Ok, today on clinical my partner drew up some ativan. It was 2mg/1mL. Dose is 0.5mg .She drew up all 1mL into a 1mL syringe. She thought it was 0.5mL , temporary lapse in judgement. Shows the syringe to the instructor and Primary Nurse ( whos in the med room with her watching her draw it up ) alerts her of the correct dose. She fixes it and wastes the ativan up to 0.25mL which is the correct dosage.
we cant do IV pushes alone, so the primary was with her when administering the ativan.
We go to lunch, she gets back and our instructor pulls her to the side and explains that she incorrectly calculated the dosage, and she is getting an unsatisfactory for the clinical day (even though she rocked it out passing a crazy amount of meds to 5 patients today), and explained that shes gonna do med passes with her for the next 4 weeks.
heres how i see it. shes a student. shes learning, she mixed up her dosage/ concentration the instructor let her know, and it was a LEARNING experience. She did not admin the incorrect dose to the patient and the patient was not harmed in any way.
I dont see why she needs to do this to her. at this level of the game its a bit degrading. and i feel like shes being picked on rather than coached.
Am i being naive in the way im viewing this ...maybe someone else or another nurse can provide some insight for me?
She was feeling really upset and frustrated and sad about it and i just told her to suck it up bc we're almost done ...ya know =/
In nursing school, we had to have our clinical instructor with us for every med pass (and we were not permitted to to IV push medicines). In addition, I'm not sure how severe of a punishment it is to be given an 'unsatisfactory' rating for any one clinical day, so it's kinda tough to say if the punishment is appropriate or not.
In my opinion, this is not nitpicking on the instructors part. I realize that this may have been a 'lapse in judgement,' but my guess is that a large percentage of med errors result from such a lapse on the nurse's part. In my mind, the learning experience is to pull the student aside, like the instructor did, and make her realize that without the second check, she could have made a serious mistake. While unit dose meds are nice a lot of times the nurse has to give half, a quarter, or some other percentage of that packaged dose and it is the nurses responsibility to know how much he/she has to give.
It sounds to me that the instructor handled the situation appropriately given the potential seriousness of the situation.
I do not think that it is nitpicking. The patient was supposed to receive 0.5mg of Ativan and the Ativan is available as a 2mg per mL solution. The math for the correct dosage is really simple. I am not even in nursing school yet and I knew that she needed to draw up 0.25mL of Ativan.
She drew up a full 1mL syringe so how did she think the dosage was 0.5mL!!!!! that was 4 times the correct dosage.
If I was her clinical instructor, I would be very nervous as she seems to not be able to even read the markings on an empty syringe.
I do not think that it is nitpicking. The patient was supposed to receive 0.5mg of Ativan and the Ativan is available as a 2mg per mL solution. The math for the correct dosage is really simple. I am not even in nursing school yet and I knew that she needed to draw up 0.25mL of Ativan.
She drew up a full 1mL syringe so how did she think the dosage was 0.5mL!!!!! that was 4 times the correct dosage.
If I was her clinical instructor, I would be very nervous as she seems to not be able to even read the markings on an empty syringe.
That's being a little too harsh...especially since you're not in nursing school yet and have not walked the proverbial mile in her shoes. Wait until you start nursing school and make your first med error--and you WILL, as you're human like the rest of us.
No one knows where the student nurse went wrong: it may have been her math, it may have been incorrectly reading the syringe, it may have been incorrectly reading the concentration on the bottle, it may have been that she was distracted...point being, this is an opportunity for the student nurse to learn how serious her mistake was, to correct the deficiency(ies), and be more vigilant.
Of all the med errors out there, you could say that this was the best one she could have made: she was caught in time, the incorrect dose wasn't given, and so no harm came to the patient. So while having to do some remedial med admin work may seem like it sucks, she really is rather fortunate.
Since your partner sounds like she's doing so well elsewhere (passing 5 patients already), she may be stunned to receive negative reinforcement. It's healthy and probably no nursing student should go through school without at least having received an "unsatisfactory" for the day.
Maybe following her for 4 weeks is a bit much but 1) it's not punishment and 2) the amount of time for remediation is completely up to the instructor's level of comfort- she needs to keep that clinical site and her position secure. It's entirely possible that the instructor may cut the 4 weeks short after your partner has proven herself.
Agree with all the above, and I think there is additional learning that the clinical instructor is trying to promote. Here's my theory. When we make mistakes, we often must accept discipline/punishment/correction or whatever you want to call it. In other professions, you take your lumps and move on. In nursing, if there was discipline, it ideally needs to followed by learning that can be demonstrated to the point that everyone is confident the mistake will not happen again. And having a "memorable experience" burned into your gray matter is one way.....
