MedError/Dismissal...What2Do

[austin heart, BSN, RN]

we didn't need an instructor or coassigned nurse present to pass meds in our final 2 semesters.

I would think that this would bring about all kinds of liability issues for the hospital as you are (were) a student, not an employee of the hospital.

We ALWAYS had to have a co-signer when I was a student and now as a preceptor, I am sorry but I want to know that the student giving meds on MY patient knows what they are giving and the side effects of the med that they are giving. After all it is MY patient and their care is ultimately in MY hands, I am the one that will be held responsible if my preceptee makes a med error. The OP proves that not all SNs know how to correctly pass meds.

[suebird3]

Good luck, and let us know what happens.....

[mysticalwaters1]

I know I am out of line here but giving a patient a blood pressure med that is 90's over 60's depending on the patient I do it all the time....... Was the patient with bladder cancer there for bladder cancer or was it part of her history. I'm also curious did this all happen in one day or a couple of them.Anyway I wish you luck tomorrow.

I was kind of confused here, possible dismissal over the bp and to not remember bladder ca! Unless maybe this has been over a while and other issues. You mean to tell me some of us never had pt's with a multitude of issues and forget or lose sight of what they have originally come in with?!? Sometimes md's even write parameters to give bp meds over spb of 90. Just like the above quote states it all depends on the pt. I guess the issue is that you apparently didn't realize to tell the nurse or let the professor know the bp before you gave the med. Maybe if this kept happening that's why they are looking into your work. Sorry about it, it stinks but have to make sure you're ready when you graduate. As far as pt load. I mainly stayed with 2 pts period during school I think 3 at the end and i'm fine! And it was hard with those 2-3. Well I think i'm detailed that's the main thing and what the professors said. The bp issue is a problem just b/c they seem to feel you hesitated to look into it further, and the other major thing the spinal dressing but doesn't the primary nurse on the floor look into that too? Or maybe that's how they knew you forgot to do it. Well you learn. No one's perfect but you do have to learn basic safe care. I found out after I graduated that some people get nursing and some don't. If you can learn from it you can get better.

[mysticalwaters1]

well all that schooling and i still don't know how to spell great even with spell check available!

[jeepgirl, LPN, NP]

I was kind of confused here, possible dismissal over the bp and to not remember bladder ca! Unless maybe this has been over a while and other issues. You mean to tell me some of us never had pt's with a multitude of issues and forget or lose sight of what they have originally come in with?!? Sometimes md's even write parameters to give bp meds over spb of 90. Just like the above quote states it all depends on the pt. I guess the issue is that you apparently didn't realize to tell the nurse or let the professor know the bp before you gave the med. Maybe if this kept happening that's why they are looking into your work. Sorry about it, it stinks but have to make sure you're ready when you graduate. As far as pt load. I mainly stayed with 2 pts period during school I think 3 at the end and i'm fine! And it was hard with those 2-3. Well I think i'm detailed that's the main thing and what the professors said. The bp issue is a problem just b/c they seem to feel you hesitated to look into it further, and the other major thing the spinal dressing but doesn't the primary nurse on the floor look into that too? Or maybe that's how they knew you forgot to do it. Well you learn. No one's perfect but you do have to learn basic safe care. I found out after I graduated that some people get nursing and some don't. If you can learn from it you can get better.

I agree with your post. And with the dressing... your primary nurse should have been there to catch it also. But on top of that we've got keep in mind that we have to use our critical thinking skills. If your other patients are having ABC problems or are becoming critical, your seemingly stable laminectomy patient might just have to wait. My point is that there are always going to be situations where we might have to make something very important just wait because of other important issues. There aren't always enough hours in the day! I'm not excusing it... but I don't know what the whole situation is either. The OP could have seen it at the beginning of the shift, have checked it halfway through the shift, and just forgot to check it at the end of the day. OR she might have just forgotten it altogether. What matters is that she learns from her mistakes.

[brotherbear]

I gave my opinion, which is what the OP asked for.

Did you notice that he isn't asking for help with the actual problem, the error's, he's asking for advice on how to get out of it.

If the post was about tips on prioritization, or a better way to reference meds

I could understand your anger, but thats not the case.

It is also stated in the OP that there have been other mistakes in the past, which is probably the reason for the threat of dismissal. These are big mistakes for a student 4 weeks from graduation and I don't think asking how to defend yourself against them rather than how to prevent them should get a lot of sympathy.

If there is any advice I need it's how to fix the problem. I do have a legitimate problem here and thats the major reason behind this whole ordeal. Pls do tell about any ideas on my correcting this.

[fab4fan]

I don't mean to sound harsh, but at this point, so close to graduation, you should be using your critical thinking skills to figure out why this is happening and how you intend to fix it. You should not be asking others to tell you what to do to fix it.

If after time to reflect on what happened you still cannot see how you went wrong, then to me that is indicative of a larger problem. This is what is going to be expected of you when you start working.

You say you have a legitimate problem; OK, then what is the problem? We've seen your list of errors; what do you think caused you to make them (not how they happened, we already know that)?

It's also not fair to fob off these errors on the nursing staff. When students are that close to graduation, they are expected to be able to follow through with their pt. assignments. To try to shift the blame onto another staff nurse is unfair and shows a lack of taking responsibility. (Not so much directed at the OP, but at others who were blaming the staff nurse.) It's the student's responsibility to keep the staff nurse informed, not the staff nurse's responsibility to go chasing after the student.

I just get the impression from your last post that you may be lacking in the ability to "see the big picture." Minimizing the errors shows that you fail to see what could have happened to those patients as a result.

