I failed my clinical on Monday

[iceangelred86]

So here's my situation. I failed my clinical on Monday.

First of all, we get on the floor at my clinical site at 6:30 AM. I had a patient with 0700 Insulin to give. Last week a nurse on the floor told me that all 0700 meds are given by night shift, and not to worry about them. Three weeks ago, my instructor told me the same thing.

Monday, one of the patients I was to care for had an 0700 insulin, but I assumed night shift gave it, based on what I was told in previous weeks, and did not worry about it. Well, it wasn't given, I found out around 900, and then gave it over 2 hours late. I was told this was my fault. Maybe it was. I don't think so.

The shift proceeded, and I was passing 1400 meds. As I was scanning them to give to a patient, I scanned Reglan (Which was IV Push), and it said that the order changed, so my instructor told me to set it aside and give the rest of the meds.

I had to hang a piggyback, which I did, and the IV pump started acting up. My instructor was trying to figure out what was wrong, and told me to go ahead an pass the rest of the meds. I did this, and accidentaly grabbed the Reglan as well. I verbalized that I was passing it. My instructor didn't say anything, So I went ahead and gave it (Yes, I should have remembered but she didn't say anything). I was going to flush the line one last time, and she realized what I had done, and freaked out.

I asked her if she heard me verbalize that I was passing it, and she said no. So, I went and threw up. I knew it was over. The order change was only that it was to be given PO rather than IV Push. I immediately told the nurse, and she was like oh, it's not big deal don't worry about it. I talked to another older nurse on the unit, and she said yea, you messed up, but that shouldn't fail you. Well, she was wrong.

So now, I'm just wondering what you all think. Yes, I made a med error. Yes, I should have made sure my instructor heard me before I passed it, but lately they've been encouraging us to be really proactive, and just go ahead and do things on our own. I assumed because she didn't say anything that it was ok to give.

I really don't feel like the 0700 insulin was my fault, based on what I had been told previously, but the other mistake may have been. I just am having a hard time believing that failed me. I'm going to meet with the director of nursing tomorrow to talk about it. I don't know what to do!!

[TheDayTheMusicDied]

I am in a similar boat, failing, but for different reasons. Yes, you were in the wrong but what is important to emphasize is that people can be so fixated on that one error you made and they fail to see you as a whole and how well you're done in other areas. Be well aware of your strengths and make them aware to those who judge; don't forget your own ambition and the blood, sweat, and tears it took to get into nursing school in the first place. I personally don't know whether they will keep me but I sure as hell will let the faculty know that it wasn't because of a lack of ambition, drive, or empathy and concern for all the patients I had under my care.

Sorry for my heated rant, just explain the situation as you explained it to us.

[Natingale, EdD, RN]

It was a couple of med errors, I think you learned a life long lesson from this. Med errors happen everyday, I dont understand why you didnt check to see if the insulin was given? Why assume? Im not going to beat you up, but good luck in the future.

I would acknowledge that you made both mistakes, and ask for forgiveness or to repeat the course. In my school they wouldve given you the old heave ho no questions asked. Good luck to you, I hope everything goes well.

[jessica<3RN]

I agree with the pp. You should never assume that a med has been given. ALWAYS check the MAR and any new orders that may have been given over night. The first thing I do when I get to clinicals in the morning is check the patient's chart for any new orders, labs, etc.

Med errors cannot be taken lightly. You're putting the patient at risk when administering the wrong medication. You are lucky that the error was caught.

[CoffeeRTC, BSN, RN]

Both are med errors and I'd say the Insulin one is more severe. What would normally happen is when you told the doc, he/she probably wouldn't care about the IV vs PO one. Alot of times we would state..may give Po or IV until XYZ dose arrives. That way they get the med while you wait and wait and wait for it to come from pharm.

Getting back...yeah...you are going to learn from these mistakes. Failing clinicals...I'm not sure on this. Does that mean you will need to retatke the whole clinical sessions or just failed for the day?

[iceangelred86]

I will need to repeat the whole course next fall (Yea, the school I go to doesn't offer it in the spring). I'm just devastated because nothing like this has happened to me before, and my clinical was actually going quite well up to this point. Live and learn I guess.

