Here's the situation...

Suppose you're a new nurse and, at start of shift, you're assigned to patients with illnesses/post-op procedures/diagnoses/etc. that you are very, very unfamiliar with (or, worse, you haven't even heard of these conditions before).

It's start of shift and the rest of the health care team is busy organizing for the day which means they probably don't have time to help you. How would you best proceed? Remember, you're a new nurse and not a student any more so that means...no preceptor to run to and you're on a busy unit.

I know it's a general question so, I'm not expecting specific answers but it's a situation that is bound to happen to nurses at some point.

I was actually asked a very similar question during an interview (I JUST graduated, which is why I'm posting in the "student" section). I had difficulty answering this question and, even after coming home, I'm still not sure.

What might be an appropriate "job interview" answer? Would you do a quick Google search before you saw your patients? Request a change in assignment (not always possible)? Any comments/thoughts with rationale would be much appreciated.

Thanks.

The nurse you get report from should be able to give you some information. Occasionally it happens, a patient gets admitted with a diagnosis (or has a chronic condition) where your response is "UHhh, what the heck is that?" The previous nurse should be able to fill you in a little, and then when you get a chance, you look it up on the internet.

I always ask wikipedia. It typically has the best, most comprehensive information, with links at the bottom to other pages and the references. I've seen our newer docs/NPs use wikipedia, too.

The hospital I do my clinicals in has older nursing textbooks lying around - in an interview, I would respond that I would refer to them for the patho-phys and nursing interventions. When getting report from the nurse, I would ask him/her to briefly explain the condition if I were unfamiliar with it. I would also Google it and use a reputable medical website for a quick run-down prior to meeting the patient.

If you're going to use wikipedia, just use it as a starting point. If you're reading a page and you see an edit button, think about it: any clown on the whole planet could have just inserted factual errors right before you clicked on the page.

The correct thing to do is to refuse the assignment, since you are not safe to care for these patients. (This is probably the answer they were seeking.) Patient safety is always number 1! If you must, call the nurse manager to come to the unit to straighten things out, but do not accept care for these patients. The shift assignment needs to be re-arranged with a group of patients more appropriate to your level of skill and expertise. At the very least, another nurse should be assigned to be alongside you to help you with the unfamiliar skills and the intricacies of the patients' medical diagnosis. What you don't know can KILL your patient. (For instance, you never give a child with a cyanotic heart defect and corrective shunts high-flow oxygen - it can kill! If a child with Tetrology of Fallot, for instance, starts turning blue or purple, instead of giving O2, you push the thighs/ knees up to the chest.)

As for consulting Wikipedia... bad idea. This is not a scholarly source, but one that literally anyone on the Internet can edit or add to... full of inaccuracies. Trust me, they will not be impressed at all if you give this answer. http://www.msnbc.msn.com/id/17740041/

Wikipedia is a great resource that is probably more up to date and reliable than most textbooks. True, anyone can edit. However, the self policing on wikipedia is amazing, fast, and accurate. Frankly, anyone can write a book, too.

However, I would like to amend my previous statement. I would not state I would reference wikipedia in a job interview. I would say that I would ask the previous nurse, check the H&P, and use the available unit reference. Most units have multiple texts available, and some even have online resources for staff (our hospital has it, but only the physicians have passwords).

The correct thing to do is to refuse the assignment, since you are not safe to care for these patients. (This is probably the answer they were seeking.) Patient safety is always number 1! If you must, call the nurse manager to come to the unit to straighten things out, but do not accept care for these patients. The shift assignment needs to be re-arranged with a group of patients more appropriate to your level of skill and expertise. At the very least, another nurse should be assigned to be alongside you to help you with the unfamiliar skills and the intricacies of the patients' medical diagnosis. What you don't know can KILL your patient. (For instance, you never give a child with a cyanotic heart defect and corrective shunts high-flow oxygen - it can kill! If a child with Tetrology of Fallot, for instance, starts turning blue or purple, instead of giving O2, you push the thighs/ knees up to the chest.)

