Dealing with nursing staff (RPN's)

  1. Hello All,

    As a senior nursing student on a med/surg floor we have a great deal more responsibility than we did in first year (no real suprise there). With multiple tasks to do ie meds, treatment, prn's for pain and ng tube insertion and management , some things like am care have to wait until later in the day.

    We had a very busy day today and my pt's had to wait until late am for their am care (you know hands face, peri back etc..) and ofcourse this is fine with our teacher as long as everyone gets their care before we leave in the early afternoon.

    So at the end of the day the RPN for that zone says to my teacher that it is a real problem that the pt's didn't get their am care first thing in the morning. My rationale was that their meds , vital signs, assessments and prn's for pain come first and then the am care.

    So I informed my teacher that I didn't not need the help of the RPN and that I was capable of managing my patients and all of their care. I really think this particular nurse was looking for a problem where there was none. Does this sound familiar to any of you guys? How do you deal with this situation?


    Mito
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  2. 39 Comments

  3. by   OBNURSEHEATHER
    Hmmmmm.....

    Well, let me say nurses are creatures of habit. We're used to doing our thing our own way. As a floor nurse, when I have students, sometimes I find myself following a student around saying "did you do this, did you do that?" I am physically unable to let some of these things go for someone else to do. We're not necessarily nagging or being mean or eating our young. We just have a hard time giving up things we are ultimately responsible for.

    When I first started nursing, when we got students, I would be happy that it was one less patient I had to take care of. I was SO wrong! Half of the time they have instructors that don't even know the routine, and it is constant double checking for us to make sure everything is done as ordered. Even though you are responsible for direct patient care during that time, it all still comes back to our liscense if something goes wrong, so please don't assume that you don't need the nurse, or that she will ever just leave you alone to do yourown thing. Any nurse that does, in my opinion, is a bad nurse.

    I informed my teacher that I didn't not need the help of the RPN and that I was capable of managing my patients and all of their care
    This is a statement you really can't make until you have a liscense of your own.

    Now don't get me wrong, it's not that I don't agree with you. As long as the patient wasn't in any physical danger, say perhaps skin breakdown, I also agree that this wasn't a big deal. Heck, it wasn't until noon today that I brushed my own teeth :chuckle The nurse could have been a little more considerate of your skill and stress level, and understood that you needed to prioritize. I think you prioritized correctly, and that she could have been a little more understanding. Some nurses do always have to find something to bytch about the students.

    I just wanted to play devil's advocate before the crotchety floor nurse bashing got underway.

    Whew! This got long fast!

    Good luck to you! Soon you'll be out on the floor following your students around! Hopefully you'll learn from this experience!

    Heather
  4. by   SherRN
    Heather
    I could not have said it better myself. Mito you will do just fine. Remember we are still responsible and we are some what anal about or pts. and duties to them.:chuckle
  5. by   OBNURSEHEATHER
    Thanks SherRN! But, I do find fault with the phrase "somewhat anal." I'm pretty much completely anal about my duties! :chuckle

    Heather
  6. by   AppyHorseFan
    originally posted by obnurseheather

    even though you are responsible for direct patient care during that time, it all still comes back to our liscense if something goes wrong,
    heather,
    first of all, i would like to say that i agree and understand most of what you say. everyone (not just nurses) have their daily routine down and if things get "out of whack" they (myself included) can get irritated. i understand all of that.

    what i don't understand is the above statement. we have been drilled, and drilled, and drilled some more, that we are not "working" under anyone's license. true, you are responsible for follow-up of what you delegate, but the person doing the "action" is responsible for their own actions. we have been told that we are not even working under our instructor's license, but basically on our application for licensure. we mess something up, we mess up our licensure application and chance to sit for boards.

    i have had great experiences with the floor nurses for the most part thus far and would by no means bash them, and especially if i didn't know them.

    i would be interested to know if any other current student's have been told the same as i or not.

    shonda
  7. by   OBNURSEHEATHER
    OK. Let's say, hypothetically of course, that you are taking care of one of my patints and you do something that kills her. Are you saying that you think I would suffer no consequences from this?

