I have a current situation going on in my clinical rotation that I don't know how to handle. Here it is:
I took care of Ms. Patient last week. She has a terminal illness and is weak.
During my last day of care for her, she asked if I could care for her again next week. I explained that I would love to, but could not have the same pt two weeks in a row.
Flash forward to this week. I am at the hospital researching and interviewing my new patient. Another student, we'll call her XYZ, approaches me at the computer and the following conversation takes place:
XYZ: Hey, KOT, remember the pt you had last week?
Me: Yes
XYZ: Well, I want to take of her this week, but she keeps falling asleep, so I can't interview her.
Me: Yeah, she's on alot of pain meds and I give her a brief history.
XYZ: Well, I figured we could save her the interview process if you would just let me borrow your care plan for her. 
Me: You don't need my care plan, if the pt is sleeping right now, you can start your charting research and interview her later when she's awake. Personally, I don't start anything until I have the patient's permission to care for them, or you might be doing alot of work for nothing. It's up to you, but I'd pick another patient.
XYZ: Like I said, why don't you just bring your notes in and I can take a look at them.
Me: Well, first of all, their my notes from last week, so they probably won't be accurate for this week. Besides, you don't have his permission yet. Sometimes, during end of life care, a pt may not want alot of extra people around, they want privacy with their family, so you better ask him. She may not want a student nurse this week...it IS their choice.
XYZ: Hell, I don't care, I'll just sit in there all day if that's what she wants.
Me: Well, if that's what you're gonna do, you can sit there and work on your own careplan - you don't need mine. Again, I strongly urge you to get actual permission. If she is not giving you a definite "yes" or "no", that usually means they don't want a student and are avoiding hurting your feelings. Did you get a response when you asked her?
XYZ: [silence and rolls eyes - then a fellow student/friend of hers walks up and says we need to go now. XYZ grabs her purse and head off down the hall. When she gets to the other end of the hall, she sing songs "Don't forget your notes!" and steps into the elevator.
I go back to my research, finish, and grab my stuff to head out of the unit. Just as I'm walking past Ms. Pt's room, her call light goes on and she yells for me. I stuck my head in the door and she says weakly, "Can you help me eat?"
Me: You know what? I'm not allowed to care for anyone if my instructor isn't here, but I'll go ahead and cut up your food for you, then I'll let your nurse know you need help eating. Is your sister here today to help you?
Pt: Shakes head no.
As I'm cutting up pt food, her sister walks in and sees me and smiles. "Are you our nurse this week?!?"
Me: No, sorry, I can only care for a patient once, but XYZ will take good care of you this week.
Pt & sister: (They both look at me like I'm crazy.)
Me: You know, the student that was in here earlier? Did you talke to her? Pt: (Shakes head no)
Sister: (speaks limited English) No new, no.
Me: Oh, did you tell her that?
Pt: No response.
Me: What's wrong Ms. Pt? Don't you want a student nurse this week - you get wonderful one on one care.
Pt: (head lying on pillow) Vigorously shakes head no and tells me to please tell her that.
Me: OK, please don't get upset. You don't have to have one if you don't want one. Take care of yourself and enjoy your meal. Bye.
I drive home and immediately e-mail XYZ (don't feel like a phone confrontation) and update her on the situation.
OK, clinicals are tonight and I've received no feedback from XYZ.
If she continues to press the issue of caring for Ms. Pt, should I say something? For instance, if she ignores my message and our prior conversation, should I speak to our instructor? To her? Help!
Sorry this is so long - thanks.
