First of all, I did majorly bomb that endocrine test. A 63% dropping my test average to 74.3%. That sucks, because I am technically failing; I need a decent grade on exam # 4 and the final exam to get through. However, that's doable and I'm not too worried. But wait, there's more and it gets even worse....
I was at clinical with the new clinical instructor (yes, same one that failed me on skills check). I'll give you a little background on how she's been teaching. First of all, she manages her time poorly. All of our meds and treatments end up being late, even though our clinical site policy leaves us an hour before up to an hour after for administration. In my opinion, there's no reason to be late. Second thing, she wants us to know everything before administering a drug. For example, she's asked me what someone's LFT is before administering 650mg of Tylenol. It drives me crazy. I understand where she is coming from, I really do, but there's just not enough time to do this: she has eight student and thus eight patients.
Well, the problem was this: my patient was due a blood transfusion. I was all excited, because as an LPN, I cannot perform this skill. I was getting real-world practice on an RN level skill. Well between all her questions and running from room to room, it took me 30 minutes to administer two pain pills and some eye drops. The blood had arrived from the blood bank, so there was a 30 minute time-limit to hang it. Since I can't even get a Tylenol administered in 30 minutes with this lady, obviously the staff nurse had to administer the blood so it didn't expire. If I wasn't in the room, I would have had no idea the blood was hung. I was then supposed to administer some low-dose lovenox as prophylaxis for DVTs. That was going to be late too so the staff nurse did it. The staff nurse did nearly everything because she, understandably, didn't have time to wait. Irritated that I had done virtually nothing all shift, I left the floor with the students to complete my paperwork.
However, I get called after clinical by the instructor. Apparently, I was supposed to do the q15 minute vital signs on this transfusion. No one asked me to; I guess it was just assumed I was. My instructor was nowhere to be found. I had no part in hanging the transfusion, no it's only natural that the person who hung it in this situation would take the v/s or at least delegate them to assistants.
Nope... totally my fault for not doing it. And I technically didn't report off to my nurse. I'm actually in trouble for not reporting that there was nothing to report. With all the stuff the staff nurse had to do, she should have reported off to me; I actually didn't do anything except an assessment, two pills, and some friggin' eye drops. The only reason I didn't formally report off was that the staff nurse was better informed of the patient's condition than I was because the tasks I was supposed to do had to get done by her so they weren't late.
What can I do? I dunno... I wrote a journal entry stating that I could improve my communication skills. Maybe I'll get off the hook with that. I just hope whatever gets done it doesn't boot me out of the program. Anyhow, I have to meet with her later so I'll post up what the resolution is.
Interested to know... what do you guys think? If you are a nurse, and you hung a transfusion, and you patient had a student, would you assume the student was going to take the q15m vitals without ever asking them? I can see where better communication on my side could have prevented this, definitely, however I don't feel the blame falls squarely on me because of two simple reasons:
- My instructor should have been present so I could have hung the blood. Crisis averted.
- The staff nurse should have asked me to check vitals. Crisis averted