    When I delegate to you, the job becomes yours. But the responsibility to make sure it was done is still mine. You forget to pass a med. Overlook a blood sugar. It's still my name on the incident report, and it's still my ass in my supervisor's office.

    I'm not saying you won't suffer any consequences, I'm sure you do. But I definately will.

    I'm glad you've had great experiences with nurses. I always try to give my students great learning experiences, and enough room to make them feel like they're running the show, even though I'm keeping a close eye. But I am watching, because it is my ass on the line too. And I won't go down for someone else's mistake.

    Heather
  8. by   fergus51
    It should be noted this is an RPN, so what are her responsibilities? If she is only responsible for am care, that may be why she is not understanding your rationale (because you may be doing her job AND the job the RN does). I have had some people get in snits about the stupidest things and this is one of them. Was anything you did harmful? Then it isn't something to go to an instructor about. She should have talked to you directly. The way she did it seems more like tattling.
  9. by   OBNURSEHEATHER
    Thanks fergus. I hadn't pulled that piece of info the first time through. Aren't you in Canada Mito? What is the US equivalent of a RPN?

    I do believe AppyHorseFan is from here though, and I answered her question as best I could.

    Heather
  10. by   New CCU RN
    I have to agree w/ Heather on everything that you have said. You stated my feelings exactly!
  11. by   mark_LD_RN
    AppyHorseFann-- you are so wrong! who ever is handing out that info is out of their ______ mind. You are unlicensed as a student and are NOT( let me repeat NOT) working just against your application. The RN is responsible for the patient even if you are caring for it. Your instructor is responsible for you and the patient, I am an instuctor and Know this for a Fact. so don't be so confident and cocky to think you don't need the RN's help or oversight because you have it all under control. Be respectful of the nurse you are working UNDER learn what you can. if they seem unjust let your instructor know.

    but it is time to get redrilled and learn that the rn and instructor is responsible they have a share of things to loose if and when you screw up. especially if they did nothing to oversee that proper care was given.

    does your instructor even bother to sign off after you in charts ,narcotic logs,and so on. you are a student nurse and bythe agreement made between the school and hospital you are allowed the privelage to learn and practice your skills there while being instructed and overseen by your instructor and or nurse.

    as an instructor i watch out and sign off on all my students stuff. I do have a few nurses that i will allow to oversee my students or teach them things .but those few i know well and feel very confiedent in the fact that they will teach my students well.

    and just as heather said, I will not go down for another persons screw up. so while i really enjoy students and love working with them usually. you need to remember youare a student and do not know it all yet. I hold my students to the same high standards i hold for my self. and If they think that is to harse then they need to find another profession or another school.
    Last edit by mark_LD_RN on Sep 27, '02
  12. by   TheLionessRN
    I think knowing what an RPN is would help this discussion a lot. If it is a licensed person, then I fully agree with everything said above.

    Having done nursing instruction myself, I do want to add that there are a lot of staff members in the host hospitals who are territorial and do not feel comfortable with students. The fact that the students usually do not stay for an entire shift does create a burden on the regular staff, in that they need to know exactly what was done by the students while there. If I was an aide whose patients were being cared for by a student nurse, I don't think it would be outside of my expectations for that patient to have gotten a.m. care while the student had him. I do know, however, a lot of aides who feel threatened by the students and are a hinderace to them.

    That said, I would love to know what RPN stands for.
  13. by   OBNURSEHEATHER
    Sounds like you're a great instructor Mark. We get to know all the ones that come to our unit, and we know who bears closer watching. We've reported those practicing unsafely and not watching the students closely enough. The best instructors sit with the students at the end of their clinical day and review the charting with them, and then not only co-sign, but make a separate entry stating that "above charting have been reviewed by instructor...."

    That not only tells me the instructor is paying attention, but is confident enough in what went on all day to also put her name on that chart!

    Heather
  14. by   mzmckim
    You guys seem so cool! I hope when I get into clinicals that I have instructors/nurses like yous guys - and not someone that leaves me out there to flounder!!!

    Judy

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