the way outside in less than 3 minutes. Fortunately, we were literally 6 blocks from the hospital. I called in my radio report from the pts driveway while hooking up the CPAP, starting two IVs, getting a BGL, and getting baseline O2 sats (in the high 70s). Needless to say, I did not have time to get a BP, but he had a bounding radial pulse. Okay, so his systolic is at LEAST 90 mmHg, but I don't want to give Lasix since I can't actually verify his BP. Our transport time was 2.5 minutes and I still was able to start the two IVs and keep him on CPAP and get a 12-lead ECG done. As soon as I walked into the ED, a nurse came over and yelled at me for not giving the BP over the radio. My response?

'This pt is alive, breathing, with a pulse, and his O2 sats are now 96% and he is crying thanking me for saving his life. In assessing his ABCs, I never got past 'A' for airway. Are you suggesting that next time I ignore the obvious and give you a vital sign that is completely irrelevant to the pts presenting problem that I cannot fix in 2.5 minutes anyway?' Fortunately, I knew the charge nurse well and had proven myself to her over the past 3 years. She came over and apologized for the nurse in her presence. She then proceeded to tell this woman that if she (the nurse yelling at me) had been in my shoes at that call, that she probably would have peed her pants because there was no one there telling her what to do and no physician to turn to for help. Needless to say, she was quite embarrassed and never gave me a problem after that.

Now, being a student we can't get away with, nor do we have the experience or knowledge, to substantiate a response like this. However, what I'm trying to allude to here is that when you know you are right, you KNOW it. Don't doubt yourself. If you have prefigured your dosages, checked your math, confirmed it in the med room, then you are CORRECT. Maybe writing your assessment steps down on your paper will help you to remember during the flustering times what you should do.

I agree that this is an extremely intimidating situation. Please come back and tell us the outcome. I wish you every success, and remember, there are lessons in EVERY situation.

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I am sorry to hear about this! It sounds horrifying. Here is something I came up with while reading this:

When she kept badgering you asking if you were sure you wanted to do this, I would've just said, "Yes. Is there a reason I shouldn't want to do this?" Because - what's the worst that could happen? She's sitting in the room with you. Even if you were wrong, she would NOT have let you administer that medication, because it would have gotten her in trouble (if it was, in fact, wrong). See what I'm saying? You're under her supervision. If she was to let you push the wrong med or push something at the wrong rate or ANYTHING like that, she's the one in trouble. Not you. So don't let her get you tore up like that. Don't let them get to you or get inside your head.

You know what our instructors told us our very first day? "Boys and girls, you've basically just entered a military boot camp, only for nurses. This WILL be the hardest thing you've ever tried to do. If you have children, GET A SITTER NOW. We better never catch you taking that elevator. (because our program is on the 3rd floor of a huge medical school) If you ARE taking that elevator, you better have a disability. And if you have a disability, you better tell us now. More than half of you won't make it through this, so get ready, because this is tough."

See? They try to get into your heads like that! You can't let 'em do you that way. Be confident in what you're doing. Because even if you WERE wrong, that instructor isn't going to LET you be wrong - or it's her butt.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Being asked to leave the program is not the same as being kicked out. You can say "no". You can also say you realize you made an error, feel terribly bad that you have looked up what it is you did wrong and why it is important to check the pulse before giving dig and that you won't be making that mistake again.

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I'm sorry to hear about your story. Guess what it's very similar to mind in some ways and I got booted OUT and just got back in. May I asked which school you are going to? I tried to explained to them what was going on. And to be honest, I deserved to move on with others but I was single out the whole time and I strongly felt that way but my voice as a student doesn't heard as clear and as loud. So, I pray for you that you somehow get through this and move on with others. I know how stressful it is trust me. I've been there and done that and I even cried in front of her and still she disrespected me by walked away. All of my close friends in that same team knew something was up but they were afraid to stand up for me and I don't blame them, however. They know that I do not have knowledge deficit and I was personally targeted. But the despite the fact that happened, I'm still here and still strong

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Specializes in Triage, MedSurg, MomBaby, Peds, HH.

So I don't understand: did you actually GIVE the digoxin without taking the apical pulse while the instructor was standing there? Or were you GOING TO GIVE the dig without taking the apical pulse?

It sounds as if the instructor averted you from actually making the error as she was standing there assailing you with questions but I'm not sure.

In any case, I will be thinking about you and hoping things turn out okay. Let us know.

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From what I understood in her post, she was GOING to give dig w/o checking apical pulse, because the teacher reminded her...so they consider that a med error, though the instructor kept her from actually making one.

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No. I think she told the instructor, she forgot to check the apical pulse and need to do that so she went straight to the room and her instructor followed behind. In the room was where her instructor asking questions and she got nervous and everything spiraling down hill, if I'm not mistaken reading it, am I right?

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Specializes in tele, oncology.

I can see where you would be upset by how you were treated. However, you could also look at it as preparation for how the real world of nursing often is; take the view that "I managed to deal with this situation, it was good training for dealing with management and belligerent families." Nursing is, unfortunately, a profession where we are not allowed to make even the slightest errors in medication administration regardless of what is going on. Better for you to have a situation like this where it was caught and you can learn from it while in school than have it be a sue-happy harpy of a daughter at the bedside just waiting to call the local lawyer. Believe me, I have had plenty of family members act just like you are describing your instructor acting...which once led me to give the wrong dose of insulin to a patient (just by 2 units, but what if it would have been 20?)...and the fact that the daughter was acting like she was part of the Spanish Inquisition just prior to the administration made not one iota of difference when I had to explain it to my manager, nor should it have. And I can guarantee you I have not made that error again b/c (eventually...once I got calmed down) I decided to analyze what had occured, role play possible scenarios in my head, and figure out what I had to do to make sure that similar situations did not rattle me like that again. Of course, it still happens from time to time, I'm only human; but I try very hard to not let it get to me.

I'm just trying to say that I feel for you, and it's awful when stuff like that happens and I have been there myself before. Just try to flip your view and instead of seeing it as "they're all out to get me" (even if they are) to "they're trying to make me into a nurse who can operate under pressure". You can't change their attitude, but you can try to take a positive away from even the most negative of experiences.

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Just to clarify, I and my instructor were in the med room, she was pulling my meds for me out of the pyxis-she is not allowing us to do that by ourselves yet, and as we did this, she asked me about each medication, mechanism of action, etc. During this 10 minute or so period of time, I said to her twice, if you are pulling that dig for me, I have not yet checked his apical pulse, I need to go in the room and check it. I said this twice as she was pulling my meds. Another student was standing right next to me and heard me. So I finally went in the room to give the meds and she followed me in, which was a little unusual. I had my hand literally on my stethescope to listen to my patient's apical pulse when she started with the questions about the IV piggy back, and other misc. things. She had me so rattled, by the time, finally 15 minutes later, I was handing the dig to the patient in the little med. cup and she said, "are you sure you want to give that med?". I stopped immediately, of course, I knew right away in here eyes I had made a med error, because had she not been there, she can say, I would have given the dig without listening.

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