...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.
I'm being fueled here by a discussion we had yesterday about how many drug errors might not ever get noticed and ones that aren't reported. I agree with whoever said there's probably more to the story. The incidents related did cause me some alarm. I became more alarmed as I thought about what mistakes might have been missed altogether.
The more I think about this, the more I'm tending to agree with whoever said repeating the semester might be a good idea. It's a plain and simple fact that in a few short weeks this fellow will be on his own in the real live world.
Don't get me wrong. You'll make mistakes when you're long done school too. We all do. But probably not that many in a few short months.
I would recommend to the OP, besides some of the excellent recommendations by nurses and clinical instructors here, to get organized and stay that way.
For example, remember the old movie karate kid? How frustrated he got at spending all that time learning movements before he could put 'em together? Well, passing meds isn't a hurry-up thing, routinely. (As in, morning meds for oh say, 3 patients.) My first year med surg instructor taught me a methodology that hasn't failed me yet. After getting assessments and vitals done, spend some quality time with the MAR (med list).
What are you gonna give this one patient, this morning? Before grabbing any med, are there cardiac drugs? Anything that is, jot the HR and BP down next to where you'd sign the drug off. Insulin? What's the blood sugar? If you don't have one, go get it. So you'll see that if you've got BP meds, you don't go to the next step till you get a BP. Pain meds? Did the patient request them? When did they last get pain meds? ...etc.
Next step, when gathering the actual meds, do it in exact order on the list, and put a little dot next to the med when you got it in the cup. Don't categorize, don't get IV pushes first, just go in order. Now that you know you CAN give the meds, it goes pretty quick. Then gather the cup, IV flushes, insulin syringes, whatever else you need and alchohol swabs, along with the MAR if you are supposed to (by your facility policy) take it in the room, and down the hall you go. Stop and sign 'em off when you are done.
That sounds like a lot and it used to take FOREVER to get it done. But if you have some organization and keep doing it the same way, you can see how it does get faster. It's not a bad thing to be a little obsessive-compulsive when passing meds.
Specializes in ER (new), Respitory/Med Surg floor.
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.
I was the one that started saying where was the primary nurse in all this. I'm not blaming that nurse 100% by any means just making a point we need to watch out for our pt's sake about issues like this. I totally agree that it sounds like other stuff was going on with the op and all of things mention do raise red flags. I hope he can pull it together. I knew nursing was hard but finding fellow nurse that can do it seems to be issues at my facility i know making it more important to check students out before they graduate.
OP did you have an internship through your schooL? If so and if not I suggest trying to find an externship program. You work one to one with the nurse (make SURE that is what it is) and teaches you assessment skills and all other nursing functions. You are supervised and working with this one nurse. It helps tremendously and helps you start thinking as a nurse in practice. Not to mention you get paid to do it. I was not untill my internship a 4 week 8 hour full time schedule with another rn that I finally pulled everything together. Oh an ask questions ask questions ask questions ask questions. I think I asked so much people started getting annoyed but keep asking to learn. Good luck!
Specializes in ER (new), Respitory/Med Surg floor.
I knew nursing was hard but finding fellow nurse that can do it seems to be issues at my facility i know making it more important to check students out before they graduate.
I'm finding out working with coworkers what I mean by this is not so much lack of doing skills but logical/critical thinking on why you questions orders and call lab values ect for various situations for some people they just don't get it. Ex. A major issue with one fellow nurse when people are on coumadin for afib there may be NO order that states call inr qd to get coumading order. Usually there is an order for pt inr daily and being the nurse see that on the labs find out why and see if coumadin had been ordered the day before and if so or if you know the pt and know they are on comadin call the md for a coumadin order. Yes the md should do it but i think sometimes forget or are waiting for the lab result. ONe coworker just would never get this and I would see comadin on previous orders. What I'm getting at you need to learn how to take all different situations and makes tons of judgement calls that you gain with experience. That's why i feel internships/externships may help the op.
I really want to thank all you guys for all your support. They read over my essay which I wrote with a lot of suggestions from this board and my sincere feelings. They deliberated for maybe 10minutes then told me I was gonna be given probation. I would have to spend an extra week on the floor to prove my ability to perform as a safe nurse. Of course there where other which all of you guys probably already know (outlining action plans, e.t.c). But the main thing is that I wanted to stress that I really appreciated all the advice and it helped me cope with the situation like you would not believe. I have definitely learnt my lesson and will apply all the preventive measures to keep all my patients safe. Thanks everybody :-)
That's great!! You will be sure to never make those same mistakes again. As serious as the mistakes may have been, I see nurses doing similar things. Examples - I had a patient with a pneumonectomy and all the nurses before me said the lung sounds were clear!! I was a student when I caught that. One would follow the next nurse and so on.
Recently one nurse described a wound on the wrong side of the patient's body. Many nurses saw that and didn't catch the mistake until a student came on board and pointed out it wasn't on the left, but was on the right!!