The 4 weeks of one-to-one direct supervision is also a test to see if indeed this person, who made a mistake that could have been very damaging to the patient, can handle being scrutinized/coached/observed and still maintain a professional attitutude, be approachable, demonstrate learning has occurred, etc.
I wonder if the student RN has even considered approaching the faculty along the lines of, "Thank you for helping me prevent harm to the patient, I appreciate it very much and can see how this mistake could have been much worse for the patient. I'm glad you were there. I've taken some time to think about how I was handling that med pass and what I was doing when I was calculating the dosages in my head. I've identified points in time where I was not following safe practices in performing a med pass (I was feeling overwhelmed with 5 patients) and have developed a system to make sure I am double checking dose calculations. See, I've created this little neon colored laminated card that has the most standard formats for checking dosage calculations, especially IV medications, and I've glued it to the back of my clipboard/calculator. When I have pulled the medications, I will have this as a reminder on the med table where I can see it for each and every med pass. Do you have any additional ideas that could help me. I'd love to hear them."
Genuine humility can be a lifesaver in this situation. Then, years down the road when you are precepting one day, you can say to your new grad or newly licensed colleague...."I remember as a student nurse almost giving twice the dose of ativan IV than was prescribed, and thankfully I was caught. What was even better was that the after effects of being extra scrutinized, watched, questioned, coached, have stuck with me to this day and I have a very solid routine for checking dose calculations. Let me share it with you."
Did this all ever happen to me? Yes, but after I was on my own. Scared the crap out of me. Gave 50 mg of metropolol instead of the 25 mg dose (I was supposed to cut the pill in half). But more than be apologetic and say, "I get it, really, I'm sorry. The patient is ok, right?" I worked with my nurse manager and identified that I was not paying attention to pills in the same way that I did IV medications. Oh, and I monitored that pt and found a stray continuous pulse ox machine and was in there every 15 minutes. And I had to explain to the pt why I was doing all this extra......but that's what a professional does, right?
Yes, it is that serious. Be thankful that there are people out there who will help improve the practice of those just learning. It can either be taken as being picked on or improving patient safety.
i think this goes back to the simplest thing: the instructor said she gets an unsatisfactory for the day because she made a med miscalculation. if that's the criterion, then that's the criterion.
i am glad to see the op having her perspective widened about the implications and mindsets about medication errors, too. being mindful is half the battle.
This was not nitpicking. It's a simple calculation she should have done correctly, and a narcotic drug, plus she would have given 2x the dosage needed if she had been alone. This is a grave mistake and she needed to be counted down for it. and meds to 5 patients, LOL. Try 44 dear. It doesn't matter how many you get right if you get the important one wrong.
When I was in school, a student was supposed to give a patient oral benadryl. They mistakenly drew it up in a IV syringe and were ready to give it IVP. The instructor caught the mistake and the student had to be monitored closely for the rest of the rotation also. I think it is acceptable that they should be monitored.
If I catch myself about to make a medication error, I don't think 'oh well, it's okay because I didn't actually do it and the patient wasn't harmed', I think 'oh my god, that was very close, the patient could have been harmed or killed by that, now what do I need to learn or to change about the way I do things so that never happens again?' If someone else points out that I'm about to make a mistake, the same thoughts go through my head, I don't think 'oh well, it's okay, no-one is perfect and so-and-so made a mistake last week'.
This may have been one, isolated, honest, human error. From the instructor's point of view, can you afford to take that chance? If it was an isolated event, no harm done...she watches this student more closely for a few weeks and the student passes with flying colors.
However, if there is a bigger problem and the instructor writes it off as a one time thing, the student could make a bigger error next week (such as actually gives the incorrect dose). Now the student's budding nursing career is sunk and the instructor is in some too-doo herself.
Instead of thinking of it as nitpicking or dislike, think of it as our instructors are finding our weaknesses and RIDING THEM. When they are done with us, we won't have that weaknesses anymore...lol I actually appreciate that approach.
psu_213, BSN, RN
3,878 Posts
In nursing school, we had to have our clinical instructor with us for every med pass (and we were not permitted to to IV push medicines). In addition, I'm not sure how severe of a punishment it is to be given an 'unsatisfactory' rating for any one clinical day, so it's kinda tough to say if the punishment is appropriate or not.
In my opinion, this is not nitpicking on the instructors part. I realize that this may have been a 'lapse in judgement,' but my guess is that a large percentage of med errors result from such a lapse on the nurse's part. In my mind, the learning experience is to pull the student aside, like the instructor did, and make her realize that without the second check, she could have made a serious mistake. While unit dose meds are nice a lot of times the nurse has to give half, a quarter, or some other percentage of that packaged dose and it is the nurses responsibility to know how much he/she has to give.
It sounds to me that the instructor handled the situation appropriately given the potential seriousness of the situation.