If we tell you how to answer your instructors when they talk to you, that will not help you in the long run. Yes, we do need more nurses, but we need nurses who can use their critical thinking skills. No one expects new grads to hit the floors running, but there does have to be a minimum level of competence. Your school cannot in good conscience let someone who is unsafe graduate. They have to be sure that you have a handle on what has been happening, and a well thought out plan to rectify those problems. You're not going to help your case if you meet with your instructors and are completely unprepared.

Like I said, we do need more nurses, but our first obligation must be to protect pt. safety. You need to make sure that when you do graduate that you are a safe caregiver. Your school needs to be doubley sure of that as well.

I hope you're able to turn this around. Be respectful and receptive to what they say. No finger-pointing or blaming; these pts. were your responsiblity. You need to show your instructors that you can accept that responsibility.

[mysticalwaters1]

It's also not fair to fob off these errors on the nursing staff. When students are that close to graduation, they are expected to be able to follow through with their pt. assignments. To try to shift the blame onto another staff nurse is unfair and shows a lack of taking responsibility. (Not so much directed at the OP, but at others who were blaming the staff nurse.) It's the student's responsibility to keep the staff nurse informed, not the staff nurse's responsibility to go chasing after the student.

I

I tend to overreact but I hope you're not refering to my post about "fobbing" the error on to the nurses b/c that was not my point at all. I don't know about others but when a student takes care of my pts even with a professor even IF they are close to graduation I check on that pt and review the nursing note. You're still responsible as well. Students are there to learn not a free pass for help with your shift. NOt that I'm saying you do that I know some do or don't even look at the pt. I know when I precept as well I still listen to the pts and review everything as if I'm the primary nurse so when issues do arrise I can help the preceptee and the pts fully. Now once i know the preceptee better I back off but still review all labs and charts and look in on the pts and vs. I just see too much when students and preceptors work the nurse originally assigned looks at them like they should be sufficient for the job when actually they are still learning and need our direction. I suggest to all nurses new and more experience and I'm only a nurse for 2 years do this b/c problems do arrise and does this mean the person should never be a nurse. It all depends but with liscenses involved I check into everything even if it may not fall on myself. I feel it's owed to the pt as well.

[BeenThereDoneThat74, MSN, RN]

to the op- as a new clinical instructor, i have a few questions for you (so i can better learn how to deal with situations like this):

-were you ever given a warning (either verbally or written) regarding past offenses)? if they were verbal, did your instructor(s) have a written account of your offenses?

-please be honest, was this the only semester where you had problems? if not, how were they resolved previously?

-again, be honest, how do you really feel your performance has been? you have just completed your final semester, and are supposed to sit for nclex. i know this is a tough question, because 90% of people walk out of school saying they are 'not ready', but imo, 75% of them are just being paranoid and neurotic (in my experiences, these were the students with the 90+ averages that made me want to :barf01: ) i think you really have to be honest with yourself.

as a last semester student, i'm sure 3 patients is overwhelming. and one of my pet peeves is when other nurses say "oh this is nothing, wait until..." but sadly, most hospitals do not give you the appropriate time to 'ease into' a full assignment. as a student, i never had 3 patients. and yes, depending on the 3, they can be more overwhelming than 6 (or more). does everyone get 3 pts as a senior? even if you can't handle it? how were you with 2 patients?

finally, i don't know you from a hole in the wall, but i feel i have to say this: nursing is not for everyone. and yes, as someone bluntly mentioned before, nursing school is hard for a reason. yes, we need lots of nurses, but we can't just pass everyone because of the shortage.

i hope today went well for you. and if it didn't, just think long and hard about it. i know you invested a lot of time and money. good luck. :)

[Mystery5]

I would think that this would bring about all kinds of liability issues for the hospital as you are (were) a student, not an employee of the hospital.

We ALWAYS had to have a co-signer when I was a student and now as a preceptor, I am sorry but I want to know that the student giving meds on MY patient knows what they are giving and the side effects of the med that they are giving. After all it is MY patient and their care is ultimately in MY hands, I am the one that will be held responsible if my preceptee makes a med error. The OP proves that not all SNs know how to correctly pass meds.

I was wondering about this myself. When I was in school, as I recall, we always had a co-signer. It's all rather a fog, but I don't remember having been given very much automony during school. But maybe other programs do things differently?

[NeoNurseChic]

I absolutely loved my last clinical rotation through the ER. That's in part due to the fact that the ER was my first 'home' as an employee at the hospital where I work. I was coming full circle and working in a different role, but with the same family. I love that. :)

However, I got to learn quickly who I enjoyed teaming up with -- some nurses dumped all the 'crap' they could on me, and they told me I had to "work my way up" as they had. Give me a break... That's not an excuse to get out of the grunt work! haha Most were not like that, however. :) I did have two nurses who would run off and expect me to hold down the fort. Ummm.... This left me feeling stressed. In one 8 hour shift, it was possible for me to have sometimes over 12 patients rotating in and out. And if we were full (which we always are, as an inner city trauma center), then I constantly had 5-6 to manage. I wound up asking a great deal of questions, because I couldn't possibly know all of the information on my own. I do spend quite a bit of time looking things up, but when you get thrown into a setting that you really haven't had any experience with, the first couple times are going to be rough! I agree with what is written above that students aren't there to relieve the nurse of work. They are there to learn. I hated the experiences I had where I was treated like I was just there to make the nurse's life easier. Nooooooo... Learning is where it's all at. :)

carrie :)

[mysticalwaters1]

I agree with what is written above that students aren't there to relieve the nurse of work. They are there to learn. I hated the experiences I had where I was treated like I was just there to make the nurse's life easier. Nooooooo... Learning is where it's all at. :)

carrie :)

Not all nurses do this. I was just making a point not so much that students should not have to alleviate the workload (that's wrong as well) but that I feel should not be expected to do all the work and the staff nurse does not check on the pt or just rely on the student reporting off.