The original assignment for Monday, September 27, 2010 was created on Saturday, September 25, 2010 and posted on the unit\'s bulletin board behind the 6CS nurse\'s station.  Due to low unit census, the students were each assigned 1 (one) patient for prep completion.  It was clearly written on the assignment sheet that the assignment would be subject to change on Monday morning.

The students were advised to pay close attention to report on all of the patients in their assigned section. After the students listened to the taped report with the nursing staff, I assigned each student 2 (two) additional patients to care for (a total of 3 patients) as the patients were alert, oriented and self care or AM care had already been provided by the night nursing staff. There were 2 (two) students who did have only 2(two) patients each as it was there first full clinical day on 6CS following their PEDS rotation. I personally informed each student of their additional assignment.  Their revised assignment was displayed in a conspicuous area on the unit\'s bulletin board behind the 6CS nurse\'s station and each nurse was advised of the revised assignment.

I accompanied the student, Jessica, into her three assigned patient\'s rooms to evaluate the her assessment skills (as I had with all of the other students in the clinical group).  During the first assessment (a new post-cardiac catheterization patient, the patient stated \" this is the first time this has been done today.\"  Upon completion of the assessment,  I advised Jessica of the need (and rationale) for early and frequent assessment of post-cardiac catheterization patients.  Jessica verbalized understanding.  All three patient assessments were completed with the student.  Jessica at no time offered any questions or concerns regarding her assignment or her assigned patients. 

I observed the student frequently sitting in the nurse\'s lounge working on what appeared to be charting on her assigned patients.  I also observed that Jessica was not available for her assigned patients when their call lights were ringing and when they were being transported off the unit for testing.  It was necessary for me to reposition and set her patient up for breakfast, and to request that she make her patient\'s unoccupied bed while he was off the unit for testing.  On numerous occasions Jessica\'s assigned post-cardiac cath patient was found ambulating independently to the bathroom and making her own bed before it was safe for the patient to engage in such activity. 

At the end of the clinical day, the student provided only 2 (two) patient charting flow sheets which required a significant amount of assistance and prompting from the instructor.  When questioned about the third patient, Jessica stated that she did not know that she had a third patient and that she wasn\'t sure why we had assessed the third patient. Jessica stated that she had not went in to see the third patient at all during the clinical day. At no time during the course of the clinical day did Jessica question why we had assessed a third patient.  All other students in the clinical group were aware of their assignment and completed all tasks associated with the care of their patients.

Prior to leaving for the day, I asked Jessica if she had reported off to the sub-assigned RN, charted vital signs and I & O\'s in her assigned patient\'s charts.  Jessica responded affirmatively and left for the day.  Upon soliciting feedback from the nursing staff, I was advised that Jessica had not documented the vital signs, glucoscan, and I & O\'s in the patients charts.  I was also advised by the sub-assigned RN that Jessica did not spend an adequate amount of time interacting with her assigned patients.  

   