Why do they have to give you an "F" for failing final compentencies?

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In my Assessment class we have a final up to forty five minute compentency which we must pass or we fail the course (even though I have a 90% average on my written exams). Now I can see not allowing me to progress without passing the compentency (which is a C or 78%). However, why hold an "F" over our heads? What would be the harm in giving the lower of a C- or your current actual grade in the class (even a D- would work). After all if I was scoring a 77% rather than a 90% I couldn't "pass" the course, but would still get a "C-" rather than an "F". In my case failing would probably mean losing my house, car and utilities in Jan because I wouldn't receive financial aid due to failing the course (and therefore not having full time status the previous semester as required. I would work overtime, but it would probably be too little and late to avoid foreclosure since we will be running 30 days late in December anyways).

There are a few things on the test which no matter how much I study I still might fail (it's not likely, but there is probably a solid 10% chance of not getting it under final conditions). For example I often have trouble locating my large partner's femoral pulse (the instructor verifies that we've actually found the required pulses by feeling where we place our hands). Furthermore, I have trouble distinguishing vesicular, from bronchovesicular sounds on the posterior chest. In addition, I have trouble "counting S1 and S2 out loud" especially at the Aortic (2nd ICS, right sternal border), and the Right Atrial areas (4th ICS, right sternal border) in my larger partner (he's a 235 pound, thickly built body builder, but not real lean yet). I also have difficulty palpating the systolic blood pressure, because I can barely feel his brachial pulse (although I generally do fine on the auscultation) Any one of these issues could cause me not to pass.

The other issue with this type of "exam" is that everyone has a different "difficulty level". Consider, that I weight 270 pounds and am an even more difficult patient for him, that he is for me. It doesn't seem fair that either of us could fail out for failing some clinical skill when the average student is maybe 19 and weights maybe 135 pounds. It would be like giving some students a written test that was much harder than others, which is almost never done. I realize of course that in the real world we will sometimes encounter difficult patients (who are frail, obese, or otherwise difficult), but it generally won't be a one shot pass/fail situation where we are not afforded any assitance. Furthermore, it generally won't be for not being able to palpate (which is almost never done clinically) blood pressure, or to distinguish vesicular/from bronchovesicular sounds, or for not being able to count S1/S2 out loud.

Also, let's say that I fail out, but still want to be a nurse ( if I fail it will be on something like failing to properly palpate the systolic BP, failing to find the femoral pulses, or improperly counting S1/S2 or mis identifiying vesicular verses bronchvesicular sounds). What would be my best path "back in". One option that I've considered is to try to find an LPN program or even a diploma program that would take me. Then after a couple of years reapply to one of the University RN/BSN programs. I am unusual in that I really struggle with the "physical skills" rather than the academics. Even in my job as a CNA/home health aid I find that things like dressing/undressing clients to be difficult. Furthermore, changing "diapers" with gloves on is a real challenge (seldom do I not rip out the tips).

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Specializes in L&D.

Have you been to a website that differentiates the breath sounds? http://www.rale.ca/Recordings.htm (try this one)

Maybe that would help you to tell the difference. How will the instructor know if you are really hearing what you say you are hearing??

Also--have you thought about making a pen mark where your partner's femoral pulse is? Find it earlier in the day and make a mark. They are letting us do that for our assessments--I will mark exactly where I can elicit the DTR's, the liver span, and the PMI. Maybe that will help you, too. Then you can take your time finding it and don't have to worry about being under pressure.

Good Luck!!!!!

Leslie

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I have listened to the breath sounds offered on our student learning resource web site and will do so again before our examination next week. They can tell because they listen with dual scopes to EVERYTHING that we do. In addition, when we are attempting to palpate the the systolic pressure via the brachial artery they are feeling at the radial pulse to see if the pulse goes away where we say that it does, and conversely comes back when we say it does.

Also, we were told that "marking" pulses is considered cheating and in our program they will try to not only remove you from the program, but also the University for cheating. The darn thing is with the brachial and femoral pulses I can "have" them one second, and lose them the next. I'm not sure why since unlike the radial or dorsalis pedial pulses you cannot easily obliterate blood flow. Honestly, my difficulty with pulses makes me wonder if I might not have some periphial neuropathy from very early stage diabetes going on (I'm only 35 and have never been tested for diabetes, but I have gained a 100 pounds over the last ten years, and my dad developed Type II at the age of 65 so it's not out of the question).

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Specializes in LTC/Behavioral/ Hospice.

You are not allowed to palpate the radial pulse for the systolic? It says right in our Foundations book to palpate the radial if the brachial is difficult to find. I just finished the vital signs competency and I located the radial. Are you given a time limit on finding the femoral or brachial pulses? These can be extremely difficult pulses to find. I bet that if you have a difficult time finding it, your instructor will to. Can you ask for a different partner for competencies? We were allowed to pick our partner for it. I went in with 3 other students because my pulses were so easy to find. :chuckle I felt like my arm would be permanently numb that day. :chuckle Anyways, my suggestion is that you bring these issues to your instructor and ask her for her help in problem solving this. She must know how difficult it can be to find these pulses. Maybe she can give you some tips or make an exception and have you switch partners for competencies. Good luck! :)

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Specializes in Critical Care/ICU.

