Dilemma in clinical?

Nursing Students General Students

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The preceptor came up to me today and told me that a nurse complained about me. What happened was a confused patient wanted to go to the washroom, I said ok I'll take you but she requested that the nurse (nurse t) take her. I told her that I can take her right now but she still said that she wanted nurse t to come give her the medication and to take her to the washroom. I asked if she was sure and she said yes..So I went to nurse t and told her that the patient wanted her to take her to the washroom. She went to the patient and told her that she has no choice and she does not get to pick her nurses. The patient then said ok and I helped her to the washroom..

The nurse then told the preceptor that i shoulkd have taken control and not called her. Which i did but the patient insted that nurse t came to help her..I think nurse t was wrong in telling the patient that they have no choice and they dont get to pick. seems very rude to me..

Who is right in this situation? Did i do the right thing here or does nurse t have a valid point? is telling a patient that they have no choice is acceptable?

In my experience, patients who need to go to the bathroom usually aren't too picky about who takes them as long as they get there. Could you have been uncomfortable with this task yourself and perhaps giving the patient reason to think he should ask for another caregiver?

I insisted to take her to the washroom what she said (verbatim) was: "I want nurse t to come give me medications and take me to the washroom" I said, I will do that for you and she repeated that she did not want to go to the washroom right now..I asked her if the final answer is to have nurse t take her and she said yes..I felt that trying to go beyond that would be breaking consent.. I just told nurse t that the patient specifically asked for her and to come and explain to her that she is unaviable..its not my responsibility to cover for nurse t...which she did in a rude manner (saying the patient had no choice) and then I took her to the bathroom..What I find annoying is that the nurse complained about me to the preceptor and how this could effect my evaluation. I think what I did was very efficient. I was diplomatic and maintained a therapeutic relationship with the patient and the result was that I took the patient to the washroom...

Specializes in Maternal - Child Health.

Perhaps when you are a staff nurse, responsible for 6-8 patients and are in the middle of a sterile procedure, complicated wound dressing, preparing medications or communicating with a colleague, you will understand how it may not be possible to drop what you're doing to communicate gently and therapeutically with a student and a confused patient about getting to the restroom.

If the lady needed to go NOW, you needed to take her. Your other alternative, to avoid "breaking consent" would have been to explain that Nurse T is not available to take her to the restroom. Either you could take her, or you could bring her a bedpan and assist her with it, and she could choose her preferred option.

I don't think that the staff nurse means you any harm, but rather wants your instructor to know that you may need to work on prioritization, limit setting and practicality.

Specializes in General Internal Medicine, ICU.

A similar situation happened on the floor that I'm working at...but between a little old lady and a male nurse.

She rang for the bathroom, and the male nurse being her nurse for the day, went to answer her call. She wanted a female nurse, but the other nurses were busy doing their own things (this was during a busy time of the shift), and he basically told her it was either him, or she'd have to wait until the unit is less busy to go. The patient ended up being toiletted by the male nurse.

While I think what you did wasn't exactly wrong, I think you should've been more affirmative and made it known to the patient that she does not get to pick and choose who the nurse providing care to her is. Patients may have a nurse they prefer or like better htan other nurses, but they do not get to pick...the same way we as nurses do not get to pick who our patients are.

Last I checked no one *has* to accept care from a student. Imo, refusing care from a student (nurse, intern, etc.) is entirely within the rights of a patient.

jt43 is spot on in my humble opinion. We students are taught in school from day one that patients run the show and have autonomy and the right of refusal etc etc.....

This may not be how it works in reality, bit it is how we are taught.....

Trying to make the student here feel that they were in the wrong is a little unfair I do believe.

Furthermore, we students are usually at a disadvantage. We dont get the keys we need. The hospital I am at locks up all the linens and everything. If a patient asks me for a blanket I have to wander the halls trying to find a nurse, interrupt them for a key, blah blah blah, it can be a real hassle.

To expect a student to function like a seasoned floor nurse is unfair. Do any of you remember when you were students?

