...Heh, I'm a nursing student and I'm like 4weeks from graduation but unfortunately I made some critical errors including a med error this past week and I'm about to be possibly dismissed. I was told however that I have a chance to present my case and be possibly put on probation but since I never had this experience before I dont know what my chances are of getting the probation vs dismissal.
Basically what happened is that I gave a blood pressure medication when the pts BP was like 96/61 and didnt remember to inform the charge nurse about the low BP. The other thing is that I totally forgot to assess the dressing on a spinal surgery patient and still forgot to chart that, and never remembered to go back and assess this pt at the end of the shift. This happened on an extremely busy day. These where the two most recent incidents and from the way our director reacted where the most serious. Previously before though I had been written up for asking if I could use the tubing for Potassium to administer an IV antibiotic, plus not remembering if a pt of mine had bladder cancer.
Now our handbook says that for such offenses "a student may be placed on probation or a recommendation for dismissal may be made" so theres still a chance of me getting probation versus getting an all out dismissal. Our director says I should write my version of what happened and strongly present my case come Monday (6/20), but I've never been in this situation before and dont know what will go well in the ears of nursing faculty. So I basically came here for help and welcome all advise on how I should go about presenting my case, and what I should present (paperwork, essays, e.t.c). I really welcome all advise no matter how silly or unrelevant it might seem. Thanks.
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.
Oh I agree wholeheartedly that not all nurses do this. In fact, most don't - at least where I was educated, anyways! I appreciate that!!
It wasn't even a common occurrence in the ER, but there were a couple nurses that the 3 of us students learned to run from when assignments were being made! I really very much enjoyed all of the learning experiences I was given in the ER. I learned more in my 6 weeks there than I did during any other single rotation. :)
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.
What we're saying is that the primary nurse is also at fault here for not supervising her NS properly. Proper to some nurses beliefs, having a NS or a GN is not a free pass from work. The primary nurse should be there beside them the entire time helping them.
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.
I'm sorry but I saw this happen often when I was in school. The nurses wouldn't be available, even though we had taken their entire teams... and the nurse techs would hide, because they thought that since we were students we had to do TPC! Not true with 5 patients and full nursing responsibilities. My GN friends complained that it continued after graduation on their respective floors. The nurse that you are assigned to work with is responsible for the patient also and should be a guide to the student nurses experience. It's not a free "manicure your nails and pick out your new hairstyle from the latest magazine from the gift shop" day (true experience).
Specializes in ER (new), Respitory/Med Surg floor.
I'm sorry but I saw this happen often when I was in school. The nurses wouldn't be available, even though we had taken their entire teams... and the nurse techs would hide, because they thought that since we were students we had to do TPC! Not true with 5 patients and full nursing responsibilities. My GN friends complained that it continued after graduation on their respective floors. The nurse that you are assigned to work with is responsible for the patient also and should be a guide to the student nurses experience. It's not a free "manicure your nails and pick out your new hairstyle from the latest magazine from the gift shop" day (true experience).
Look at my post before that one. Believe me I was tramatized on a neuro floor when I didn't make it to getting the bedbath done b/c I was working on meds with my professor and 8 other students. Looking back I could have done it with no problem now but not as a student. I remember the techs talking with one another and looking at me why i didn't do it and then the nurse yelled at me why didn't i do it yet. I'm SURE she was busy but I almost cried. My professor talked to her but jeeze. Yeah it does happen. Maybe b/c it is so busy with our jobs that we are SO catty it's crazy. And i'm talking not the staff nurse being the sole supervisor of the student. Just with those few pts make sure the care is done and done correctly that's all.
Specializes in ER (new), Respitory/Med Surg floor.
I'm sorry but I saw this happen often when I was in school. The nurses wouldn't be available, even though we had taken their entire teams... and the nurse techs would hide, because they thought that since we were students we had to do TPC! Not true with 5 patients and full nursing responsibilities. My GN friends complained that it continued after graduation on their respective floors. The nurse that you are assigned to work with is responsible for the patient also and should be a guide to the student nurses experience. It's not a free "manicure your nails and pick out your new hairstyle from the latest magazine from the gift shop" day (true experience).