Wow. This is what really bugs me about nursing school. Aspects of the educational process is so unlike the real world. I mean, of course it's good to know all of this stuff, but are they training your class to be vascular nurse experts or something? I keep trying to think of the critical thinking that might go into being able to find and palpate all of these pulses, but I can't.

Counting out loud? Is the evaluator listening at the same time you are?

Practice, practice, practice!

I remember skills testing. We too had to pass with 100%. The stress was incredible.

You'll make it in spite of the obstacles your program presents!

Good Luck!

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1. We must use the partners that we are assigned.

2. We get 45 minutes for about five pages of skills, and evaluations covering pretty much all systems head to toe.

3. We must palpate the brachial not the radial arteries for the blood pressure. The instructor is verifying our results by feeling the radial.

4. We must count S1/ S2 out loud while the instructor listens with a dual scope. This must be done at the Aortic, Pulmoic, Erbs, Right Atrial, Tricuspid, and Mitral locations. We must state whether or not S-1 or S-2 is louder at each point.

5. We must distinguish bronchovesicular from vesicular at each ausculatory point on respiration. According to our text none of the points in which we auscultate should (on average) produce bronchovesicular sounds. However, they seem to think that we may (should) hear bronchovesicular at several of the locations (which the book indicates normally produce vesicular).

My biggest peeve is that if we fail we can't "fail" with a C- (even if we have an A or B in the class). We have to fail with an "F". On the other hand those students who fail the lecture (by not getting a 78% on the written exams) actually earn the grade they get (although they don't pass the course high enough to progress). It's the "F" that threatens to end my college career, and terminate my financial aid. To put it another way if I cannot palpate the femoral, or miscount S1/S2 (the most common error being to run over into the next pulse. Imagine what MY partner is facing since my pulse commonly pushes 100 on these exams!) I get a much worse grade despite having a 90% in the class, than someone who has only scored say a 74% on all of the exams but who passes this comp (who earns a C- which although not high enough to progress counts towards their financial aid and other University requirements.)

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good luck to you on your exam...

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Specializes in Med-Surg.

Good luck Roland, you'll do fine I'm sure.

It would be heartbreaking to fail competencies while making such a good grade in the classroom. But competency in patient care is what it's all about. One should not progress if one can't do the hands on care, no matter how book smart they are.

Again, good luck. Let us know how it goes. :)

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Thanks, for the encouragement 3rd Shift. However, I still don't understand the logic in assigning an "F" when I have earned a B+ in all facets of the class for which a grade is assigned. Why not just give me a C- (you need a C to progress to the next nursing class) or even a D- for that matter (which would still count towards my financial aid and allow me to reapply to the nursing program or pursue some other degree option). As I indicated above a student who only obtained a 77% in the lecture would not progress (it takes a 78% to get a "C" the minimal passing grade) BUT would get a C- for the class. However, if I can't find the femoral, or miscount S1/S2 I will lose my financial aid and probably be out of school, and will probably lose my house to foreclosure, and my car will be repoed (did I mention my wife may very well leave me and take my son as well?)

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Specializes in jack of all trades, master of none.

Damn, my heart goes out to ya... Our competencies were pass or fail... no in between, no matter what your class average was...But, my instructors were not as anal as yours, & as for marking pulses... how is that cheating, I do it all the time, if I have someone that needs a doppler for pulse checks.... Saves everyone time in the long run.... Maybe the video tapes would be of help, or online stuff.... it is everywhere, type in a search for breath sounds, & heart sounds... You are sure to come up with something.

I hope you pass, for your sake...(P.S. Your wife sounds like my brother's wife....he's having troubles with his physical after being in the navy for 14 years... she is making the same kind of threats... So I really feel for you)

Good luck

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Roland, you are obviously a smart, skilled, conciencious nurse and you have the ability to do fine on the exam! My suggestion is to stop obsessing on the unfairness of it all and just get it done! Affirmations really work! When you find yourself dwelling on the numbers, force yourself to stop and begin thinking about all the skills you have! The only one who can stop you here is yourself!

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I practiced with my partner today for about six hours and feel somewhat better. I'm still shaky at finding his femoral pulse (and occassionally his brachial, but I can usually bring that one into focus by hyperextending his arm).

I'm almost at peace with this whole process. I've done my best and either it will be good enough or it won't. Should I fail I will simply work extra hours to keep the house/car. Then maybe, I will go back to school and get my LPN (with the goal of progressing to another RN program eventually). The universe will continue to expand and God's WILL, will ultimately prevail. In any case my main goal is to be a good husband and father, and no compentency no matter how high the stakes can determine that outcome.

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