My CI is doing things that are unsafe

[bootsandcats, MSN, RN]

I'm in my last couple of months of nursing school. My instructor is one of those who can do no wrong (in her eyes). They often belittles students in front of patients/family/staff. (For example: she has yelled at me about wanting to tell the nurse that I was doing something for the patient.)

I normally don't care about these things. But something has been bothering me. They has been my clinical instructor for several clinicals. We sometimes get into small spats because she wants me to do something that is unsafe. (ie: pushing a medication too fast. or once she tried to give a pt 5x the amount of prescribed drug.)

I don't normally have problems with telling people how I feel. And to be honest, I am worried about the patients she treats. I am lucky that I always ALWAYS look up medications and protocols and have prevented something very catastrophic happening. But I fear that not everyone is as concerned about this... However, she is going to be in charge of my grades for the next several months. They have been known to..... Change them if the graded item is subjective..... But my patient advocacy side is kind of nagging at me. I'm scared of reporting her though, I'm even nervous posting here. Am I wrong in not wanting to report her?

[Ginger's Mom, MSN, RN]

I have a hard time believing that your instructor is so unsafe her nursing license should be pulled. do that staff nurses feel she is unfit? The staff are her clinical equals not the students. You may think your issue is important to tell the staff but your instructor may have been told to limit student staff interaction. If the other students feel the same I would report her to the school. But I am guessing you will be the only one speaking up.

[guest1048932]

I have been there! I had a professor who would belittle me in front of the class, and in anything subjective, I would mysteriously fail while passing all other objective assessments with flying colours. My professor was an absolute horrible person to me, and more than once I held it together in class only to burst into tears at home, or in the washroom when I was alone.

That instructor taught me that you need to be sure of yourself, but that you are not infallible. It never hurts to double check when someone questions you, just to be safe. I've had people go, "Those aren't my pills!" before, and I ALWAYS go back and confirm before administering them, even if I am 100% sure of meeting all my medication administration rights. It is better to find a mistake before it's made than to actually make a mistake and have to fix it. While this professor bullied me and made me feel about as valuable as a bed bug, I learned a lot about how to handle bullying, harassment, and unprofessional behavior in the workplace. I learned to always act professionally even when other people are not, and I learned how to simply walk away when things are getting toxic.

This professor also taught me that if you need to question your superiors, be darn sure you have good reason, evidence to back it up, and are sure of what you're talking about. You can't argue "but she said" because stories can change, and as she is a clinical instructor and (hopefully) holds a nursing licence, she will be believed most of the time as she has more to lose.

Let your dean or the person in charge of clinicals know what is happening so you have documentation. Voice your fears of this CI failing you, and ask if it would be possible to have other CIs assess you. Build a paper trail by documenting the incidents as accurately and as objectively as you can. B careful about saying she is bullying you, as unless she has made a threat, it is more likely harassment and unprofessional behavior. Don't try to label behavior as much as describe it accurately. Make sure your CI will not know it is you who has come forward with concerns! At the hospital, bring other nurses in to teach you skills/watch you do things (if appropriate) so if your grades come into question, you can have other people vouch for your competency.

The best case scenario is that your CI is testing your ability to use your nursing judgement, perform under stress, and refuse unsafe delegation and orders. Worst case scenario, she actually is that incompetent and a danger to her patients. Hope for the best case, but also don't negate the worst case.

Do not feel bad about questioning unsafe practices, but do keep in mind that what you learn in school, best-practices, and hospital policies will all differ on the same procedure. Just because one varies from the other does not mean something is "wrong".

[ruby_jane, BSN, RN]

Worry the most about YOUR practice. You are doing it right. Look it up, have the data to support your clinical decisions. Don't worry about everyone else's practice until they do something blatantly unsafe right before your eyes.

I like how you want to advocate for everyone but right now: Make sure your practice is impeccable. Document everything unusual (use a legal size tablet and date/sign like nurses notes). Realize that a "you say, she says" argument with anyone above you is likely not going to go well for you (and that sucks but, rightly or wrongly, it is what it is). If you witness with your own eyes a med error, follow the chain of command to report that med error.

[Cowboyardee]

If you are in a situation where someone's life or limb is in real danger because of a practice you are witnessing, you are obligated to speak up. Then and there. If you are in a situation where someone's habitual bad practice would appear to routinely put others lives or limbs in danger, then you are also obligated to speak up.

BUT... you are a nursing student, and are not likely to be a reliable judge of when someone's life or limb is in real danger. You didn't give enough detail in the OP to clearly indicate one way or the other. Some medications are often given faster than your pharm books would have it by experienced nurses in the trenches (but certainly not all meds or in all situations); it would be more uncommon to administer 5x the ordered dose of some medication without it being a serious error, but on the other hand, you didn't say which medication or describe the situation - some hospitals treat 10cc NS flushes as medications.

Experienced nurses have seen many students and new nurses who wield policy like a weapon without understanding the 'why's, and who swear that it's not personal and that they are merely concerned about patient safety. That may not be you in this case, but be aware that even if you have only the most noble of intentions, you run a real risk of being seen as a retaliatory policy-enforcer if you report your CI. And while being seen this way may not be great for for people who already have their RN, it's much worse for those who still have school work to complete.

So... if you witnessed some behavior that is obviously and severely dangerous, then you've got to speak up, whether or not it hurts your reputation. You can't weight your reputation against another person's life. On the other hand, if you witnessed some practice that is poor and sloppy but not clearly detrimental to a patient, I would urge you to keep quiet about it and finish your education.

And if you don't know how dangerous the behavior truly is...

I would encourage you to privately ask your CI in a non-accusatory manner about practices she takes that differ from policy, by-the-book practice, etc. Ask other (non-student) nurses and doctors about them without mentioning your instructor. You might learn something useful.

At any rate, don't go marching into administration to report that your instructor suggested pushing IV famotidine over 30 seconds when the book clearly says "1 to 2 minutes."

[bootsandcats, MSN, RN]

Hi all,

Thanks for all of the replies.

A couple of us got together and did report her. She tried to give PRN medications way too closely together, and also was improperly administering insulin. In both scenarios would have caused some significant damage. It turns out she has had numerous questionable behaviors when I was asking around. We did what you all said, we documented everything. Literally everything. We all went and reported her anonymously. She is no longer allowed to teach clinicals. Thanks again!