Woops i think i stated my post wrong, i need to go back and learn english again! I meant that it's wrong to use students to alleviate workload of the staff nurses but my main point was not so much that but that the primary should make sure the care is done for the pt's and done correctly.
I'm sorry but I saw this happen often when I was in school. The nurses wouldn't be available, even though we had taken their entire teams... and the nurse techs would hide, because they thought that since we were students we had to do TPC! Not true with 5 patients and full nursing responsibilities. My GN friends complained that it continued after graduation on their respective floors. The nurse that you are assigned to work with is responsible for the patient also and should be a guide to the student nurses experience. It's not a free "manicure your nails and pick out your new hairstyle from the latest magazine from the gift shop" day (true experience).
Yes, the nurse precepting should have checked, but a lot of what I read sounded like the responsibility was being dumped back on the precepting nurse. Wrong, IMO. Usually in the last semseter of senior year, you're expected to be able to do certain things (like giving po meds) without being supervised. Dressing changes should certainly by that point be done without supervision. And while the nurse should have asked the student how things were going, the student also bears responsiblity to keep the precepter informed.
There's a whole string of "I forgots" here: Forgot to check the BP before giving med, forgot to tell precepter med was given when it should have been held, forgot to change the dressing, forgot the pt's diagnosis...
If the student "forgets" or doesn't know when to ask for guidance, then that's a problem when that student is 4 weeks away from graduating.
I feel like there is more to this story. I just find it very difficult to see someone getting so close to graduating and having these kinds of problems.
I don't know where you went to school or where you work, but precepting here certainly isn't "manicure" time. That's insulting to those of us who take precepting seriously.
You cannot rationalize away mistakes like this. Luckily, the pt. didn't become severely hypotensive. Luckily, the spinal surgery pt. didn't have an infected wound/wound wasn't leaking CSF. Luckily, the question about IV meds was answered correctly. Luckily, it wasn't a doc who discovered the student caring for his pt. didn't remember the pt's dx.
I hate to hear of anyone having a difficult time in nursing school, but the bottom line is that it is hard work. We had people dismissed the end of my senior year because of clinical issues. It's hard because people's lives are at stake. If someone is already in the habit of minimizing/rationalizing/trying to blame others for his/her mistakes as a student, what on earth is going to happen when that nurse is out practicing independently?
I hope the OP is able to work through these issues with his nursing program. Maybe a year off then going back would help, or perhaps repeating the final semester. I hope whatever is worked out is for the good of the student and ultimately the patients.
What surprises me with this whole situation is that the instructor is only minimally involved in oversight of the students. I see this at work more and more that the staff nurse is forced into being responsible for a student. I know that when I was in school(not all that long ago) we couldn't do ANYTHING without the instructor being there. Meds were absolutely NOT given without being questioned extensively by the instructor. When did all this change??
I don't know where you went to school or where you work, but precepting here certainly isn't "manicure" time. That's insulting to those of us who take precepting seriously.
It's insulting to nursing students as well, but it does happen. Some nurses don't enjoy having to "deal" with student nurses, and others are more than happy to just drop their load and relax... hoping that the clinical instructor is keeping tabs on the students. Sad but true.
HI, just wanted to comment. I am sure you are a wonderful person and will someday make a wonderful nurse. We have all made errors/mistakes and hopefully learn from them.
On the other hand, you are 4 weeks away from being out in the real world on your own. A world where you may have 5 or 6 or 7 patients, not only 3. A world where there is no instructor to page and decisions have to be made quickly using critical thinking. I think that forgetting to assess a post-op dressing is unacceptable. The person could have bled out underneath them and you would not have known. Would you want someone nursing you like that? I am not trying to put you down at all or say you will make a bad nurse but I do think you could benefit from some more time as a student. This is my honest opinion. Just to get a little more organized. Try not to be offended from this advice as I am also trying to look out for your best interests. How awful would you feel if you took a new job and could not keep up and made a potentially fatal error?
