Unfair Fundamentals Clinical Testing?

Horseshoe, BSN, RN · Apr 16, 2018

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.

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.

Horseshoe, BSN, RN · Apr 16, 2018

That you would even consider asking for a refund or incomplete based on this scenario makes me wonder if this post is for real, or if you are bored and jerking our collective chains.

elkpark · Apr 16, 2018

You didn't fail because the instructions were unclear, you failed because you made multiple serious errors and clearly didn't know what you were doing. You failed the class, so you're not eligible for an "incomplete" (you did complete the class), and people don't get refunds on tuition because they failed a course. I'm afraid you're just out of luck on this. If you choose to try to continue on into nursing, you need to look long and hard at your own responsibility in this situation and figure out how to avoid the errors that you made this time. Best wishes for your journey!

blondy2061h, MSN, RN · Apr 16, 2018

Your test experience reads to me like an experience someone with no nursing school experience at all would have trying to demonstrate those skills flying by the seat of their pants. Did you go to class? Study? Practice these skills? At all before the test? Usually for skills tests they give you an idea of what skills you need to demonstrate. Have you started caring for real live people yet?

If you think skills testing is stressful just wait until you have a sick patient counting on you to help them get better. And their physician/nurse/lawyer relative next to them in the room.

allnurses Guide · Apr 16, 2018

I remember how stressful skills check-offs are and I remember rehearsing over and over for them to be sure all the little details were in my head. However, skills themselves aside, your errors were of the most egregious sort, given that you didn't perform safety checks, check orders or take stock of your equipment prior to starting. These are baseline things that underline you just aren't getting it. As an educator, the skills are something I can teach. However, if you aren't getting the critical thinking, baseline safety, sense-of-responsibility to the patient portion....that is a huge red flag. I would have serious misgivings about you being near patients.

You won't get a refund and you won't get an incomplete. I am sure this feels very harsh to you, but it is honestly both fair and just. You had the same opportunity as all the other students - those who passed and those who did not pass. Once you reach the testing portion of skills lab, you have been taught already about baseline things that got skipped here.

If you get another chance at this in the future, always take a few seconds before beginning your skills to assess your situation. Remember, the first step in any nursing process is always assessment. If you don't see orders, start moving things around until you figure it out and find them. Then look at what you need to do and cluster together what you will need for each skill so you can inventory whether you have everything. Remember, you don't touch the patient until all these baseline things are in order, you have checked patient identifiers and your brain is settled enough to safely proceed.

A skills check is a mock-up of safe patient care. It is done on mannequins because you are a novice. You have to prove you won't harm the patient prior to getting a chance to perform the skills on a live one. These baseline things matter greatly and will be part of any skill check-off you do. Over time they become something that can settle your mind instead of make you nervous, because they should become completely habitual, knowing if you fail to perform even one of them, you fail the skill test period. In the school I attended, if you began a skill without checking your orders and patient identifiers you'd have been stopped and failed then and there with no opportunity to even show the skill itself. This is important. These things are such that your mind should have known, critically thinking, that you would not be performing a skill in which you have no orders, so they must be there somewhere and to keep investigating until they are found.

That Guy, BSN, RN, EMT-B · Apr 16, 2018

Refund or incomplete? Neither. You deserved to fail. Own up to it and stop trying to find excuses or you will fail again. This is coming from someone who failed a class.

**NICU Guy, BSN, RN** · Apr 16, 2018

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"

No, her instructions were clear. She told you the skills that you need to perform, you have all the supplies that you need, you have 30 minutes to complete the skills, and you can not ask any questions once the exam starts.

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.

The binder was you MAR/ doctor's orders, etc. Why did you not look in it prior to the start or at least ask where the MAR was? How can you be tested on a skill if you don't know what an enema is?

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.

If you practiced the skill, you would have known that the saline wasn't included. You should of asked where the saline was before the test started. This is a skills test. There is no substituting (unless the instructor has stated "We are out of saline. Pretend the peroxide is Saline".)

