I don't know what to do.

CuriousMe · Nov 20, 2008

I think you have to go to the Director of your program and explain everything, including your fear of retribution.

I go to a private ASN school that sort of recycles its instructors (you have most instructors twice.) I had a seriously BAD experience with a clinical instructor I have had as a teacher in another semester. I never had a problem with her before, she complimented me and I even received the highest scores in her previous class.
Well, the other day, I was at a clinical site and I'm no stranger to clinical rotation! I have done WELL every semester. So this instructor, we'll call her Sara (because Dear God, I'm even terrified that she might read this BOARD!!) hands me my assignment and like usual, I go about my normal routine. After about 15 minutes, she is breathing down my neck and yelling at me that I'm not finished with this and that and the other. I've only been on the floor for 15 minutes and I have more than one patient (by the way, I did prioritize and started with the patient who was the biggest concern). She's yelling about my documentation because I didn't do it the way SHE does it. She's making me NERVOUS while I'm signing off on the MAR because she thinks I should hurry up. She has only TWO students on the floor: another girl and me. But she is following my every step and telling me I'm doing stupid things wrong like the order I'm making the patient's BED!
But it gets worse...a medication error is made. For one, I don't have access to the medications. For two, Sara got them and handed them to me. And for three, Sara didn't allow me to check them against the MAR before administering the medication--she said "HURRY UP!!" when I attempted to grab the MAR to look. So, while I should have refused to give the medication without checking, I was terrified Sara was going to fail me (she has failed other students for less). So I gave it. It was double the DAILY amount the patient should have received. Another nurse (we'll call her Kate) caught the error because Kate saw that I had not signed off on another med (Sara took two of the same medication tabs instead of one tablet of each medication.) I read the back of the package and signed off on what was handed to me. When Kate was talking to me she said, "Didn't Sara hand you the ____ and the ____?" I said "No. Sara handed me two tabs of ____." Sara heard me talking to her and put it all together.
She pulled me into the back area and screamed at me that it was my fault for not checking the MAR when she wouldn't let me!!! Then to cover her you-know-what she gives the patient the dose of the missed medication. Normally, this wouldn't be an issue, except that the double dose of other medication with a normal dose of the missed medication could cause HUGE problems. Then she says "IN THE REAL WORLD, we would have to write an incident report." DUH! Clinical IS the real world!! My patient is a living human being!
I'm terrified about having to go to clinical next week to deal with crazy woman. I can't go to the director of my nursing program because back when I was in her class, she locked a friend of mine in classroom when everyone else had left and screamed at her until she cried. Then she told my friend, "If you talk to ____ it WILL get back to me." More or less, she has threatened reprisal. One girl I know went to tell the director today that she clocked in at the clinical site while she was teaching because she works at the clinical site. I'm counting down the days, but I'm afraid I'm going to fail and I can't talk to anyone about it at my school. I don't know what to do. I'm afraid to ask this woman any questions for fear she will start her routine of treating me like crap. I just don't know what to do.

RhodyGirl, RN · Nov 20, 2008

Oh. My. God. Please say something to someone!!! I know you're afraid to, but you must!

bluelegacy1920 · Nov 20, 2008

I'm very sorry that you had to go through that. You definitely should keep a written log of every minute detail that occured that day. I have a feeling that you'll need it in the future. Don't be afraid to stand up for what's right and defend yourself.

ErinJane · Nov 20, 2008

I would inform the head of your department, and in the future. NEVER EVER administer meds without checking the MAR and ideally don't administer meds you did not personally prepare/draw up. I had the same experience as you but I just refused to administer them. When it comes down it is that will be YOUR license. After refusing to administer them, the teacher backed down.

Daytonite, BSN, RN · Nov 20, 2008

yes, you can talk to someone at your school about this. you just have to talk to the right person--the director of your nursing program. first of all, you shouldn't be gossiping with any of the other students about this.

is this a nurse that should be teaching students? you already said it--she sounds crazy. why would anyone want to see her continue being around students? this medication error is the perfect incident to send her packing. you just don't know how much power you hold in your hands here. let me educate you.

what the instructor did wrong. . .i wonder if kate wrote your instructor up for making a med error? you have to understand that your instructor is practicing unsafely. her actions did not follow good nursing practice. no instructor worth her salt ever hands a student medications and refuses to let them verify they are correct with the mar before giving them to a patient. we were never taught that in nursing school! that is unsafe. you, unfortunately, have been forced into the position of having to do something about this. sara, your instructor is going to try to be intimidating with you because she has more experience and thinks she can save herself from being disciplined for her own wrongdoing by threatening you. this is bullying behavior. the reason she screamed like that at you is because she's trying to scare you in order to bully you. this is what a bully on a playground does to shut another kid up from tattling on them.

what she should have done. . .was be a role model, apologize for her behavior, review the 5 rights of medication administration and the medication administration procedure. she should have shown you how to make out an incident report and taken responsibility for her mistake in this.

she didn't do that though, did she? instead she chose to do everything she could to try to cover her mistake up by pulling you into it and making you feel just bad and culpable. that was wrong and instructors who are supposed to be training nurses don't do that. this woman has no business being an instructor if she behaves like that. the head of your nursing program needs to know what she is doing.

and, i wasn't clear about who locked your friend in the classroom and yelled at her, this instructor or the director of the nursing program. it is kidnapping. nevertheless, you don't really know what was going on with your friend except what your friend told you. when patient safety is at stake, it has to be reported through the chain of command. this instructor not only put patient safety at risk, but is teaching you the wrong principles of medication administration. you really need to sit down and very concisely and clearly write out what happened and address it to the director of your nursing program who is this instructor's boss. it has to be in writing and she is only going to know about this substandard instructor if you tell her about this incident. you owe it to the future safety of patients. her boss can't do anything without written documentation by you.

