mistake in clinical and instructor freak out.

[LilPeanut, MSN, RN, NP]

Ok, I made a mistake in clinical, but I think my instructor was way over the top. I'd like other opinions. Sorry this is long. You can probably skip to the end if you're in a hurry *L*

We're on a renal med/surg floor. I have a pt. who has lung CA, DM, CHF and a few other issues. My nurse is a float. Drs. come around and put the pt. on a clear liquid diet because they want to scope her the next day. Dietary is notified and so she is not given her morning tray (which meant I couldn't give her her sliding scale, BS 205) Meanwhile, the abx she's supposed to be on is not in the pyxis or her drawer. I call pharmacy to get it sent up. Meanwhile, I'm updating the pt. and she says that she's allergic to another drug in that class and the dr. had said the night before that they were going to change it.

I immediately call the pharmacy to advise them of her unlisted drug allergy, they say to hold the med, they're trying to get a hold of a dr. for her service to get something she can take RX'd. As I'm dealing with all this, I realize the tray is still not up and it's almost 10am. I can't find my nurse, call her on her phone and she says to grab stuff from the diet room and just give it to the pt. and gives me what to give her. In there, I finally find my instructor, and I give her an update, stating that I'm going to feed my pt., then will need her so I can immediately draw up her sliding scale to administer it.

I go into the med room, catch my instructor's eye as she is walking past, knowing that I just told her I needed this, figuring she would be in momentarily. I wait and wait, she doesn't show up. Eventually, I go looking for her, and nearly a half hour later, I find her in a conference room. She verifies my dose and I give it.

In about 45min, pt. starts complaining of not feeling right and possible diabetic symptoms. Her lunch tray is about to be brought up again, and combined with her symptoms, I recheck her BS. It's 270 now. I again can't find my instructor. Apparently my float nurse was off the floor at a meeting in another wing. Pharmacy is still calling me about this abx issue. I see one of the people who rounds with the drs. and ask him if they are still on rounds and he starts leading me somewhere. His office is with the CNS's for the floor btw.

He leads me to another area past a code key entry. I say that I don't think I can be back here, he assures me it's ok. He then takes me to a door to a conference room and I feel very unsure, but again he tells me it's ok, to go on. I talk to the dr and update her.

Apparently, the docs were in conference following rounds and the attending was incredibly pissed that I interrupted. My instructor b*****d at me for 10 min in the halls, then another 10-15 in post-conference with all my classmates there. From the beginning, I admitted my mistake - It wasn't life or death, I should have tracked down my instructor first. And I shouldn't have listened to someone's advice who wasn't my instructor. Oh, and she says that I shouldn't have checked the BS at all the 2nd time, even though it was due again (I should have delayed it because she ate late) and she was feeling "funny".

But my instructor keeps going on and on and on about how the attendings walk on water and I've just committed a mortal sin and later when we're talking about what are the things that could get a clinical group kicked off a floor, she says things like pi$$ing off the attending like I did could.

There have been people with med errors that didn't get chewed out like I did. It's really frustrating for me. It was not a great choice, but it was an error in the pts's favor, it's a freaking teaching hospital, you'd think that drs. would be a little more understanding about students.

Am I right in feeling that my instructor overreacted a bit? Or am I not taking it seriously enough?

[traumaRUs, MSN, APRN]

Whew - it sounds like a very busy day for you! I don't think what you did was that awful. The attendings, resident physicians, etc., DO NOT WALK ON WATER. I think you know now what to do. Its over and done with. Believe me, the docs I work with don't remember these things at all. I wouldn't worry about this. Yes, I agree that your instructor is over the top. However, I think if she is supervising students on a crazy med-surg floor - she is probably stressed to the max (after all she doesn't know these pts either) and probably just reacted badly. I would let this go and go on. If nothing more is said of it, fine. If the instructor belabors the point anymore, I would take it up the chain of command.

[mom23RN]

I have to say that the docs DO NOT walk on water. I would have been very offended by that statment. They put on their pants the same way you do in the morning.

It certainly sounds as if your instructor overreacted. I don't know what she's hoping to accomplish but she needs to tone it down a bit.