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.

You are performing a Primary bag skill, why would you think that you can perform a skill without the bag. Once again, if you did not see the bag prior to starting, why did you not say something BEFORE you started? The instructor didn't respond to you because she stated "You can't ask any questions ONCE the test starts."

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.

First, you did not understand that Heparin is not given IM. Second, you never guess what you are giving a patient and the amount. Even in a skills test you need this basic information.

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.

The primary bag and the saline was on purpose and part of the test. You were to be able to recognize that you did not have the primary bag and saline. That is why they were close to the nurses station, but not on the table. Because she did not hand you the binder, instead it was on the table, it was her fault you failed??? Why did you not ask for the MAR prior to the start?

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.

Yes, it was correct for her to fail you. It seems that every nurse that has responded to you agrees.

EDNURSE20, BSN · Apr 16, 2018

You repeatedly said you don't know what an enema is, which is one of the skills you were expected to complete, yet think it's unfair why you failed??? Did you even go to class? Or practise? You were given a second chance to re do this, and you go in not even knowing what one of the skills are. This can't be real!

Meriwhen, ASN, BSN, MSN, RN · Apr 16, 2018

You made numerous mistakes and didn't demonstrate the required competencies. The instructor did not set you up to fail. You set yourself up, and failing was 100% on you.

You could attempt to ask for a refund or incomplete but IMO, that would be an exercise in futility. With regards to a refund, classes have a "withdraw by" date--if you go past that date, you're not eligible for a refund. Since you've completed the class, you're gone well past that date. As for the incomplete...again, you completed the class.

Now you need to decide what to do next. If you really want to become a nurse, then you need to retake this class...and pass it. If you don't want to retake the class, then perhaps nursing isn't the career for you...and that's OK. Sometimes we don't know what's best or not best for us until moments like this.

Sorry if this isn't what you wanted to hear. Best of luck whatever you decide.

KelRN215, BSN, RN · Apr 16, 2018

Do you realize that if you connected an enema bag of tap water to an IV, you would KILL your patient? (I've never seen enema tubing that could fit on an IV but I wouldn't think anyone would try to connect a feeding tube to an IV either and there have been cases of patients dying because of tube feedings infused intravenously.) You deserved to fail. You don't get an incomplete or a refund.

Here.I.Stand, BSN, RN · Apr 16, 2018

How was the enema bag labelled -- as in, what is in the solution? I ask because I have never seen an enema bag labelled 0.9% NaCl, LR, 0.45% NaCl, 3% NaCl, NS w/ 20 mEq KCL or the words "For Injection"...... This is because enema bags don't contain IV fluids. And anyway, the tubing isn't even IV tubing.

And you assumed which vials contained heparin based on their size??? What if the vial contained vecuronium or adenosine or undiluted KCl?? (Look them up. I'll give you a hint: you would want your code button within arm's reach.)

Academic "incompletes" are given when the student CHOOSES to cut his/her losses and withdraw from the class **prior to the school's predetermined deadline.** You didn't withdraw; you failed.

Honestly if this instructor HADN'T failed you, I would be convinced that this instructor is incompetent. She was THAT right to do so.

Crush · Apr 16, 2018

If you can't differentiate an enema bag from a primary bag of IV fluid, you deserved to fail. I am sorry but I cannot get over this one. You even mentioned you did not know what an enema was so you started with wound care. You indicated you have gone through this exam before and still don't know what is expected. Yes, good for the teacher, you deserved to fail.

And if you just draw up at random what you think you need for an IM injection because you aren't handed the MAR, you deserve to fail. You should have asked beforehand about the MAR and/ or looked at the binder. Med errors are serious and not to be taken lightly and guessing dosages is scary.

All you have listed are basic skills. Basic common sense. I don't mean to sound harsh or snarky. I do mean to stress the importance of preparing, studying and practicing. You set yourself up to fail, not the teacher.