Obviously you need to watch out for med areas. Cardiac meds are so important. A nurse the other day gave my 80 year old patient two very potent meds and the man was knocked out the entire day. Respirations were really off. I'm considered a "student" now as I'm getting back into nursing, but I knew that nurse shouldn't have been giving that man so much!!
Being a nurse is tough. We all make mistakes, but somehow you are expected to make no mistakes in nursing!! No wonder we're all so stressed!! Good luck
That's great!! You will be sure to never make those same mistakes again. As serious as the mistakes may have been, I see nurses doing similar things. Examples - I had a patient with a pneumonectomy and all the nurses before me said the lung sounds were clear!! I was a student when I caught that. One would follow the next nurse and so on.
Recently one nurse described a wound on the wrong side of the patient's body. Many nurses saw that and didn't catch the mistake until a student came on board and pointed out it wasn't on the left, but was on the right!!
Obviously you need to watch out for med areas. Cardiac meds are so important. A nurse the other day gave my 80 year old patient two very potent meds and the man was knocked out the entire day. Respirations were really off. I'm considered a "student" now as I'm getting back into nursing, but I knew that nurse shouldn't have been giving that man so much!!
Being a nurse is tough. We all make mistakes, but somehow you are expected to make no mistakes in nursing!! No wonder we're all so stressed!! Good luck
I was in the hospital at one point and taking an MAOI for headaches. I had been on pamelor (nortriptyline) quite some time before that, and a new nurse came in and just handed me a pill. I asked her what it was (mistake #1...i had to ask what my med was). She told me, and I said I can't take that. She kept on insisting that it was prescribed and I should take it.
Finally, without raising my voice, I said that combining a TCA with an MAOI can be fatal, and I will not take that pill. She said okay. :)
The nurse she was working with that night is someone I've known for several years now. I called her in the room just to let her know what happened. I told her that I didn't want the newer nurse to get into trouble, but I just thought she should know...as an educational type thing.
I remember being very stressed out that entire hospital stay because it was over New Year's and between new nurses and nurses pulled to our unit to cover during the holiday, it seemed like little mistakes were happening all over the place!
Mistakes do happen....just very important to recognize them, make sure the patient is okay, and then plan what you will do to ensure that doesn't happen again.
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.
The RN who is assigned the patient may have some say in this situation also, in that I ask or personally get my VS on my assigned patients (no more than 6, thanx Ahhhnold!) and so am aware if there are any "red flags". I also have a note in my med book telling me the student name, meds they can pass, PO, IM, NGT, PR etc. and the hours they will be giving them.
If I am assigned a post op patient I will always check the dressing myself so perhaps there was a bit of miscommunication here between the nurse and student? All in all, it sounds like this kid is feeling bad about his actions and knows he needs some intervention. I would suggest the option of repeating the course, maybe request that at the meeting. At least the instructors would know he is admitting he wants additional experience, time and a chance to regain his confidence.
Specializes in psych both adult and kids, cardiac.
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 agree because when I was in school our clinical instructor was with us at all medication adminstration times. We were quizzed right in the med room about meds, side effects and also in post conference. However when I was an new RN about 1 year out, I was asked to precept LPN students and their clinical instructor was not even on site. Our nurse manager had agreed we were to precept these students besides having a full patient load and I was scared to death because they were riding on my license. Needless to say I parted ways with that organization quickly. I felt my hospital and the technical center were way out of line on that one.. Besides I had one LPN student say to me that I didn't do things by the book I said to her this is the real world and I do take care of my patients safely. I think really the school should be accountable for students and the students accountable for themselves. We have to be safe for our patients are depending on it.
In case not all of you read my "thank you" post I was kept in the program and put on probation, so I do thank ALL of you that participated in my thread. I respect this site so much and would like y'all to give me tips on how to prioritize and organize my clinical day as this will be really valuable for me. I have already written down some but more nurse heads are better than one. Thanks again guys.
Why where you allowed to pass meds with out an instructor or a preceptor?
this is the best one.. .. Where was the instructor?? He or She should and is responsible to check first and allow lyou to explain to him or her what you're doing before you do it. that's how i learned. :)
.. Where was the instructor?? He or She should and is responsible to check first and allow lyou to explain to him or her what you're doing before you do it. that's how i learned. :)
OntCaRPN
40 Posts
I'm being fueled here by a discussion we had yesterday about how many drug errors might not ever get noticed and ones that aren't reported. I agree with whoever said there's probably more to the story. The incidents related did cause me some alarm. I became more alarmed as I thought about what mistakes might have been missed altogether.
The more I think about this, the more I'm tending to agree with whoever said repeating the semester might be a good idea. It's a plain and simple fact that in a few short weeks this fellow will be on his own in the real live world.
Don't get me wrong. You'll make mistakes when you're long done school too. We all do. But probably not that many in a few short months.