Unfair Fundamentals Clinical Testing?

  1. I want to ask you a question so I can finally put closer into this school issue. I retook the clinical exam that I was talking to you about and a failed for the second time so I had to withdraw from the course. Although somehow I think that the instructions by the professor was not clear and that's why I failed. The four skills I had to perform were (1) wound dressing (2) tap water enema (3) Intramuscular injection (4) hanging a primary and secondary IV bag. When I got inside the lab, all the instructor said was "these are the three things, all you're supplies are there (she gestured to a table which was against the nurse's station), you have 30 minutes, and you can not ask questions when the exam begins" On the table, there was some supplies, however, not everything was there, and a thin binder that was closed. During previous clinical exams that I took, I was always handed the MAR so I didn't think to look inside the binder. I also did not know what the enema was so I figured that I'll do the first thing I know which was the wound cleaning. I grabbed the dressing care tray and went to the mannequin. Immediately after opening the tray I realized that I did not have the saline, but when I looked at the table, it wasn't there. In the tray there was hydrogen peroxide swabs so I used that thinking that since the saline was not on the table, the swabs must be the alternative thing to use to clean the wound. After, I went back to the table and since I didn't see the primary bag, and I had no idea what the enema looked like, I assumed the enema bag is what I should use because it the only thing that looked similar to the primary bag. I obviously couldn't do it because there are no ports, so I just hung the secondary bag. However, I kept saying that there no primary bag and the instructor did not say anything. After, I proceeded to give the IM injection and there was three vials that were there so I chose the Heparin since the other two vials seemed very small. Later I she told told me that Heparin is given SC, so it may have been the other two, but I'm not sure. Also, I didn't know how much to give since I was not given the MAR so I just gave 3cc. Last, I told her that I don't know what the enema was. Then, I saw the primary bag which was on the side of the nurse's station and the saline which was behind the counter. In my opinion, the instructions were so unclear from the start because all the supplies were not on the table and she implied that "everything I need is there." The sterile gloves were even in the closet which I asked for at the beginning and the mannequin did not even have a wound, she had to put a bandage on it in the middle of the exam. At the start she also kept referring to her sheet which had the three skills, instead of handing me the binder so I didn't think to look inside the binder. Sara thinks that I am 80% wrong because I didn't know my stuff enough to ask for the MAR, prepare my supplies to notice that what was on the table was incomplete, and realize that the enema bag can not be used as a substitute for the primary bag. Do you think it's right for her to fail me, or do you agree with me that the instructions were so miss leading and confusing, almost like a setup so I can fail again? Should the instructor also be responsible? Sorry if that this message is so long, but I wanted you to have write all the facts.
  2. Visit jbernardo profile page

    About jbernardo

    Joined: Apr '18; Posts: 1; Likes: 1
    from NY , US

    41 Comments

  3. by   dudette10
    First off, you cut and pasted an email you sent to someone. A friend or someone higher up than the professor?

    Quote from jbernardo
    Although somehow I think that the instructions by the professor was not clear and that's why I failed.
    No one fails anything due to unclear instructions. You might not do as well, but failure because instructions were unclear is not common.

    On the table, there was some supplies, however, not everything was there, and a thin binder that was closed. During previous clinical exams that I took, I was always handed the MAR so I didn't think to look inside the binder.
    This time you weren't. Why didn't you look in the binder? Did you ever find out what was in the binder? Maybe it was additional instructions to find those items that were missing, so your instructor was CORRECT to say, "Everything you need is there."

    But, let's say the binder didn't contain information about the hidden items. You do realize that in the real world, supply doesn't always put things where they are supposed to, and we go hunting for them. It's part of the job. We DO NOT just used whatever is available that can cause harm to the patient....as you did throughout your clinical test.

    After, I went back to the table and since I didn't see the primary bag, and I had no idea what the enema looked like, I assumed the enema bag is what I should use because it the only thing that looked similar to the primary bag. I obviously couldn't do it because there are no ports, so I just hung the secondary bag.
    Why didn't you know what an enema bag looked like? Was there supplemental material for the class that you didn't review? Did you miss a lab session, so you weren't present when this was reviewed?

