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!!
I am sorry to hear you failed clinical. Their are a couple of lessons to be learned. 1st, I understand that your instructor and the nurse told you not to worry about the 7:00am insulin, because night shift gave it, however, I never assumed that it is done. I ALWAYS
SORRY THAT YOU didnt pass, however, look at it as a learning experience. YOU WILL NEVER MAKE THIS MISTAKE AGAIN. It totally sucks that you have to wait until spring. GOOD LUCK AND DONT QUIT.
IF ALL NURSES WERE HONEST THEY WOULD TELL YOU THAT THEYVE MADE MISTAKES BEFORE. Dont get discourgaged.
I am sorry to hear you failed clinical. Their are a couple of lessons to be learned. 1st, I understand that your instructor and the nurse told you not to worry about the 7:00am insulin, because night shift gave it, however, I never assumed that it is done. I ALWAYS check to see, if it was given. I no their has been plenty of times that night shift was supposed to give a med and they didn't, but in the end, it would be your fault because you didnt check to see if it was given. As for the reglan IV push, Always make sure your instructor know what is going on, the way to do that is to repeat what you said and make sure they acknowledge you. Before I give any med, I always double check the order and in my program, we could not hang any IV's, give injections or IV push any med without your instructor.
So what is the outcome? Can you re-take that clinical over or did they expell you from the program? I hope they allow you to re-take the clinical over. Good luck to you
Yes, fortunately I can take the course again next fall. My instructors actually all really want me to come back, as I was doing well overall, I just had a really bad day. They even told me they think I have the capabilities of being a very good clinical leader next fall for those who have not yet been there (It was our first semester of Med Surg).
It still bites, but life goes on, and I'm trying very hard to see positives.
I am so sorry to hear of your situation. It sounds eerily similar to mine so I can really sympathize. I am glad that you are able to come back and hope you are able to take the things you have learned, apply them, and come out ahead in the end. Good luck.
I agree that you should never assume a med has been given; you should have inquired that with your nurse. And at my school we are allowed to do all meds except IV push's due to the risks. This is my problem, I don't see how a CI can fail you on the spot! What does your student handbook say?
If we are written up or at risk for unsatisfactory performance, our main staff is alerted and we are given ample time to improve. If needed, our dean will show up unannounced and supervise the student in question and perhaps be allowed extra hours in our lab to remediate. They cannot just fail us; there is a documented process. I would appeal ASAP. That is BS!
Hmm, I am confused, and I am not trying to make you feel bad, but we I have been taught is that you give insulin with meals, meaning that if the insulin is scheduled @ 7am and breakfast gets there @ 8am, you give that insulin when the meal tray is there, I am just making sure I was taught correctly. I am so sorry for what happened to you. Try not to get flustered and just remember to breathe and think! You will do better next semester for sure!:loveya:
I don't think it's the level of risk of complications of the med that count so much as a lack of focus in your med passing. Whether a patient got thier AM insulin and how much is usualy given in report- there are reasons to hold it or delay it's adminiistration- late trays, npo, low FBS, pt refused to eat- alternative meal ordered- it falls to you as the next shift to follow up. As to the reglan- the problem wasn't so much that you gave the dose but that you gave the dose immidiately after you were told not to. If you didn't see the order for the change in route until after you gave the IV dose I doubt it would be such a problem. The patient isn't likely to die from IV vs PO reglan but what if the instructor told you not to give a med that the patient had shone to have had a potentialy life threatening response to- but you got distracted and gave it anyway. Not what did hapen but what may have happened if the reason for holding the med was different. The biggest problem was failing to follow specific instructions about an IV med- not the med error itself. Good luck. I hope they let you back in. An error like this can be a very effective learning experience but you have to have the opportunity to prove you learned from it.
When I was a student nurse, I made a med error in my last semester while doing my preceptorship (when we work with a nurse on their shift for a 40 hour week). Like you, it was a Reglan order. The pt was supposed to get 5ml of a PO liquid that came in 10ml doses. I missed that I had to give only half of the dose. I was so scared! The nurse I was with also said it was no big deal, but I felt really horrible about it (I know that Reglan is not really a dangerous drug, but all I could think was what if it had been something else like a heart med). We called the doc, who was not mad, just had us hold the next dose of it. It was a horrible experience, but luckily the pt was OK, and I learned to pay much closer attention to what I was giving and the 6 rights of med administration. Even still, as a nurse, you are going to make mistakes. It sucks, but you learn from it. I was not failed, and I did graduate, but I took that experience and learned from it.
As an RN, I have made other mistakes (thank God, they are few, and did not result in any harm), and the most important thing I have learned is that if you do make an error, do not try to hide it, but immediately let your supervisor know, call the MD, and write it up in an incident report. As a nurse you must have the integrity and honesty to do the right thing for the patient, even if it means the MD gets mad, and you have to be reprimanded for it. I don't think you should have been failed, but that's my opinion.
Also, with the insulin, for future reference, I would have rechecked the blood sugar before giving any insulin since it had been 2 hours and the pt had had a meal, and called the MD to let them know what happened and what the current blood sugar was to see if the dose should change.
They must serve breakfast mighty early there if night shift is administering 0700 insulins!
I work night shift as a LPN and we do give 0700 inuslin - especially Lantus. I will NOT give humalog unless my pt. is a tube feeder and it is running at the time, because trays don't come until 0745 - long after I'm gone. It is possible that someone might get insulin at 0600 if they are on an acute unit and if they are IV only - they are usually checked every 6 hours and covered by SS.
In my facility, all 0700 meds are assumed to be given by the night shift - unless otherwised reported, but if it not signed for it should be brought to the attention of the instructor or charge nurse. I've been called a couple of times at home to verify that I gave a 0700 med. My instructor that I have now would not have counted that as a med error since we are responsible for 0800 meds and on. But it really depends on the facility, the shift hours and the instructor.
Sounds like you learned a valuable lesson, don't give up!!!! Take the chance to repeat.
i know of people in my school who had to repeat a whole semester because they didnt pass a skill (check off)
So just imagine how much more severe this error was, you put the professors license in jeopardy, granted that the patient was ok. Im glad youre able to repeat the semester, at least next time the semester will feel more like a review and it might come easier to you.
Wow...sorry you have to repeat a whole semester. Sounds like the director of the program was reasonable and understanding.
I'm just first semester, but I have to say that it has been drilled and drilled into us that we should never assume a medication that is to be administered during our shift was given by someone else from the previous or current shift. It is our responsibility to ensure correct drug administration, no exceptions. And this is a perfect example of why.
Now, for the other situation...yeah, you made an error, and serious one, but what the HECK was your instructor doing? I know she was fiddling with the IV pump, but if she's supposed to be supervising you administering the med, then she'd sure as heck better be supervising you and not putzing around with the IV pump. So, in my estimation, while you clearly made an error, you would have never had the opportunity to make that error had your nursing instructor been doing what she's supposed to do during student med administration.
PEBBLES1
284 Posts
I am sorry to hear you failed clinical. Their are a couple of lessons to be learned. 1st, I understand that your instructor and the nurse told you not to worry about the 7:00am insulin, because night shift gave it, however, I never assumed that it is done. I ALWAYS