I hope that you learned your lesson (it sounds as if you did) and you can go on and put this behind you.

[sharann, BSN, RN]

What was the mistake? I am not getting it

[canoehead, BSN, RN]

I would have done the same thing in the same order that you did. If your patient is having symptoms that concern you,then you need another opinion to help. The RN wasn't there, the instructor wasn't there, the doc was walking by...and one presumes that if a doc has a problem, then they have a mouth and can tell you "Just a minute".

The instructor was out of line, and as a student you can't really tell her so without putting your grade on the line. But as a coworker-and you will be a coworker in a few years you would have been within your rights to tell her so.

I think in a similar situation you could move on to the charge nurse, but if she is tied up then the patient's needs still come before the doc's convienence or the instructor's feelings.

[LilPeanut, MSN, RN, NP]

The mistake was interrupting the docs in conference. It wasn't immediately life-threatening, so harm would not have been done by waiting longer.

And thanks canoe - though the issue was they weren't just walking by, they were in a room having their version of post conference. So, it was a mistake and one I won't make again.

I think part of my problem is that I'm used to working in an ICU environment in a children's hospital, where the drs. are much more accessible and the issues are potentially much more serious.

[BittyBabyGrower, MSN, RN]

First Attendings don't walk on water. Second, where was your instructer and did you page her, even overhead page her. I don't get this new way of having students on the floor without supervision. And you shouldn't have had a float nurse as your resource person, it should have been one of the regular nurses, and if your instructor knew you had a float nurse she should have been more readily available.

What a day...honestly, the only thing that you did wrong was not hunt your instructor down.

[irish_std/n]

so the instructor was only mad cos you interupted a doc at a meeting? So what? The docs no.1 job is pt care...you had a concern for one of your pts...Doctors are not Gods, its awful when they think they are...and even more awful when nurses (like your instructor) pander to them and treat them as if they are!

If the only 'mistake' you will ever make is being overly concerned about a pt then I think you r doin pretty well!

[Sis123]

Hi Lilpeanut;

From what I read, the main problem was that you could not find your instructor. If you *had*, you would never have needed to find the doctor, unless she told you to.

When she did this:

"But my instructor keeps going on and on and on about how the attendings walk on water and I've just committed a mortal sin and later when we're talking about what are the things that could get a clinical group kicked off a floor, she says things like pissing off the attending like I did could."

She was deflecting the blame from herself and putting it on you.

This is not only wrong, but shows lack of character on her part, I am afraid.

:o :o

[Works2xs]

Meanwhile, I'm updating the pt. and she says that she's allergic to another drug in that class and the dr. had said the night before that they were going to change it.

Let's see... the doctor said she'd change the medicine the night before. So because she didn't get that done - patient came nose-to-nose with a med allergy that you averted through scrupulous attention to process. Then, when opportunity presented itself during morning rounds, the doc yet again neglected to follow through on her promise. As a result, this ended up sending a student and at least one pharmacy person scrambling around doing a bunch of extra leg work that would have been totally unnecessary had she been at least a tiny bit more diligent. In short, she put a patient at risk through sloppiness; sent at least 2 busy people on scrambles she caused; and baitched about another human for putting the brakes on something she set in motion.

I think someone owes you an apology.

[enfermeraSG]

Wow! I think you had my last med-surg instructor. Do you go to school in Colorado?! We got chewed out like that in the halls, in front of pts, anywhere - about a dozen times a day. Usually over minor things like being 10mins late checking a blood sugar because your other pt just had an explosive BM all over the place that you had to clean up! My advice, try to shake it off and move on. SG

[LilPeanut, MSN, RN, NP]

Thank you all for your input! Bottom line for me is yes, I should have tracked down my instructor first. But it really helps my head and heart to know that my instructor was off the deep end a little. Of course, this is the woman when giving my my final eval for the quarter the day before, the only thing she could say negative about me was that I was too bubbly. :lol:

It's quarter break, I'll have a new clinical instructor next quarter and chalk it up to a learning experience. All I care about is passing and moving on!