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 =/
No not harsh at all. She was potentially going to give double the ordered dose.There was no harm this time but if she doesn't catch the difference between 0.5 mg and 0.5 ml she could be headed for a big error down the road.
She was potentially going to give 4 times the ordered dose.
ETA: Based on dosages pulled from a Pyxis and the lack of waste documentation, I think a previous shift's nurse double-dosed one of my patients on Dilaudid. Repeatedly.
IMO, dosage calculation tests using real-world scenarios should be a part of licensing renewals and competency testing in facilities. Striking a little fear into all of us on how quickly and easily we can make a mistake might be good for safe nursing practice.
I was late getting to the class picture session. The last message I got was to be there at 9:15. Instead, the class met at 8:45 and made a pilgrimage to the photography studio. Where was I? At home getting ready to be there at 9:15. Alas, I show up while people are still having their pictures made so I really wasn't late for anything.
Next, we make a journey to a meeting. We had to wear our scrubs, which was downright tacky given the occasion, but hey we did. On the way home, I changed out of them and back into regular clothes since the day was over. We were on my time.
I got wrote up for not being in uniform as well as being late for a clinical lab. What the heck?! I'm downright furious!
Specializes in Critical Care, Emergency Medicine, Flight.
Let's talk about NITPICKING!
I was late getting to the class picture session. The last message I got was to be there at 9:15. Instead, the class met at 8:45 and made a pilgrimage to the photography studio. Where was I? At home getting ready to be there at 9:15. Alas, I show up while people are still having their pictures made so I really wasn't late for anything.
Next, we make a journey to a meeting. We had to wear our scrubs, which was downright tacky given the occasion, but hey we did. On the way home, I changed out of them and back into regular clothes since the day was over. We were on my time.
I got wrote up for not being in uniform as well as being late for a clinical lab. What the heck?! I'm downright furious!
I wouldn't call it nitpicking. What happened to three checks though? If she's still in the med room and haven't reached her third check yet, how is this a medication error? The incorrect dosage wasn't administered YET so there was no med error to chart. I'm wondering if the student would have caught herself at that third check before giving the med. In that case, that's not unsatisfactory. I can understand the instructor's actions though.
Specializes in Critical Care; Cardiac; Professional Development.
I have a feeling there is more to this. This is probably not the first time or an isolated incident. There are probably factors adding up to a dangerous situation that the OP may not realize the instructors are watching and talking about. Given how harsh SOME instructors can be, it seems this one is willing to put in the time and effort to help this student straighten things out.
Specializes in Critical Care, Emergency Medicine, Flight.
I have a feeling there is more to this. This is probably not the first time or an isolated incident. There are probably factors adding up to a dangerous situation that the OP may not realize the instructors are watching and talking about. Given how harsh SOME instructors can be, it seems this one is willing to put in the time and effort to help this student straighten things out.
Possibly, however this is the same instructor who failed a girl last semester bc she couldn't get one of her earrings out ( not in a normal spot type deal) , so the instructor considered out of uniform & failed her!
That student was informed of the uniform policy before she arrived for clinical that day. The student chose to leave it in and take her chances. Your instructor still sounds fair.
The story told by the student was it was just for leaving an earring in. Which if true, still fair. But usually there's more to the story. Much like when someone gets fired or reprimanded "just for" whatever they choose to make the story. Which can be anything, since the other side has a responsibility to keep things confidential.
Specializes in Critical Care; Cardiac; Professional Development.
Yes, if there is a uniform policy and she failed to meet it, that is fair. To her AND to everyone else who DID manage to meet the standard. Where do you suggest the line get drawn? Be in uniform unless she thinks she has a good reason not to be? The instructor didn't fail her. The student failed to meet the standard. She failed all by herself. The instructor merely held her to the standard that had been set, which the student was aware of. Can't get the piercing out? Go see the parlor in which it was done and have it removed.
She has signed up for a higher standard. She will either meet that standard or not. And fairness won't be the arbiter. The ability to hold the higher standard will. Thus far she is showing questionable ability to meet the standards that being a nurse requires. The instructor has no control over that. Only the student does. Who is really being unfair here?
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
In my program, we can't give ANY medication -- not even a PO Tylenol -- without the CI being present, even with the primary nurse's permission and supervision.
I've had primary RNs hand me meds to hand to the patient (just because I was standing closer to the patient, like passing the salt shaker at Thanksgiving dinner), and I had to hand them back to the primary and step away, because my CI wasn't there with me, and that would count as "administering" a med.
Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Also, my program has a "one set of stud earrings in the lobe only" policy. Any other piercings need to be covered with a bandage or removed. It's spelled out clearly before starting the program, and it's really not that hard to understand. I sure wouldn't want a nurse caring for me if she couldn't manage to remove an earring she's known for two years she couldn't wear...
Possibly, however this is the same instructor who failed a girl last semester bc she couldn't get one of her earrings out ( not in a normal spot type deal) , so the instructor considered out of uniform & failed her!
So idk, maybe yes Mebbe no?
I think the post that pointed out that there may be more to this meant there is more to this with the student, not with the instructor. Perhaps the student had made a 'near' med error in the past and that is why this instructor was keeping a closer eye on her.
As for the uniform issue...it seems harsh to 'fail her' over that, but I'm guessing the uniform policy is clear and perhaps this was not this person's first uniform (or other type of) infraction.
The instructor didn't fail her. The student failed to meet the standard. She failed all by herself. The instructor merely held her to the standard that had been set, which the student was aware of. Can't get the piercing out? Go see the parlor in which it was done and have it removed. 
dudette10, MSN, RN
3,530 Posts
She was potentially going to give 4 times the ordered dose.
ETA: Based on dosages pulled from a Pyxis and the lack of waste documentation, I think a previous shift's nurse double-dosed one of my patients on Dilaudid. Repeatedly.
IMO, dosage calculation tests using real-world scenarios should be a part of licensing renewals and competency testing in facilities. Striking a little fear into all of us on how quickly and easily we can make a mistake might be good for safe nursing practice.