Put On Probation for Clinical

[luv2shopp85]

Last semester I was put on remediation for my clinical behavior, not being professional enough and not filling out paper work adequately. SO then I started this semester and I thought I was doing good. We had our midterm evaluations last week and I found out that I was put on probation because I didn't meet the same 2 objectives again but for different reasons. I always do my paper work and make sure its done correctly, and I'm doing a lot better on the professional thing.

I think I made a big mistake of telling my instructor that I was on ADD... i feel like she was always looking for me to make mistakes and didn't expect much from me and expected me to mess up. I was having trouble second semester with my meds and all that but I got that straightened out over Easter break and then now I feel like I"m doing a lot better.

I got a letter in the mail today and this is what it says:

Objective 2- unsatisfactory in regards to self directed behavior and identifying your strengths and weeknesses. Now last semester I was told I wasn't confident enough and second guessed myself too mcuh. Now my instructor ttold me that she thinks I"m too confident or something. I just don't get it.

Objective 3: Continue to demonstrate problems with transferring theory to clinical. I always end up with easy patients like all the time. SO when I get a hard patient I have trouble transferring theory I Guess? The first two semester I never had to do IV meds and this semester I've had to quite a few. Sometimes I get confused when theres all these wires everywhere and I don't know where to hang the IV. Its confusing because I've never dealt wtih it before. I even went back and looked at my IV notes and I didn't find much on them. Theres so many different ways to give IV meds it just confuses me! I'm a student so I think I should be able to ask for help right? I alwyas look up my meds and know everything about them... I just get confused when giving IV meds.

We learned about Isolation first semester but I never had a patient on it until 3 weeks ago. They were on contact isolation so I wore a mask gown and gloves to go into the room. One time I was going into the room just to ask if the medication was effective and I asked one of the nurses if it was necessary to put everyhting on because I was just going in and out and she said yes. Then apparently she told my instructor that I asked about that and I got objective not met for that week. WIth teh same patient my instructor and I were having trouble injectiing a med into a triple lumen my patient had because there was a clot so my instructor told me to go get the nurse. So I walked out of the room about 10 feet to get my nurse. Then the same nurse who told me no about going into the room not fully dressed said you cant leave the room like that! Okay, soi I learned my lesson and its not going to happen again. I'm a student so shouldn't I be allowed ot make mistakes? Thats how you learn right? Its just so frustrating. And I know this nurse was always watching me every day and telling my instructor about things I did wrong, NEVER what I did right.

So I guess I'm going to drag all my books with me to clinical to make sure I never make a mistake and do great patient care. My instructor also said that I show her I know what to do when I do my mini maps (care plans) but she doesn't see me actually doing the stuff that I say I do. I dont really understand that because I do it. Sometimes when I go home and look at my care plan book I'll see stuff in there that I should have known to do but I Didn't do it.

I hvae to make an appointment to meet with the dean of the school of nursing about all this. I never told her about my add, should I? I Just feel like it will be held against me. I know that I need to meet the same standards as everyone else and I'm not trying to use it as a cop out.

I have a new instructor now for the last 4 weeks of school and I have to get all my objectives met or else I will fail and have to repeat this semester next year. Does anyone have any ideas or suggestions for me? I'm really worried about this and I don't want to fail!

[DEE 2006]

first you need to take a deep breath! slow down a bit. if your are feeling like that nurse was watching you and going back to your instructor then you need to foster a relationship with her. ask her to help you out when trying to figure out all the lines. to give you some pointers when caring for this patient etc... then Never put something on the care plan that you do not intent to do, review it often to make sure you ARE doing what you said you will do and review it agin when you are documenting the care given to make sure you documentation reflects what you did, you might want another student review your documentation as we often do not catch our own mistakes. The fact that you are ADD should not matter but YOU do need to learn to focus, and carry out patient care systematically with one patient or you will never be able to manage several patients at a time on the floor. and finally pick one care plan book and make it your bible. individualize the plans DO NOT use verbatum from the book unless you can verify it fits. And do not address problems that you can not do something about.

[Daytonite, BSN, RN]

I can give you some ideas about the IVs and IV meds. When there are a lot of IV lines, the best way to ferret it all out is to actually put your hands on the IV tubing and run your hands along them to see where they go. So, if you know you are going to do a direct IV push of a medication and you want to inject into the port that is closest to the IV site you can start at the IV site and trace the IV tubing backwards. Once you hit the first Y-connection, continue to trace the tubing backward by actually touching it with your hands to find out where it starts.

I can't tell you how much of my time I spent untangling IV tubing. Between the patient and other employees twirling the IV poles around it's a wonder anyone can tell what is what. IV piggyback tubing shouldn't be hanging more than 24 hours, so piggyback lines older than 24 hours should be disconnected from the mainline and thrown out. I've also worked in places where we were supposed to put new tubing on each piggyback, so the only IV lines were the ones on the mainline bag. Any IV bags and tubing that are old (24 hours is a good time limit) and just hanging there doing nothing should be discarded. That solves a lot of the tangled line mess.

I'm sorry you're having the other problems. I really am at a loss as to anything to tell you about that.

[firstyearstudent]

Regarding IV piggyback, one of our instructors makes a big deal about making sure the med is compatible with the solution (I think you can check this is most drug guides).

[clemmm78, RN]

Regarding IV piggyback, on of our instructors makes a big deal about making sure the med is compatible with the solution (I think you can check this is most drug guides).

Well, this is an important issue so I would hope that the instructor does do this. Putting a med in an incompatable solution could cause serious injury.

As for the other issues from the OP, is there any way you can have a meeting with the instructor to go over the comments? For example, the one about confidence. If you could explain that you were trying to correct an earlier impression, this could help the teacher to see what you were trying to do.

All I can say is that if you want this, don't give up. I'm sure I have undiagnosed ADD and I failed a clinical in nursing school.

It was my fourth semester of 6, peds. The teacher told me that I wasn't empathetic enough to be a good nurse, that I didn't and wouldn't have the necessary skills. At one point, she told me that I had a nursing assistant mentality. That was, in her opinion, a huge no-no. I think she meant that I was being too task oriented rather than goal oriented. However, since I feel nursing assistants are an incredibly strong part of our team, I told her that I didn't consider that a bad thing. :chuckle

Anyway, I dropped out of the program, worked in an office for a while and then a year or so later I decided that I *did* want to be a nurse. So, I went back. I completed the program and despite the instructor's dire predictions, I turned out to be a pretty darned good nurse. I've worked on the floors, in the units, as a supervisor, I've taught and I've managed. I'm now working as a medical writer and I still work clinically PRN in palliative care.

So, to that nursing instructor: