Help! Dig error, accused of lying?

[queenjane]

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.

[Nurses-Rule1987]

We are students so we are in school to learn and correct any mistakes. So I dont think they would ask you to leave the program.

We have to stay positive and hope for the best through prayers. I have you in mine.

take care.

Thanks for sharing such a crucial lesson. I just started telemetry for my second rotation and this was definately a drug that was mention a lot.

God Bless you!

[RNof2008]

You Just Have To Be Careful You Are Expected Not To Do Harm! What If This Patient Had Coded And Died? You Can't Let Others Distract You. Just Try To Stay Focus.

[Jolie, BSN]

I can picture the entire exchange in my mind, with the instructor frustrating and distracting you. I completely understand how that could contribute to your forgetting to check the apical pulse.

BUT, I would encourage you NOT to mention that during your meeting. I think yor best bet is to go to the meeting prepared to accept full responsibility for the error, discuss the possible implications for the patient had you given the med without checking his apical pulse ad propose an action plan to prevent such errors in the future.

In reality, med errors are rarely the sole responsibility of one person. They usually result from a cascade of circumstances, as yours did. BUT nursing school is not reality. Your instructors don't want to hear how they contributed to a near-miss. They want to hear what you have learned. So give them what they want and give yourself the opportunity to finish your education.

[lholland]

A couple of things that I pulled from this. One, I have been a nurse for 14+ years and have had very good and very bad days. One thing I can say is, while I disagree with the way this instructor handled the situation, I do feel that it is a good learning experience. While instructors are tough, physicians can crush you. It doesn't matter to them if you are a new grad or experienced, they expect the same level of competency. I know that it hurt your feelings the way the instructor spoke to you, but you're going to have to stiffen your spine, use it and learn from it. They are not there to be your friend (or enemy) but they are there to help you learn. Some have better ways of doing that than others.

Second, of course, we all know, you don't give dig with a pulse

[SunnyAndrsn]

I know this doesn't help you know, but hopefully it will help other students.

I had a a clinical instructor who was very no-nonsense and virtually all of my classmates were terrified of her. I still can't figure out why, she was a very nice woman, but direct and to the point.

Anyway, she was famous for the questioning in the pt's room as you describe, and I simply started talking my way through everything she was doing so that she didn't get a chance to ask a question! Basically, I was thinking out loud.

While I'm now done with clinicals, if an instructor asked a question when I was beginning to take the AP, I would take the pulse FIRST, the apologize to the CI for not answering her right away. What was she going to do, stop you from doing the job correctly?

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.