I really do wish you the best of luck. Keep your chin up and I hope you will consider taking a little more time in school:)
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?
Our instructors take the meds out of the pyxis with us, well allow us to do it while they supervise. My instructor has allowed me to "make a mistake" pulling out a med, get out the door of the med room and have me review my meds to see if I caught it. Yes I did and back to the pyxis we went to put the incorrect med back in and remove the correct one (I had pulled out of th wrong pocket). I learned SO much that day. I was happy he let me get that far with the error, it was completely under his control, but he let me panic and see how it felt to nearly make that error.
Once we have gotten our meds out of the pyxis and verified they are correct with our instructor, I've often given the PO meds alone. The sq and im meds he stays with me and watches.
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.
We have had lengthy discussions in our post conference about how to handle the staff as we take on more patients. Where we do our clinical we have CNA's and LVN's. I "cleared" this with our instructor, but I wanted to make sure that it was OK to expect the cna to continue to do their portion of the team work. I am not opposed to doing bed baths, vs, or adl's. However, when I am functioning as the rn with 3 or more patients...... even the "seasoned" rn's are not doing complete patient care. Why should I as a student nurse be expected to be able to handle more work than a seasoned rn? It only opens me up to making an error out of disorganization and stress.
I think part of the "growth" process as a student is coming from that place of being expected to do the grunt work to saying to the staff, wait I am truly too busy to take that patient to the bathroom, when the cna is standing in the hallway chatting. Only if I *am* too busy that is. I am the one responsible for the well being of my patients I want to have as much organization as possible.
Before anyone gets bent out of shape with my theory, remember I am not yet at that point in school. Nor am I one of those students who thinks that "once I'm an RN I wont have to clean up x, y, or z" If I am working in a team setting, I expect there to be teamwork. That expectation follows through onto myself. I dont expect anyone else to do something that I won't do. Within everyone's scope of practice, of course.
Yes, the nurse precepting should have checked, but a lot of what I read sounded like the responsibility was being dumped back on the precepting nurse. Wrong, IMO. Usually in the last semseter of senior year, you're expected to be able to do certain things (like giving po meds) without being supervised. Dressing changes should certainly by that point be done without supervision. And while the nurse should have asked the student how things were going, the student also bears responsiblity to keep the precepter informed.
There's a whole string of "I forgots" here: Forgot to check the BP before giving med, forgot to tell precepter med was given when it should have been held, forgot to change the dressing, forgot the pt's diagnosis...
If the student "forgets" or doesn't know when to ask for guidance, then that's a problem when that student is 4 weeks away from graduating.
I feel like there is more to this story. I just find it very difficult to see someone getting so close to graduating and having these kinds of problems.
I don't know where you went to school or where you work, but precepting here certainly isn't "manicure" time. That's insulting to those of us who take precepting seriously.
You cannot rationalize away mistakes like this. Luckily, the pt. didn't become severely hypotensive. Luckily, the spinal surgery pt. didn't have an infected wound/wound wasn't leaking CSF. Luckily, the question about IV meds was answered correctly. Luckily, it wasn't a doc who discovered the student caring for his pt. didn't remember the pt's dx.
I hate to hear of anyone having a difficult time in nursing school, but the bottom line is that it is hard work. We had people dismissed the end of my senior year because of clinical issues. It's hard because people's lives are at stake. If someone is already in the habit of minimizing/rationalizing/trying to blame others for his/her mistakes as a student, what on earth is going to happen when that nurse is out practicing independently?
I hope the OP is able to work through these issues with his nursing program. Maybe a year off then going back would help, or perhaps repeating the final semester. I hope whatever is worked out is for the good of the student and ultimately the patients.
NeoNurseChic
25 Posts
Oh I agree wholeheartedly that not all nurses do this. In fact, most don't - at least where I was educated, anyways! I appreciate that!!
It wasn't even a common occurrence in the ER, but there were a couple nurses that the 3 of us students learned to run from when assignments were being made! I really very much enjoyed all of the learning experiences I was given in the ER. I learned more in my 6 weeks there than I did during any other single rotation. :)