Dilemma in clinical? - page 4

by mursetudent25

4,074 Views | 49 Comments

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... Read More


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    Quote from wooh
    A whole lot better than you remember when you were a nurse.


    Learning to work through situations like this is the whole reason you're in clinicals. This is a good reason to get a job as a tech or CNA while in school, to learn to deal with patients.
    Wow always the snide comeback eh? Well I reckon its always good for a chuckle Anyway Wooh, I think you missed my point. Please go back a few pages and reread what I wrote, in context please....

    Do you really remember when you were a student? Out of the gate you were the expert that you are today? I suppose it's possible.......

    I really do see things from both points of view. I get that nurses are stressed and I get that adding wide eyed students into the mix just really can send the day over the tipping point.

    However, I really do think that a small minority of seasoned nurses may forget now and then what it was like to be a student.....

    That said, I have worked with some really wonderful experienced nurses, and I will never forget them. Some were hard on me, but in a nice way. They grilled me and I really liked it because it exposed my many weaknesses.

    So, to my fellow students I say this. Do try to see things from the nurses point of view. They have an EXTREMELY difficult job. If you sense that a nurse is stressed, assess if you can help them in some way. If you sense that it is not going to be a good time for the nurse to have a student to deal with, communicate with your cliinical instructor.

    To all the experoenced nurse out there. Thank you. I know how hard it is to have to deal with 7 or 8 pts, with a student or TWO in the mix. We students really really do appreciate and respect you VERY MUCH!!
    Cessna172 and Miss Molly like this.
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    Quote from osdbmom
    Okay, thank you for explaining that. So, if this were a small child I would say something like this:
    "Okay, I understand what you are saying, but Nurse so and so can't come right now. If you need to use the bathroom, I can take you. If you aren't ready right now, thats fine. Just let me know when you are ready, and I will come and take you."

    Would that be right?
    By my reckoning that would be outstanding
    Jolie, Orange Tree, and jt43 like this.
  3. 0
    Thank you.


    I really do want to learn to do this the right way.

    It can be hard to apply class learning to real life situations. In class, we are told, "Even looking for a vein or putting on a tourniquet w/o consent is battery. You will be sued. You will get fired. Don't touch a person ever w/o consent."

    Sometimes it feels like any step you take might get you in serious trouble.
  4. 0
    A really great starting point is to strive to treat the patients how you would want to be treated if you were in their shoes.....
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    Quote from osdbmom
    Okay, thank you for explaining that. So, if this were a small child I would say something like this:
    "Okay, I understand what you are saying, but Nurse so and so can't come right now. If you need to use the bathroom, I can take you. If you aren't ready right now, thats fine. Just let me know when you are ready, and I will come and take you."

    Would that be right?
    Exactly right!
    Jolie likes this.
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    I think the OP was in a catch-22: by doing what they did and getting the nurse for the patient, the nurse complained. But had they not gotten the nurse for the patient and insisted that they could help the patient with toileting, the patient would have complained. Either way the OP would have been raked over the coals. Damned if she did, damned if she didn't.

    Sorry it happened to you, OP. But I agree with a lot of the posters here: tell the patient that the nurse isn't available and that you'd be happy to assist her with her ADLs. If the patient refuses, you can't force her to accept your help but tell her when she is ready you can come assist her. Some patients think they can pick and choose their caretakers and sometimes limits need to be set.

    Most importantly, tell the nurse--and your CI--that you did offer assistance to the patient but the patient refused it so you're just letting the nurse know. That helps to cover your rear.
    melmarie23, Cessna172, RN/Mom, and 2 others like this.
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    Op, you did fine. Remember nursing school is something to be endured...

    Most likely your instructor and that RN don't at all have the patient or your best interests in mind most of the time. If you had done what the nurse and your instructor hindsightedly told you and the patient complained about it, you would have been blamed faster than you can say, what the heck. That RN, and your instructor both know that the "complaint" made about you was childish. Maybe just an aside by your RN was enough. Telling "mommy" makes that RN a joke in my eyes. Your instructor admonishing you makes her also a joke in my eyes.

    Your RN for that day is one not to trust. One of those who is a child in an adult's body.
    Miss Molly likes this.
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    OP, what you did wasn't a big deal. Just a few things:

    1) You said nothing in your posts about the depth of knowledge you have on the patient's personality and behaviors. Possibly the patient had a habit of demanding things, and the nurse was implementing a legitimate nursing intervention called "limit setting." That said, I wouldn't judge her too quickly on what she said to the patient.

    2) The nurse ran to mommy, and that is one of my biggest pet peeves in this profession. Because what you did wasn't a big deal in the great scheme of things, it could have been an opportunity to talk to YOU a little bit about limit setting with patients, if that's indeed what she did. Instead of a teaching opportunity (which takes all of a couple of minutes), it turned into a "complaint." That's ********. And before anyone tries to tell me, "It takes tiiiiiiiime to teach students," I have to point out that there was probably more time spent venting to the preceptor about the student. Time that could have been used in a much more constructive fashion.

    3) What is missing from your replies, though, is your preceptor's reaction when she spoke with you about the nurse's complaint. I'm curious to know how that conversation went.
    melmarie23, GrnTea, Cessna172, and 3 others like this.
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    Patients do have the right to refuse care. It is also possible to find a way to handle a situation like this but it usually takes some floor experience and a knowledge of the history of patient/staff interactions and strategies and interventions staff has in place to deal with that patient.

    I work with several patients who become explosively angry if their routine is disrupted. We have years' worth of documentation on those patients and a morass of interventions, care planning, care conferences, and strategies to deal with those behaviors. And also, a list of staff who no longer work with those patients because of concerns about the way the patient reacts to those staff members.

    I would not expect a student or a new staff member to be aware of that and would encourage them to talk to me if they had a problem with the patient.

    We go to nursing school to learn. So the OP made a mistake. I don't even think this was a mistake. She did what I would have wanted her to do. This was a "teachable" moment and the nurse did not handle that well.

    I'm not sure if the nursing student talked to her preceptor about what was going on with the patient before talking to the nurse, but that probably would have been the way to go.
    Last edit by mazy on Mar 24, '12 : Reason: to add
    dudette10 likes this.
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    Dealing with difficult patients successfully takes experience and is a learned skill. I don't know the age of the OP, but I would think it's fairly hard for a younger student to be able to stand their ground with a difficult pt than an older student who has had more life experience in dealing with difficult people. I wouldn't worry about it too much, I feel the primary could have given you some better guidance on how to handle the pt and sent you back in to try again. We are in school to learn, unfortunately quite a few nurses find us a bother, take it in stride and try to get as much out your experiences with RN's who care enough to teach.
    loriangel14 likes this.


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