Today I made a big mistake.

loriangel14, RN · Apr 2, 2014

clearly loriangel14 has never ever made a mistake in nursing school ever.

Hey i didn't say it was fair. Dismissal is a harsh out come. But I have seen it happen.

ReOxyS · Apr 2, 2014

Well, OP, how did things shake out?

silverbat · Apr 2, 2014

OK, I am also confused... When you say this "is your second clinical", do you mean it is the second day or rotation of clinicals in this semester, or do you mean it is your second try at clinicals, thus implying you failed once before?

If its your true second.. I would think you would be scared to death of making a mistake and hardly moving without the instructor by your side, so no way a mistake could be made. If its your second try at clinicals--what happened the first time, and have you learned anything? and i would think you would still be scared to death to make mistakes....

mrsboots87 · Apr 2, 2014

This may sound harsh, but I just don't understand how you can "forget" you need an instructor and that they weren't there? Some programs allow students to admin meds alone with instructor approval and some don't, but they all make their expectation clear as to which type of program they are. And secondly, how does a patient recognizing their med in any way mean it is ok to give it? The reason our instructors check is because med errors can kill people. Especially with a drug like Lovenox. As long as we are safe and following the rights, then it shouldn't happen, but it could. I don't necessarily feel like you should be kicked out of the program over it, but you should definitely have some remediation. A patient recognizing a their meds and talking you into giving them without your instructor is worrisome. What if a patient says they always get a narc at lunch, would you give them that too? I;m not saying you would, but that statement is along the same thought proves you used in not waiting for your instructor. And if an instructor is supposed to be present for the med admin, how did you even get your hands on the meds? I would think they would watch all the steps and not just you giving it to the patient. Weird.

nurseprnRN, BSN, RN · Apr 2, 2014

The thing that most students don't realize is that in clinicals you're working under your instructors license. The are responsible for the care you provide to a certain extent.

A very common misconception but completely untrue, no matter what they told you. Students have clinical placements based on contractual agreements between the school and the facility. Students are well-aware of the scope of practice they have (for example, in this case, "Students can't give meds unless the instructor is present.")

IF an instructor directs and supervises a student in an action that is outside of the scope of practice of that student or that nurse AND harm results, then action may or may not be taken against the nurse's license, depending on many factors. Loss of license is reserved for very serious things, not just "mistakes" such as most students make from time to time.

A student does not practice "under" an instructor's license. Students are adults and responsible for their own behaviors. A student practices under authority from the college, and has the responsibility not to exceed his/her scope of practice as a student. A student can lose his/her position in the college by making a serious enough mistake (the kind that makes you just slap your forehead and say, "What the fresh hell were you thinking?") or repeatedly makes lesser mistakes on things s/he should have mastered already, with no awareness of how that's a problem. But these things do not cause action on the instructor's license, no.

Lev, MSN, RN, NP · Apr 3, 2014

Did you check the BP before giving the bystolic? What was the HR? What if something happened?

marie.rn2419, RN · Apr 3, 2014

I have seen nursing students that were dismissed from their programs for far less... Regardless of your chance of winning, APPEAL IT. Although your appeal may not be successful, I think it is very important that you put your explanation on record with the program, in hopes of being considered for re-entry or acceptance to another program.

Rather than arguing that the patient recognized their medication right away/encouraged you to administer it, it is very important to take responsibility for your mistake. From the nursing program's point of view, you are a student (not a professional; limited experience). You are not legally capable of assessing the patient's capabilities, mental status or medical knowledge. The patient is not the authority; the patient is under your care. First and foremost, we are responsible for ensuring their safety.

akulahawkRN, ADN, RN, EMT-P · Apr 3, 2014

Every program is different and every situation is different. While I can't say what your program will ultimately do, the fact that you administered medications to your patient without your instructor is very serious. In my program, our first semester students do not ever give meds without their instructor present. Our Second Semester students can give only certain meds after they have been checked off by their instructor. Our Third and Fourth Semester students can give lots of medications on their own, but administration of certain medications or medications administered by certain routes must be observed by either the instructor or the patient's primary RN. It is up to each student to know what they can and can not do without supervision and be able to communicate that to the nurse they're working with.

At my program, what you did might not result in dismissal, but it would certainly put you very far down the disciplinary process and close to dismissal. Patients take their own medications at home all the time. The problem is that this is not home and they're not administering their own medications to themselves. While I'm reasonably sure that no harm came to the patient, had this been a different drug, this could have easily resulted in harm, and possibly death. You're too new to be able to give medications on your own.

I'm about to graduate from school and many of the drugs that I can only administer under supervision are available to me. Could I administer them? Sure. Those drugs are available. It's very, very tempting to do it without supervision. Guess what? I don't administer those drugs, even though it slows me way down at times, because I respect and follow the scope of practice that I have to work under. I'm also licensed as a Paramedic and I'm very familiar with giving medications by pretty much all the routes without supervision. You might be able to imagine the irritation that brings and I very much recognize that if I were to administer the drugs entirely on my own, I'd be able to do the med pass much more quickly. I don't use those other routes without supervision. Why do I make sure that I follow the rules and respect the scope of practice that I've been given? It's because I'm not about to jeopardize my upcoming graduation, my future license, nor my school's standing with that hospital.

In a way, it's a test to make sure you won't exceed your scope of practice if/when you become a nurse.

I don't know if you will be dismissed from your program and I don't know if you'll be allowed to return to the program if you are. What I do know is that if you don't recognize, own, and correct the behavior, you likely won't be allowed to proceed further in the program. I know that around here, if you're dismissed from any nursing program, you're usually ineligible to apply to another one for several years. The nursing programs in your area may or may not have similar policies.

You're in for some serious self-reflection and you're going to see how even some very seemingly innocuous things can have some very significant impacts upon your life.

I wish all the best for you no matter what life throws at you in the future.

amygarside · Apr 3, 2014

Just be true to yourself. They will understand it. :)

duskyjewel · Apr 3, 2014

Just be true to yourself. They will understand it. :)

This sounds like a line out of a storybook. This is not how real life works. She very well could get kicked out and the school would be within its rights. Once you get out into the world and start working, going to school and building a career, you have to grow up.

allnurses Guide · Apr 3, 2014

Just be true to yourself. They will understand it. :)

They will absolutely understand that poor judgement was used that jeopardized the safety of a patient.

Is that what you meant? Spot on.

HoosierJumper · Apr 5, 2014

I too am a little bit confused on how you received the wrong medication. Even if she were to be able to get her own medications, how did she know what med to pull? Regardless, the 6 rights of medications ( Right documentation, time, dose, route, patient, and medication) was not used! Like the others said before, appealing and explaining what you learned from the situation would be a good idea. Also writing a letter to the unit wouldn't be a bad idea either . I hope everything turns out good for you though. I heard about only one other med error happen. it was not in my college. The instructor and nurse both verified the med. Turns out the nurse the shift before wrote it in the wrong spot (this was awhile back when computers were not widely used) and blood pressure medication was given at 0600 and 0800. The student did not get in trouble, but it was a big deal. Lesson learned that its better to check yourself than to trust someone else. Let us know what the turn out it!