based on what you posted, here's what i see her she doing wrong and what you must detail in writing and in a meeting with the director of your nursing school asap:

she using the word "stupid" when telling you are doing "stupid" things wrong
wouldn't allow you to check medications she gave you for the patient against the mar before administering them saying "hurry up!" [this is a huge safety and practice issue that put her license in jeopardy as well as the patient's safety - this alone should have resulted in her being written up by the nursing staff, and she just may have been.]
clocking in while teaching [if she actually did this it will serve as documentation that she is cheating one employer for work she is not doing]
knowledge of her locking someone in a room--that is a form of kidnapping--oj was just convicted of that

another thing you can do if you feel nothing is being done about this instructor is write a compliant about this medication to your state board of nursing as well as her double clocking in. the state board of nursing will need the exact date, patient name, medical record number and the name of the nurse who also found the error for evidence against her. the state board can subpoena time cards and pay records. you can also threaten her that you are going to do this if she starts to get nasty with you and you feel like you need some ammunition to fight back. i'd love to see the look on her face then. you can't fight the state board when they have the evidence to support someone's wrongdoing.

be assured that you are not the one doing something wrong here. you are the learner and questioning what the teacher is telling you to do. when a teacher is giving you wrong instruction, especially instruction that is in violation of nursing law, even if you follow it, you are not at fault because you are under the supervision of that instructor.

Me, SN · Nov 21, 2008

I knew she was in the wrong. I feel INCREDIBILY HORRIBLE for giving the patient the medication without checking the MAR because I knew I should have. If I could go back (and I know I can't) I would have refused to give the medication without looking at the MAR even though she was yelling at me. I am just seriously TERRIFIED to report her. She is the ONLY instructor for clinicals this semester. So it's not as if I can be reassigned. If nothing is done about it immediately, I am surely garanteed to fail this semester. Since she's been a nurse for over 15 years, she knows more about how to turn things around to make me look like a bad student who is just upset and looking for a way to get back at her. She even failed a girl I know this semester for asking her to observe her while she removed a Foley because she had never performed the procedure on a human being. The girl didn't want to mess anything up (not that it's a complicated procedure by any means, but on the floor it's hit or miss if you get to do one skill or another and she was comfortable with it).

How would I go about contacting the board of nursing? There is a WHOLE CLASS who witnessed her clocking in. I have the patient's name, the date, Kate's real name, and I wrote down all the specifics through teary eyes as soon as I got home in case I got in trouble. But I don't have the medical record number because I'm not allowed to take any identifying numbers or names of patients (I just remembered the patient's name and wrote it down when I got home).

I have 17 days until I either pass or fail this clinical. I wondering if I should just wait. (Though I feel like if I do, I am doing wrong by HER patients.) Also, several of the other students had witnessed me crying on the unit. I'm already afraid that the rumor of how she treated me is going to get around and she'll think I did it. I think I'm going to walk like I'm treading on glass for the next 17 days.

Daytonite, BSN, RN · Nov 21, 2008

how would i go about contacting the board of nursing? there is a whole class who witnessed her clocking in. i have the patient's name, the date, kate's real name, and i wrote down all the specifics through teary eyes as soon as i got home in case i got in trouble. but i don't have the medical record number because i'm not allowed to take any identifying numbers or names of patients (i just remembered the patient's name and wrote it down when i got home).

you merely write a letter to your board of nursing with the information. the address will be on their web site. there may even be a specific complaint form to print out and accompany the letter. it would be on the website of the state board of nursing.

are you that sure that the director of your nursing program would be that unsupportive? the state board will want to know if you reported this to the director of your nursing program first and what she did about it. if they investigate this incident the director of your nursing program will be contacted and asked what she knew about this and what she did about it, so you might as well tell her what happened. start naming names of the people who knew what happened and were involved. the more who knew, the safer you are going to be. they can't cover this up if a lot of people know about it, especially the staff nurse who discovered the drug error. they can't intimidate or threaten her.

Melinurse · Nov 21, 2008

Daytonite had some really good advise. I don't have anything to add really, just wanted to wish you good luck. Keep us posted.

allnurses Guide · Nov 21, 2008

Terror or no, you really need to do exactly what Daytonite said. If you wait, she may fail you and you'll be accused of retaliation if you bring it up then. Wait any longer and she may turn in paperwork saying YOU made the med errors.

Nursing is full of hard decisions, you got smacked with one earlier than most. Ethics are sometimes a hard call, self interest or patient safety first?

caliotter3 · Nov 21, 2008

If she is like one of the clinical instructors that I had she will do paperwork accusing you of the med error. So take the advice of Daytonite and calmly go about reporting this. You can't take the chance of waiting until the end to see if you pass or not. You need to take preemptive action now. Good luck.

Me, SN · Jul 22, 2009

A long overdue update on this post:

I didn't say anything. She did try her hardest to fail me, but I was persistent. She suggested I attend more clinicals than I was required to do and though nothing was ever, EVER as dreadful as spending more time with that insane woman, I did it for the sake of passing. I ended up with an "A" in the class because I aced both the midterm and the final/ATI. My teacher for the lecture (the clinical instructor's good friend) did her best to keep me from an "A" as well by giving me the lowest possible grade on my process paper though when my peers and I compared our work, we all believed I had done a superior job (which was an effort to prove that I should pass). However, every single one of them received a better grade than I did on the paper, yet I was the only one in my clinical group to get an "A" in the class.

I do feel like I was a coward and morally I should have done something, but I sit here 58 days from graduation thankful that I am this close even if I did have to trade my ethical beliefs in for my associate's in nursing. I did learn a valuable lesson early and without fatal consequences and I NEVER administer a medication without checking and rechecking the MAR. So my awful experience may have saved some lives in the future.