    After, I proceeded to give the IM injection and there was three vials that were there so I chose the Heparin since the other two vials seemed very small. Later I she told told me that Heparin is given SC, so it may have been the other two, but I'm not sure. Also, I didn't know how much to give since I was not given the MAR so I just gave 3cc.
    Last, I told her that I don't know what the enema was. Then, I saw the primary bag which was on the side of the nurse's station and the saline which was behind the counter. In my opinion, the instructions were so unclear from the start because all the supplies were not on the table and she implied that "everything I need is there."
    The sterile gloves were even in the closet which I asked for at the beginning and the mannequin did not even have a wound, she had to put a bandage on it in the middle of the exam. At the start she also kept referring to her sheet which had the three skills, instead of handing me the binder so I didn't think to look inside the binder.
    Sara thinks that I am 80% wrong because I didn't know my stuff enough to ask for the MAR, prepare my supplies to notice that what was on the table was incomplete, and realize that the enema bag can not be used as a substitute for the primary bag. Do you think it's right for her to fail me, or do you agree with me that the instructions were so miss leading and confusing, almost like a setup so I can fail again? Should the instructor also be responsible? Sorry if that this message is so long, but I wanted you to have write all the facts.
    You obviously didn't know your stuff. At all. Yes, it was right for her to fail you. Based on everything you said, why would the instructor be responsible for what you should have known but didn't?

    See, this is the exact opposite of what instructors look for in good students. Rather than hitting the books/videos/lectures/skills lab to do better next time, you want to argue that your failure was someone else's fault, thereby bypassing your obligation to learn the information and improve your performance. Given everything you have said here--and you admit that these are "all the facts," it is clearly YOUR fault that you failed.

    I had the exact opposite experience today with my student. I graded her care plan, and she got a 40%. She came to my office, and the first thing out of her mouth was, "Do you have some time to go over the care plan with me so that I know what I did wrong?" We sat for 15 minutes reviewing all my comments, and she ended with, "Now I understand what I did wrong. Thank you." As she left, I stopped her and told her that I had to commend her for her wonderful attitude and desire to learn. I told her, "THAT is what makes a great student." She got a little teary when I said that, and so did I in response.

    Ends up that I decided to allow a revision to the whole group for a final assignment grade that will be an average of the two grades.

    It would behoove you to take a lesson from my wonderful student. Go forward learning from your mistakes, rather than trying to manipulate a better grade when you clearly have not earned it.
  4. by   imhorsemackerel
    I understand how stressful performing skills can be in front of your instructor, and when you're given a time limit, that probably increased your anxiety a bit. You really should've asked to practice those skills so you could've familiarized yourself with the equipment. I understand you have your own life outside of school, but so many other people do as well. Were you the only person in your class to perform poorly? If so, you have to find it in yourself to take ownership of your actions.

    Then again, perhaps some schools may not have the resources/staffing to have their students come practice on their own outside of class time. In this case, you could've asked your instructor if you could've spent a few minutes before or after class to practice.
  5. by   KelRN215
    Yeah, if you can't differentiate an enema bag from a primary bag of IV fluid, I'd say you deserve to fail.

    And if you just make up how much medication you need for an IM injection because you aren't handed the MAR, you deserve to fail. No one is going to hand you a MAR in real life.
  6. by   ItsThatJenGirl
    So why'd you fail the first time?
  7. by   broughden
    Quote from ItsThatJenGirl
    So why'd you fail the first time?
    Grammar and spelling? ;-)
  8. by   KrCmommy522
    It sounds to me like you didn't practice at all. It seems like you didn't know what a lot of things looked like or what to do (e.g., enema bag, using the enema bag as your primary bag, the other vials "seemed very small" so you must not of known which one to choose, not knowing heparin is given subcutaneous). You should have practiced all the things you were going to be tested on. You should have practiced so you knew each step and what all the supplies were. When you went in, even though she said everything that you need in there (as other posters have said, there are many times were you need to go and hunt your supplies down), the instructor could have thought all the supplies were there and just assumed they were all there. Either way, she also told you that you could NOT ask questions once the exam BEGAN, so if you assumed the MAR was in the binder, you should have looked or at least asked if it was, you should have looked at the supplies and made sure all was there and gotten what was missing. Really, the main point here is that the instructions don't matter. But, since that's what you asked - they weren't misleading or confusing. She told you where the supplies were (yes she said they were all there, but it was YOUR responsibility to make sure they really were) and she said you couldn't ask questions once the exam started, so you should have asked BEFORE it started. But, the main point here is that it seems like you didn't practice at all and didn't know what you were doing. It doesn't seem like it was the instructions that were the issue. It seems like your preparation for the exams were what the issue was. Sorry, I don't mean to be harsh. I get that performing skills with your instructor watching is stressful, but that is why you PRACTICE, PRACTICE, PRACTICE so you are PREPARED and hopefully more confident and not as nervous. But, you didn't even know what an enema bag was, and you knew one thing you could be tested on was giving an enema?!!! That is the problem here! NOT the instructions.
  9. by   vanilla bean
    It appears as though the consensus when you posted about this in your first thread was that you deserved to fail (I don't disagree). This is not a situation in which you would be given an incomplete as your grade - you *completed* the course and did not pass. You do not get your money back when you complete a course regardless of whether you pass or not.
  10. by   mrsboots87
    I would have failed you for just about everything you did here. Every nurse knows you need a MAR with orders to administer a med. part of your exam was to administer. That right there tells you you need a MAR. Part of you steps to properly administer would be patient identification and the 5/7/8 however many rights your school teaches for med administration. Also, basic med knowledge tells you that heparin is never given IM unless your intent is to cause a huge hematoma on your patient and risk heavy bleeding.

