How not to get ****** at clinical?

[noyesno]

The following situation occurred in clinical last week during medication administration:

-I was giving medications with my instructor

-She wants me to scan patient, scan all the medications but wait until the end to click the confirm button (so she can look them over)

-After scanning each medication, I set aside the wrapper in case something went wrong with the computer and I needed to scan them again

-My instructor yelled at me for not immediately putting the wrappers in the garbage, so, I put all the wrappers in the garbage

-I explained to her that I was saving them in case I needed to scan them again but she told me to throw them away anyways

-I threw them away

-Meanwhile, a PA is removing my patient's hemovac and replacing his dressing with a new one

-She places the blood filled hemovac and the old dressing in the garbage on top of my wrappers

-The computer logs me out (because it was taking too long to confirm) and I have to re-scan the medications, you know, the ones that are in the garbage

-So, my instructor makes me dig through the bloody garbage (mind you this is a MRSA patient) to retrieve all the wrappers and I re-scan the medications

*The reason it was taking so long was because my patient felt like he was going to throw up and I wanted to give him some time to feel okay before asking him to swallow some pills (I got him an emesis basin and some ginger ale).

Situations like the above seem to happen a lot in clinical and I get ****** off. So far, I've been able to keep my frustration inside but I fear that I will loose it sometime soon and say something like the following, "I'm not too thrilled to be digging through the bloody garbage, especially since I had set aside all my wrappers in case this situation arose but you made me throw them away and now I am not happy." Obviously, this would just screw me over and biting the tongue is the best thing to do. However, this is very difficult.

So, anyone have any advice as to how to not get ****** off in situations like the above?

How do you keep your cool?

[nursel56]

Oh dear oh dear what a nightmare!! Send:ALL noooooooooo!! :) I already have superpowers of zorching documents I've worked on for 2 or 3 hours due to (I think)a spasm of my pinky finger brushing against what must be the speed-key of death on my Toshiba. I do like typing them because the speed makes the stream of consciousness really hilarious with lots of exclamation points, question marks and the dreaded ALL CAPS on occasion. I do need to be more careful!! My favorite loud music after all these years is still Led Zeppelin and Southern Man Neil Young. I don't care if I'm in a time-warp! That thing still kicks *ss!

[BeenThereDoneThat74, MSN, RN]

Can an instructor who is not perfect make a positive difference in students' lives?

I'd like to think so. I am proof positive of that. I know I am not perfect (and my students know it too), yet I manage to do a damn good job

Moogie:I love you :redbeathe (in a completely platonic way). Your post was perfect!

[all4ofus, ASN, RN]

Noyesno, I too have been asked to dig through the trash for medications wrappers during clinical. The hospital was on a e-MAR system, but failed to get us as students set up in time for clinicals. As a result, our instructor had us using paper MARs. When I was done administering the meds, the staff nurse asked me for the wrappers so they could scan them in. I told her I threw the wrappers away, so my clinical instructor told me to go dig the them out of the trash. I went back to the patient room, but luckily for me housekeeping had come in right after me and emptied the trash. Some of the other patients were taking the same meds as my patient, and the staff nurse just scanned the wrappers from those meds instead and then put them back in the patient drawers. Clinicals seem to be for the most part chaotic at my school, and the instructors seem to like those who "go with it" the best. So I just try to shrug everything off in a good-natured way and tell them I will do better next time, even when I feel the blame could be shared.

[HouTx, BSN, MSN, EdD]

All,

I am pretty familiar with bedside medication verification systems.... and they ALL have a 'time out' feature. If too much time elapses between the time you scan the med and the time you scan the patient's bracelet - it kicks you out and you have to start over.

There are all kinds of ingenious work-arounds to cope with this.. I remember coming across a nurse who had photocopied the barcodes on a laminated index card in her pocket... but I digress. In most instances, the nurse simply hangs on to the wrappers until the meds are administered in case they need to be rescanned. It's no biggie.

As for the lack of common sense dealing with contaminated garbage. . . I got nuthin'

[morningland]

I personally think it sounds retarded to open a med in the med room, scan it then bring it to the patients room. How do you REALLY know what you are giving even if you checked it in the med room. I pull my meds from the pixis, check them on the mar in the med room, find a roller computer and check the med and dosage before I open it up and throw it in the cup IN THE PATIENTS ROOM. I have caught many incorrect doses simply from my system of checking and it seems very hard to make a med error but the other way sounds just reckless.

As far as digging in blood... that is outrageous and I would have said something about it and if I was failed for it I would sue the **** out of the school for putting you in danger. That instructor sounds like a real ding bat and a tool. Seriously... having your dig around in blood???? I smell a lawsuit. Anyone who agrees with that should not be a nursing instructor.... just saying.

Just waste the #*$ing med! How much is your health worth? Is the hospital more instrested in saving money on a medication rather then your health? Then *** em'... seriously.

[redhead_NURSE98!, ADN, BSN]

I got nothing on the instructor, because it seems that you don't want to confront or say anything to her. However I would report the PA to the infection control officer too, just so I feel better about myself, and because that's DISGUSTING. I might also work into the convo that I noticed this because my teacher made me dig in the trash to find the barcodes. Because that's not kosher either.

[Fermin Hernandez, ADN, ASN, RN]

Going through any trash is a bad idea. The MRSA part is not important in this case, as a skin infection is very different from a blood borne pathogen.

If your patient is in isolation it is unlikely that regular trash bags are in the room anyways.

That said, you should assume all patients have blood borne pathogens and use at least standard precautions.

As the event is done, my advise is to use it as a learning experience for when you are guiding students (either as a facility nurse or in a teaching role). Making an issue of it now will not benefit your goals and, unfortunately, may prove detrimental.

If you have concerns for future students, then include it in your end of program evaluation.

Focus on your improvements, getting orders in on time before computer lock outs, etc. This will improve you as a nurse. You can tap many mobile units to keep them from logging off.

[redhead_NURSE98!, ADN, BSN]

Going through any trash is a bad idea. The MRSA part is not important in this case, as a skin infection is very different from a blood borne pathogen.

If your patient is in isolation it is unlikely that regular trash bags are in the room anyways.

What kind of trash bags are in contact precaution rooms at your facility? Because all the trash bags are the same where I am.

[decembergrad2011, BSN, RN]

Aside: I'll be completely honest - my clinical instructor last semester made me cry after 90% of my 12 hour days with her. One of the reasons why she did this was because she questioned every single thing I did in an intimidating way. She also played favorites and gave some students a lot of skill opportunities (like the chance to start IV's and foley caths, get patients who had procedures, etc) whereas I got very few chances to start IV's. Early in the year, I was ONE MINUTE late one time because it was snowing outside and the shuttle bus waited 20 minutes (it normally waits 5 minutes) at the bus stop. After that, she was on my case constantly until midterm.

The last two clinicals in the semester, she backed off. Guess what? I blossomed. I am so much more confident in myself when I'm not being watched and I do well. I have anxiety and I am in group therapy for it, but because of it I have more problems with answering questions aloud. I almost always know the answer in my head, but I have a lot of anxiety about speaking it. I give the OP kudos for being able to speak their mind to your instructors with confidence, I feel like I always could have said it better later on. I agree that they don't always want your opinion on their teaching style or information or care, and you learn quickly whether they are open to constructive criticism or not.

To the instructors - I think it's important to realize that your nursing students are different and to try your hardest to tailor your approach for each of them. At the same time, it's important to form a system where skill opportunities are available to every student. I also would add that charting is important to learn, but in a med-surg setting, the skills practice is so valuable and I think everyone can agree that charting will have plenty of time for practice in the real world!