I realize that many students act badly and are rightfully in need of reprimanding. However, many staff nurses seem to go out of their way to be hard on students when it is not called for. It makes me sad.

I can't believe that nurse ratted you out to your instructor! Way to be petty about it... I agree as a general rule that patients don't get to pick their nurses on any given shift. However, there are lots of reasons a patient might choose to see a particular nurse he's had in the past. Like someone else said, maybe he had a question that he felt could only be addressed by his nurse. Maybe she saw his rash yesterday and he wanted to know if it looked better or worse. Maybe he had a complaint about the facility that only an actual staff member could assist with.

You absolutely did the right thing with having Nurse T deal with the patient. There's a reason you're the student and she's the RN. Maybe delving into the patient's reasoning behind wanting Nurse T instead of you would have been a better tactic, but ultimately the responsibility for the patient lies with Nurse T. She's the one who works there, she's the one with the nursing license, and she's the one getting paid. I can imagine the nurse would be singing a different tune if you had said, "suck it up, I'm taking you to the bathroom and that's that" and the patient starting crying abuse.

I hereby promise that once I am a working RN, I will always do my best to be understanding and helpful to students.

I don't think it has anything to do with patients running the show or being nice to students or anything like that. Patients have the right to refuse treatment by a student. Period. It's wrong imo, for a nurse to coerce or force a patient to accept treatment from a student. It would be an entirely different situation if the OP had been a new grad hire.

To expect a student to function like a seasoned floor nurse is unfair. Do any of you remember when you were students?

I realize that many students act badly and are rightfully in need of reprimanding. However, many staff nurses seem to go out of their way to be hard on students when it is not called for. It makes me sad.

I am both an RN student and an LVN. Where I go to school, we are taught to function as independently as possible while on the floor -- good communication skills, time management and prioritization are all clinical objectives for us. I imagine most RN programs have similar objectives.

It doesn't sound to me that anyone (the RN or the preceptor) was being hard on the OP when they told him he needed to take better control of the situation and not bug the RN with tasks he should be managing on his own. Since the OP's pt ultimately did allow him to assist her to the toilet, it was not an issue of refusal but rather preference for a particular caregiver. The OP should have assessed this to be the case and dealt with it without bugging the RN.

I have had the same issues at work as an LVN, except I'm dealing with CNAs rather than students. I will be busy charting or passing meds (things I can't delegate) when a CNA comes up to me and says "The pt in room 122 needs you." I'll ask, "What does he need?" CNA says, "I don't know, but he asked for you." Then the CNA goes and sits down while I have to stop what I'm doing to go see what the pt needs -- and 9 times out of ten, it's something the CNA could have helped the pt with themselves had they actually cared enough to assess the pt's needs.

The RN should not have had to stop what she was doing in order to deal with communication issues a student nurse is having with one of her patients. The RN was right to inform his preceptor of this, and I would have done the same.

Hi,

You have not done anything wrong.You did your duty what you are suppossed to do.Its ok at all.....

Specializes in ICU & LTAC as RN. FNP.

Well, seems you've been told that you should have taken the patient to the bathroom regardless of her wishes. I think that you acted appropriately. Several people who have responded have assumed that the nurse was so overwhelmed that she just had to leave her other patients without care to help the patient to the bathroom. Some agree with you too. Another thing you were jumped on about was that you (the student) said the patient was confused, therefore would it matter what the patient wanted?

Yes, I was treated similarly by an old hag nurse when I was an lpn student. Never forgot her either, but I was able to have a little comfort knowing that she got fired one day due to her same sadistic attitude, and she was close to retirement. The point is, did it do you any good to be "told on"? No, but probably made the nurse feel better about herself. A simple discussion on dealing with so-called confused patients would have sufficed?

Specializes in ED/ICU/TELEMETRY/LTC.

Patients, or residents have the right to refuse assistance from nursing students. I am quite sure that they have to AGREE to have a student.

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