Lost & feeling like I'm in a free fall.

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This is my first time posting. I am a senior nursing student and I am supposed to graduate in May. Our class has had SO MANY problems over the last 2 years that we are all burnt out and ready to be put into the psych ward. We've seen about 7 staff changes (some fired, some quit, some took someone else's position and the other was demoted), cheating by a group of students (they purchased test banks and nothing ever happened to them), bullying... you name it, we've probably seen it.

Last week in clinical (on a progressive coronary unit), a mistake was made between myself, my instructor, and the primary nurse. I was assigned 5 patients and was in the process of passing meds. My instructor was over my shoulder every step of the way telling me what to click, and quizzing me on meds. In one of the rooms, I had given PO meds and was pushing lasix over 4 minutes. The instructor went over to the computer and said, "I'm going to okay this," because she wanted to see an updated order, and she had already done it before I had a chance to say anything. I finished pushing, and went to the computer, hit save on all the screens that were up, and logged out. At some point, the nurse came and asked my instructor if she wanted her to do the meds on 2 rooms (& said the numbers), and my instructor said yes. It was after 11:00 and we were still giving 9:00 meds because she INSISTED that we give them all, even though they were way late because she was trying to get us all to "get used to having a lot of patients". So that was unsafe in itself. I assumed the nurse meant give 11:00 meds since those were due and since we had just been in that room.

Long story short, (there's so much more detail), the medications weren't saved and the primary nurse gave the meds again. 3 BP meds, synthroid, and lasix. The patient's BP dropped to the 70's, his EF was 25%, and he was sent to ICU. In the process, my instructor yelled at me in front of the doctor, the nurses, the other students, and the hysterical family and said it was all my fault and that I didn't save it. She didn't even ask me what happened and denied being on my computer. First of all, I know I hit save on every page. There's only a "save" and a "save and exit" button on the page... and if you don't hit that and try to X out, a box pops up. Second, she was also on my computer during admin. Third (I found this out later), 2 other nurses on the unit had problems that day with their MAR being wiped and no meds were saved. And the primary nurse didn't check his BP prior to administration of all those meds. Point is: It very well could have been a glitch, and she (my instructor) could have just as easily messed up my meds being saved. Now I am in remediation, humiliated, and not even sure what to do with myself. I was so sure I wanted to be in the ER or CCU, but at this point I have halted all applications.

Yes, the patient is fine... and I cried for about 2 days over the fact that he could have died. My dilemma now is that I feel like crap because, even though I'm taking the fall and total responsibility, I don't feel it was completely all my fault. And I'm questioning if I can do this. Any advice would be appreciated. I honestly just feel so defeated and unsure of myself.

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Specializes in ED, psych.

I'm sorry this happened to you.

My first question, is how can she deny being on your computer when she signed off on your med administration? The time would come up that she signed off, correct? I think I'm confused here.

Nevertheless, it was all about communication and it was mismanaged between all 3 of you: the instructor, the primary nurse, and you. Stating specifically what needed to be given (instead of just room numbers, but "yes, can you please give Mrs X of room x, bed x her 9am meds of lasix, metoprolol and insulin) would have been more appropriate. However, that isn't just on you but you CI as well.

Keep this as a lesson learned and don't let it discourage you from applying to those jobs you desire.

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She was under my sign-on at the time, and at the end of the day, the other clinical instructor-in-training signed off on my other documentation. Our instructors don't sign off at the time of documentation, they do it at the end of the day.

Yes I 100% agree that communication was mismanaged on all our parts. In my plan of action that I had to write up, I wrote specifically that I would do my best to improve communication skills so that all people involved in my patient care were on the same page. I also said that i need to be more assertive and learn to speak up. I didn't say anything because a) I thought she meant 11:00 meds, b) she specifically addressed my instructor and our instructor HATES any kind of interruption, & c) I was distracted at the time (giving flu and pneumococcal vaccines) & it didn't occur to me that she meant 9:00's.

