Set up to fail clinicals

[Nurse Beth, MSN]

Dear Nurse Beth,

I retook my clinical exam and 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.

My friend 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?

Dear Is Instructor to Blame,

I've always thought that this manner of testing is nerve-wracking because it's used to immediately fail anyone who misses even one step or does something out of sequence. Like you said, it can feel like a setup to fail. There are some programs where this kind of clinical test is the culminating exam of the entire program, and it seems too much weight is given to just one exam. I wonder what the pass rate is in your school, and if it is a for profit school.

At the same time, you made some serious mistakes, and if I had observed you, for instance, giving heparin IM, I would not have passed you. Were the instructions unlcear? Perhaps, although you do not give a clear example of an unclear instruction. Maybe it was more a matter of incomplete instructions combined with you not reading the cues. A binder on the supply table should have prompted you that this was something you would need/use during the exam.

It's natural to feel angry when you feel you were not treated fairly, especially when this is so fresh. Ultimately you'll realize that hanging on to the anger will only hurt yourself. The school is not going to reverse their decision, so it's best to put this whole situation in your rearview mirror as soon as you can.

Moving forward, I would enquire about pass rates and testing methods when choosing a school. Low pass rates can indicate that the students are not adequately prepared to test.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[AnxietyMaven, BSN, RN]

The professor is absolutely not to blame. The OP violated the rights of medication administration x3.

Heparin isn't IM, but SQ (wrong med, and the med given the wrong route)

And OP guessed at the dosage, and meds to be given since OP couldn't find the MAR. (Wrong dosage)

My clinical instructor would have failed me for just that alone.

[riggy3, MSN, RN]

Dear Setup

Maybe prior to the exam the instructor should have given clear expectations and an opportunity to ask questions if something was not understood. I am unclear what term you are in? There is reference you did other clinical exams.

You mention a " thin binder " was there but do not look in it. Was this information similar to what we would find in a patient chart ?

I see a few serious deficiencies quoting from your story. "I also did not know what the enema was " .....

"I assumed the enema bag is what I should use because it the only thing that looked similar to the primary bag." .....

"Also, I didn't know how much to give since I was not given the MAR so I just gave 3cc."

Reading your story makes me ask what kind of preliminary Clinical Lab skills training were given to you? There is something wrong or missing from your story about prior instruction.

As you describe you were never told what was expected in this exam?

You said this is the second time taking the exam?? If this is the second time you were poorly prepared to retake. Did you practice these skills ?

You did not know the difference between an enema bag and a primary IV bag?

You gave medications without even knowledge of what it was or a dose.

I would have stopped you to immediately fail you.

I am a pretty liberal clinical instructor. I am sorry to say while I see some possible missing information from the professor. You were totally unprepared and should be failed

[caliotter3]

I thought this situation was the topic of a lengthy thread recently. There were plenty of responses, but apparently not what the OP was looking for?

[Rose_Queen, BSN, MSN, RN]

I thought this situation was the topic of a lengthy thread recently. There were plenty of responses, but apparently not what the OP was looking for?

This was originally posted last month, so maybe the member who posed the question posted their own thread as well?

[retiredmednurse]

Title of Thread: Failing second clinical twice.

I agree with riggy3, MSN, RN and his comments above. Seeing your story I see so much wrong. Did you do or at least state the simplest stuff such washing you hands and introducing yourself to the mannequin? One should always think of the mannequin as a real person. Did you check his name band for right patient?

If you had looked, the binder was probably being used as the chart including the patient's name, doctor's orders (fake, but taken for real), and the MAR. It may also have included a med sheet on the IV med for compatibility and a copy of the hospital procedure for the enema for reference. Without a MAR, how did you know if the time was correct to even give the med?

Regarding the saline enema, if you had given the enema before you were stopped, did you remember to expel the air from the tubing before administrating? Did you give the "patient" any instructions? Did you voice for the tester how far an enema tube should be inserted? And what can be some of the complications, such as not being able to insert the tube, and would you then verbalize that you would stop and check your hospital's procedure book or call the MD?

And when you gave the heparin, you mentioned you gave "3 cc". Depending on the concentration of the heparin, it easily could have been a lethal dose.

I realize that I may sound harsh to you, but look at the school's point of view-they need to make sure you do know what you are doing for your patient's safety and your sake. Believe me, a mannequin is whole lot easier than a living and breathing patient. Go back and ask the tester what you missed or failed to do. This will help you next time and will remind you when dealing with actual patients. You won't forget the next time. Good wishes.