I think as far as the insulin goes, the thing I find funny is that my roommate is also in nursing school with me, and he has his clinical the same day that I do. He told me he has never, ever given the 0700 insulin, nor has he even checked on it and they were told the same thing that we were, that night shift has given it. But, yes, I do understand that I should have checked this anyway.

[Meriwhen, ASN, BSN, MSN, RN]

If the medication is scheduled to be given during your shift, then you need to assume responsibility for it. Better you inquire about the 7am med every single clinical and every single clinical be told "the night shift did/does it", than not ask.

And if they tell you the night shift did it, you and your instructor should verify that. That's what our CIs tell us: never go on someone's word alone, especially when it comes to orders or medications--find it in writing in the chart. If that ticks the staff or your CI off, too bad: it's your future you're out to protect. As you found out the hard way, no one else will protect it for you

I think it was harsh of them to fail you though. Good luck with this--I hope it works out for you somehow!

(p.s.: I wrote this while you posted, I didn't mean to sound redundant!)

[shoegalRN, RN]

I am so sorry this happened to you.

I'm not gonna really harp on your mistakes, because I'm quite sure you feel bad enough. However, when it comes to med errors, they are not taken very lightly, even with licensed nurses. The one thing that jumped out to me is that you ASSUMED that the insulin was already given by the night shift, although it was scheduled for 0700, which is really during your shift.

The first thing you should have done was checked the eMAR to see if the insulin was actually given by the night shift. If not, then it was your responsibility to give it. I understand you probably was given this info in report, but still, you double check when it comes to meds and orders.

The thing we did in clinical was get our patient info the day before, and then come in the next morning and go over the chart and check for order changes, as well as the eMAR for new meds, etc. We did this even before we headed off to get report from the night nurse.

The lesson learned here is ALWAYS double check your eMAR and orders before med pass.

When you go talk to the dean, let him/her know that you learned a very valuable lesson here, and it will not happen again. I'm quite sure they will let you repeat the clinical and remain in the program.

Good luck to you!

[truern]

They must serve breakfast mighty early there if night shift is administering 0700 insulins!

[FireStarterRN, BSN, RN]

It sounds as if there are problems on the floor that they need to work out. There has been controversy in different hospitals as to who should give the AM insulin. Best practise is to administer short acting coverage immediately before breakfast, which will have it fall on day shift. That unit needs to clarify their policy, it was definitely a system error that led to that insulin being given late. I hope that you included all what you said to us in your incident report.

As far as the reglan, I think you instructor is trying to avoid responsibility there. She is trying to wiggle out of blame by laying it entirely on you. You'll encounter that in real nursing one day too. Since she has the power, there's nothing you can do.

I think you are the unfortunate victim of circumstance here. I'm glad you'll be able to repeat next fall. You'll do fine, you sound smart and capable. Good luck.

[fiveofpeep]

It's scary to see how easy people get failed from clinical. For the future, I always ask during report if the 0700 insulin was given and check the MAR just to help in the future. I can understand how you might accidentally give the push if you were nervous because the instructor was there but it definitely was a mistake but at least it wasnt a deadly one. Punishment sounds severe but we dont know your whole story. Take this semester off to relax from how sucky nursing school is and take some GE or fun classes or something. I am really sorry for you and would be upset if I were in your shoes as well.

[iceangelred86]

Well, I met with the director of nursing here, and she was very kind about everything, and told me that they want me back next fall (and all I can think of is $$). I did share things from my perspective, and she was very respectful and listened to what I had to say.

As far as the 0700 insulin goes, she clarified for me that normally night shift does give insulin, but that for this particular patient was to receive it immediately after breakfast. This made sense to me, but either this was no reported to me, or I just completely overlooked it, because I don't remember this at all.

All in all, I do realize I made some mistakes, thankfully they weren't fatal, and I've definitely learned from them. It makes me feel good that my instructors have told me that I'm very capable, and they all want me to come back in the fall. So, I may just take the next semester off and work, and then be back next fall, and hopefully do a lot better.

Thanks everyone for your responses.