Thank you for your input. It's definitely a lesson I'll never forget.

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You will recover from this. It is instructive that others experienced similar problems on the same day.

I have reviewed charts from facilities where these sorts of technologies have gone in the fritz for one reason or another, with similar (or worse) results. You can bet IT and pharmacy and risk mgmt are all looking into it.

Never, ever say to yourself, "I think she means..." Always verify. You will not look stupid, you'll look professional and careful, and we like that. :)

Also, NEVER let somebody else sign off on your stuff or even be on the computer under your name. If you step away from it, sign out first. I know it's a pain in the neck, but ... is it more than a pain in the neck than all this?

Forgive yourself and move on. Part of education is making errors and the important thing is learning from them. You have. (And when you're precepting a student or get your first faculty position, you can tell this story as a cautionary tale. :) )

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It wasn't just your fault. Instructors should only assign enough patients that the students can handle at their level of experience and knowledge and that the professor can safely oversee.

I know you must feel so terrible. Keep in mind that everyone makes mistakes. Thankfully everyone is fine. You had 5 patients as a student. My program's allowable student to patient ratio is around 1:2 unless you're assigned as charge nurse. You're definitely getting some valuable experience as a student and will become a wonderful nurse, since you would have already faced so many difficulties, learn from them and overcome them.

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Specializes in Critical Care, Education.

Wow - (educator here) I'm nearly at a loss for words.

As a student without a license of your own, you ARE practicing under your clinical instructor's license. Any of your mistakes are HER MISTAKES. It is her responsibility to oversee your actions (ensuring the patient's safety & compliance with all applicable standards) until your own competency is validated sufficiently to perform the task without direct supervision.

In my state, that instructor's conduct would be deemed "unprofessional" (in violation of our NPA) and subject to BON discipline, particularly since she threw her student under the bus and tried to cover her own error. I hope that someone at the facility is going to follow up and make sure your school takes appropriate action.

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With all due respect, we hear this popular misconception often. Students are legal adults and must practice under their own scope of practice, that of student, which is defined by their school's contract with the facility and the facility's policies and procedures governing what students can and cannot do. Nobody "practices under another's license." No BoN of which I am aware has language like this in its section on student practice. Texas specifically corrects this misconception in their FAQs. As ever, I am willing to be corrected if people are aware of language in their states' nurse practice acts that explicitly states that students "practice under" another's license, whether faculty or preceptor or anyone else.

That said, students, nurses, and faculty must be aware of what their limits are. If a student learns how to do, say, IV push meds in learning lab but the hospital where she's in clinical says no student will ever push an IV med, then even if the DON is standing right there and says, "It's OK, honey, I'm right here to watch you, go ahead," you dast not.

If student does, say, push that IV med, whether or not something bad happens she's in big trouble for doing it, because it's not in her scope of practice. The DON who said she could and supervised her doing it is also in big trouble, because it's not in the student scope of practice and she can't override that. They each bear their own share of responsibility.

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Specializes in ICU + 25 years as Nursing Faculty.

  1. Let it go. Stop focusing on what happened. Stop fussing over who did what. You cannot change it. LEARN from it.
  2. Focus on the present. You feel like you want to quit. Welcome to the real world of nursing. We ALL make mistakes. Fortunately, most don't hurt patients. Of course, some mistakes DO hurt patients. When I was a new grad, I made a series of bad judgments and a patient died. That was VERY difficult for me. However, I have had a good career in nursing despite learning early how easy it is to REALLY screw up. Hint: If you meet a nurse with 5 or more years of experience who says they have never made a medication error, you know that he is either an idiot who never identified their errors, or a liar who is hiding their errors.
  3. Get back on the horse! Charge back into clinical. Reactivate those applications for the jobs that you want.

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While I understand the seriousness of the situation, I don't agree with berating you in front of multiple staff members and family. You will get thru this. Unfortunately mistakes happen and we are human. Just keep your head down and learn from your error. Communication is key.

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