    You also cannot perform wound care without and order which also requires order verification and patient identification. Same for the tap water enema.

    Tests are for ALL the steps. Not just the actual skill itself.


    And why in the world would you ever hang an enema bag as primary tubing.

    Anything your are tested in is reviewed in class and lab before hand. If you don't know what a tap water enema bag looks like it how to do these skills properly, you should have paid attention in class and studied. The mistakes you made are incredibly dangerous. Mostly because you just acted without knowing what you are doing. At work as a new grad when you get an order for something you've never seen, would you just make it up as you go and hope the patient isn't injured.

    You will be marked as a fail and not an incomplete and there is no refund for failing to study properly for exams.
  11. by   Coffee Nurse
    I am seriously trying to imagine what must have been going through your poor instructor's head as she watched you blunder your way through this fiasco. Even though this was an exam, and even though you were not allowed to ask questions, there comes a point where the professional thing to do is to stop, admit you have no idea what you're doing, and take the hit. In the real world, nurses are faced with unfamiliar equipment, medications, and procedures all the time. We do not MAKE IT UP as we go along, and the fact that you chose this approach -- rather than slowing down and actually thinking (honestly, you didn't even consider opening the binder?) -- only compounds the fact that you didn't know the procedures.

    No, you are not eligible for either a refund or an incomplete. Try taking some responsibility for your own actions.
  12. by   CharleeFoxtrot
    Yes, she was right to fail you as it is obvious you did not study well enough to demonstrate these essential basic skills. Seeing as this is your second thread looking for people to validate your failure as someone else's fault, I suggest you quit trying to fix the blame and concentrate on fixing your issues if you are truly wanting to be a nurse. Because IRL you don't get a do-over or a chance to appeal to a higher authority after you make an error that has the potential to be a sentinel event.
  13. by   Lucydog14
    You didn't know what you were doing and you failed. Why would this qualify for a refund or an incomplete? You need to do the class over and pay attention next time.
  14. by   Horseshoe
    Quote from jbernardo
    On the table, there was some supplies, however, not everything was there, and a thin binder that was closed. During previous clinical exams that I took, I was always handed the MAR so I didn't think to look inside the binder.
    Quote from jbernardo
    However, I kept saying that there no primary bag and the instructor did not say anything. After, I proceeded to give the IM injection and there was three vials that were there so I chose the Heparin since the other two vials seemed very small. Later I she told told me that Heparin is given SC, so it may have been the other two, but I'm not sure. Also, I didn't know how much to give since I was not given the MAR so I just gave 3cc.

    This alone should have been enough to fail that exam. Of COURSE it was one of the other two, because Heparin is not given IM. Your instructor wanted you to look at the MAR in order to ascertain which med to give and how much. The fact that you just chose to give a random dose of a medication without seeing an order or the MAR is so beyond dangerous. It completely baffles me how it did not occur to you to open the binder, which was most certainly where you would have found the MAR. This exercise was also likely testing you on dosage calculations, because you probably were not going to get off so easy as being required to use a whole vial of medication. But no, you gave 3cc of a medication just "because."

    Sorry to pile on, but there really is no other possible reaction when faced with your refusal to accept that you and you alone blew it.

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