On  April 23, 2012 I had the opportunity to work one on one with Anthony to further assess his clinical skills and give him the opportunity to repeat his medication pass which he failed on April 16th due to being unprepared and not researching his medications..  Below I have listed several of my concerns  while working with Anthony throughout the day.
1)	While watching Anthony perform a physical assessment, he told me he could not hear the heart beat after listening for about 20 seconds..  I walked over, listened to the patient without difficulty and discovered Anthony had his stethoscope turned the wrong way.
2)	Anthony was counting an apical rate prior to administer digoxin.  When questioned about the rate, he stated he was not sure but thought it was 62.  The heart rate was 84 and irregular.  Anthony listened again and verbalized he also counted the heart rate of 82. I did instruct him not to listen on the sternum and redirected him to the 4th to 5th intercostals space MCL.
3)	Anthony was assessing his female patients sitting in a chair while kneeling down in between the patient’s legs.  I instructed him that this positioning was inappropriate and his assessments should be completed while the patient is in bed  and pointed out that this positioning may make female patients uncomfortable and  that placing his knees on the ground is unsanitary.
4)	Anthony did not obtain a blood pressure prior to attempting to administer verapamil despite being questioned if he needs to do anything else  before administering the medication.
5)	Anthony could not verbalize why his patient was on Keflex
6)	Anthony did not change the IV tubing for his patient despite being told to do so.
7)	Anthony did not assess his patients right hip despite having a week old hip fracture causing pain.
8)	Anthony’s patient was short of breath and verbalized such.  This patient had been on BIPAP throughout the night.  Anthony did not listen to her lungs after her report of feeling short of breath or obtain a pulse ox until told to do so.  At that time it was 85%. He did not tell his sub-assigned until prompted to do so. Patient was then placed back on BIPAP.

As discussed with Anthony and Mrs. Barush, I do not feel Anthony is performing as a Level 4 student should. I am concerned over his anxiety and inability to function in the clinical setting.

                                          Jodi Olenginski BS, RN