As for consulting Wikipedia... bad idea. This is not a scholarly source, but one that literally anyone on the Internet can edit or add to... full of inaccuracies. Trust me, they will not be impressed at all if you give this answer. http://www.msnbc.msn.com/id/17740041/

im not sure they would be seeking that answer.. how would a new nurse be able to grow and learn if they deny all new experiences.. of course you would have to do some research and always ask a more experienced nurse for advice.

im not sure they would be seeking that answer.. how would a new nurse be able to grow and learn if they deny all new experiences.. of course you would have to do some research and always ask a more experienced nurse for advice.

But a new grad nurse's need to learn does not supercede the patient's need for a nurse who knows what to do. For a new grad nurse, just taking care of a full load of patients with more common conditions is the "new" experience. It's baby steps to experience, really. :)

Maybe the answer they were looking for was a combination of refusing the assignment but showing a commitment to researching the condition and nursing interventions so that one could be prepared for a similar assignment in the future.

Thank your for all the replies. I think when it comes to situation like this, you really have to fall back on the basics and one of the fundamental concepts I was taught in nursing school was patient safety (remember the rights of med administration? Right reason, right knowledge, etc. etc. same applies to this situation I think).

I don't think anybody wants to hear that the new grad nurse "can't handle it" and wants a reassignment but, as another poster suggested, that's probably what might happen in reality. But combine that with what dudette10 said about showing commitment to research and prep for next time gives a more well-rounded answer as well.

During my interview, I answered that I would seek help from my fellow RN colleagues and, failing that, would bring up the issue with the charge nurse. However, I didn't elaborate enough and didn't go so far as to say I would decline the assignment and request reassignment nor did I say I would research it for next time...a pretty so-so response on my part.

I think they were looking to see that:

1. You aren't afraid of challenges

However:

2. You wouldn't take on a challenge if it would jeopardize patient safety, if the health care team is too busy to help, you would make them, make time

I would have had a hard time answering that question well on the spot.

You emphasized safety in your response so that's good.

During my interview, I answered that I would seek help from my fellow RN colleagues and, failing that, would bring up the issue with the charge nurse. However, I didn't elaborate enough and didn't go so far as to say I would decline the assignment and request reassignment nor did I say I would research it for next time...a pretty so-so response on my part.

Your answer doesn't sound that bad to me. To flat out say that you would not accept the assignment is something that I have never wanted to hear in an interview. What I have wanted to hear is that the Charge Nurse would be told ASAP and that you would seek help from him/her (and or others). The Charge Nurse may decide to change the assignment so that the new grad would not be involved in the care of that patient -- or may be able to juggle the assignments so that the new grad keeps the challenging patient with some extra help being provided by a more senior nurse. But that's the Charge Nurse's call -- not the staff nurse's call.

In real life, there are times when NO ONE knows much about the patient's condition. Sometimes, we are ALL "winging it." Sometimes, no one (including the docs) has a good handle on the diagnosis. We can't ALL refuse the assignment.

I think it is also crucial to use the change-of-shift report wisely in such a situation. Get as much information as you can, ask a million questions -- and ask the off-going nurse to help you talk with the Charge Nurse. Be honest about your lack of knowledge about this patient and ask for his/her help in doing some quick learning -- and in supporting your need to tell the Charge Nurse ASAP.

As someone who has hired lots of nurses in my life -- I have never asked this question. But if I did, I would want to hear that they would enlist the help immediately available (off-going nurse), notify the Charge Nurse ASAP, and be willing to "stay with" the situation to ge the patient the help he/she needed -- even if that meant calling the Nursing Supervisor, etc.. I would not want to hear the applicant say that she would simply refuse to take the assignment without doing these things.

Like previous posts have said you find someone to give you the 411. Whether its another nurse, charge nurse, house supervisor, clinical nurse specialist, nurse educator, or call the ICU or ED and ask for someone to talk to. And yes, in a PINCH, you can certainly call the doctor :) I know I'm gonna get laughed at for that one, but who better to ask what the most important assessments and treatment. Don't forget to look for the careplan as well. No matter what the disease process, you are responsible for the ABC's, etc. Internet is a great source as well as PDA's or blackberry apps :)