Clinical instructor punishes patient instead of me *rant*

[Murse901, MSN, RN]

Hello all,

On September 9th, I called in late for a clinical rotation due to vehicle problems (I broke down on the way to the hospital, so I couldn't exactly call in an hour before the scheduled time). Clinicals started at 6:30am. I called the instructor to let her know what happened at 6:45 (had to walk awhile just to find a payphone). Once it was all said and done, I got to the hospital at 10:30am.

When I got there, I immediately went to my patient to check in on him. When I entered the room, I was immediately hit with a strong odor of urine and feces. I proceeded to bathe him, change his gown/diaper, changed bed linens, and did an assessment. I asked my patient how long it had been since he had been checked in on. My patient, although in a nursing home, is alert and oriented x3. My patient stated to me that the last time he saw a nurse was when he was given his morning meds. This was at 6:00am.. My patient went over 4 hours without so much as being checked up on. The instructor knew I wasn't going to be in, but failed to let a CNA or another student know to check up on my patient.

Initially, I had thought that it was perhaps simply an oversight on her part. I understand we can all be overwhelmed, and maybe it had just slipped her mind. However, yesterday, I was speaking to a classmate about the issue. She told me that she asked the instructor if she (the student) should check up on my patient. The instructor told all of the students specifically not to check on my patient whatsoever. This instructor deliberately denied care to this patient simply because she was (apparently) upset at me for being late.

I don't mind doing work and getting my hands dirty. If I did, I wouldn't want to be a nurse. I don't mind the fact that I had to come in and do all the AM care for my patient. I would have had to anyway, had I shown up on time. But why should the patient suffer because I was late? Why not punish me by making me help with other patients throughout the rest of my shift? Plenty of patients are pooping their diapers and need other types of care. Why not just make me do extra work rather than force a patient to lie in feces and urine for 4 hours?

Thankfully, the patient was a PEG feeder, and his feedings were scheduled for 6am and 12pm. What if this patient were to receive a normal feeding? Would he have to go hungry just because I was late? What if we were allowed to push meds? Would she withhold medication because I was late?

This is ridiculous. Again, I don't mind doing the work. What I do mind is a clinical instructor who feels it's okay to withhold care from a patient simply because a student is late for clinicals. I'm strongly considering writing a formal complaint to the program director. If the hospital found out what happened, we probably would no longer have that site as a clinical site. If the state found out what happened, the instructor would likely be brought up on willful neglect charges.

ARGH! :angryfire:

[twinmommy+2, ADN, BSN, MSN]

That is ubsurd!!!! And illegal I think too! I think if it were me I would pull the instructor aside or during office hours I would have a talk with her since its obvious that she is trying to get a message to you (not the right way though) and if that isn't productive then go up the chain of command. Don't be afriad to stand your ground on this cause she will do this again to another student and another patient.

:redlight: You had know way of getting there that morning, so you should have not even been punished let alone the patient of all people.

Perhaps you should let the nursing supervisor of the nursing home know what happened. If something like this comes down again they will want a history on paper (and so will you) against the instructor. They are the ones ultimatly responsible for the patients you guys take care of.

Just increadible! Good luck in this course hunny...

[Catys_With_Me]

Wasn't there paid staff personnel (RN, LPN, CNA etc...) assigned to this patient in addition to you as a student? Are you sure you've got the whole story? Just because the instructor indicated to the other students that they were not to assist your patient does that mean that the instructor knew the patient would be left without care? Where were the regular personnel?

[suzanne4, RN]

Funny thing is that your nursing instructor is the one that is legally responsible for the care that this patient receives, not you. You are working under her license. Perhaps she doesn't understand that....I do suggest that you do a follow up with the director of your program, as this is completely unacceptable. It was your instructor who should have provided the care if you were not there, if she needed to. She had the assignment from the facility, not you.

[truern]

Wasn't there paid staff personnel (RN, LPN, CNA etc...) assigned to this patient in addition to you as a student? Are you sure you've got the whole story? Just because the instructor indicated to the other students that they were not to assist your patient does that mean that the instructor knew the patient would be left without care? Where were the regular personnel?

Absolutely...just because a student is assigned to a patient does not mean the other healthcare staff aren't responsible for their care, too. Face it: all nursing students aren't the creme of the crop

To the OP: I wouldn't cause a huge stink without all the facts...heck, you never know: the other student could be trying to stir the pot.

[Murse901, MSN, RN]

Wasn't there paid staff personnel (RN, LPN, CNA etc...) assigned to this patient in addition to you as a student? Are you sure you've got the whole story? Just because the instructor indicated to the other students that they were not to assist your patient does that mean that the instructor knew the patient would be left without care? Where were the regular personnel?

No. When we're assigned a patient, that's "our patient". The CNA's do nothing for our patient. Only the other patients on the unit who do not have a student. The only thing the LPN's/RN's will do are push meds (at least until we can do it with the instructor's supervision) and any other treatments we're not trained for. Otherwise, no one would check up on the patient unless the instructor informed the CNA's/nurses on the unit.

Between the patient's verbalization, my classmate's word, and what I witnessed myself, I'm 99.99% sure everything went down exactly as I stated.

[JoBug]

Being a LTC nurse, in a nursing home that works with the local nursing school, here is what I have to say...

IF the Pt was A&O X3, why on earth didn't he put his call light on and ask for assistance? Surely someone would have answered the light, and helped him out. Also, we know the students are there, but as working on the floor, we ,in the nursing home are still the ones responsible for the resident, period.

I can compleatly understand your anger and frustrations, but honestly, would not "stir the pot" I would however discuss with your instructor the condition of the resident when you cam on duty, and see how it could be prevented in the future..thank you for caring about the RESIDENt,,,as I say EVERY day, it could be YOUR mother father grandparent, treat them with respect, dignity, and give them what YOU would want and need

JoBug

[stressgal, RN]

I agree with Jobug.

It is VERY important to NOT listen to what others tell you, but rather go directly to the source. If you have a question of the instructor, go directly to the instructor.

I am also confused with your post, first you state that your client is in a LTC facility, then you state that if the "hospital" found out you would lose the clinical site. Just curious.

[jasonn]

"patient not being looked at for 4 hours".... no, its not right but happens every single day. I will bet you anything that there was documentation made on the pts chart during the four hour time span. As students they pump you with "ethics" and such... the real world is not like that unfortunately.. Just wait you'll see

[jasonn]

No. When we're assigned a patient, that's "our patient". The CNA's do nothing for our patient. Then your clinical instruc is legally responsible for pts care not you.

[Katnip, RN]

Even in the real world, when a nurse comes in late, SOMEONE takes report on her patients and provides coverage. That doesn't mean they're going to get to everyone for every little thing, but in this case the instructor was responsible for covering your patient.

[Murse901, MSN, RN]

IF the Pt was A&O X3, why on earth didn't he put his call light on and ask for assistance? Surely someone would have answered the light, and helped him out. Also, we know the students are there, but as working on the floor, we ,in the nursing home are still the ones responsible for the resident, period.

I specifically asked him that question while doing an assessment. He basically said that he didn't want to bother anyone, and that he knew someone would eventually come (not his exact words).

I am also confused with your post, first you state that your client is in a LTC facility, then you state that if the "hospital" found out you would lose the clinical site. Just curious.

The nursing home is one building out of several in a much larger facility.