Dilemma in clinical?

classicdame, MSN, EdD · Mar 23, 2012

good grief. You did the right thing and the other nurse was just put out because she did not want to mess with the patient. Also, her remark to the patient was inappropriate in my opinion. You had the right instincts!

nurseprnRN, BSN, RN · Mar 23, 2012

it's possible that the patient had 1) an embarrassing condition she didn't want to share with yet another person, 2) an embarrassing question she wanted to ask a nurse, not a student, or 3) really did want her medication too, so she knew to ask for the nurse.

if this happens again, say, "i will help you to the bathroom and then i will ask the nurse to bring you your medication." and then be sure the nurse knows you're not wimping out on the bathroom detail, and the patient did ask for medication.

RN/Mom · Mar 23, 2012

I agree with the nurse, especially so if the patient was confused (as you stated she was) and perhaps had no good reason for requesting assistance from her nurse over her student nurse. In that case, yes, you could have done a better job of reorienting her to who you were (her student nurse), and then politely explained to her that YOU would be taking care of her meds and ADLs that day.

Where I work (a busy med-surg floor with 20-24 patients at any given time), we often have patients who try to request help from particular caregivers/nurses. We make it clear to them, however, that while we make sure their needs are met, we do not have adequate staffing to allow our patients to individually choose who their caregivers are going to be. Can you imagine the chaos that would ensue if we allowed each patient to only accept care and meds from their favorite nurses? And, keep in mind, if you allow ONE patient to do this, it's only fair/ethical that you allow ALL patients this privilege.

If there is an issue that arises where a pt specifically refuses a particular nurse or CNA, that is different and the issue is investigated and dealt with accordingly by the charge nurse or manager.

So, yes, while I don't condone rudeness, I understand where that nurse was coming from. She was probably busy taking care of 4-5 other patients and was taken aback when you delegated a task to her that you could have easily completed yourself.

loriangel14, RN · Mar 23, 2012

Patients DON"T get to pick.You don't need a special nurse just to go to the toilet.The reality is that in a busy environment you don't have time to be allowing patients to make demands like this.You wouldn't get any work done.You have to explain that the nurse they want is busy with other patients and you are here to help her to the bathroom right now.

mursetudent25 · Mar 24, 2012

Patients DON"T get to pick.You don't need a special nurse just to go to the toilet.The reality is that in a busy environment you don't have time to be allowing patients to make demands like this.You wouldn't get any work done.You have to explain that the nurse they want is busy with other patients and you are here to help her to the bathroom right now.

I agree..But how do you tell the patient this? she asked for a specific nurse and insisted on it..Saying otherwise would be breaking consent, am I not right?

loriangel14, RN · Mar 24, 2012

Breaking what consent? You say "she's busy taking care of her other patients.I will help you. Let's go."

mursetudent25 · Mar 24, 2012

Breaking what consent? You say "she's busy taking care of her other patients.I will help you. Let's go."

I agree, but the patient insisted on having that specific nurse come to him..how could I say no? I tried....What are the possible ramifications of my actions anyway?

loriangel14, RN · Mar 24, 2012

The patient is not in charge.You have to learn to stand your ground and assert yourself.You tell the patient that nurse is busy.There are no ramifications.It's a trip to the bathroom. There is no reason they need a specific nurse for this.

RN/Mom · Mar 24, 2012

I agree..But how do you tell the patient this? she asked for a specific nurse and insisted on it..Saying otherwise would be breaking consent, am I not right?

You said the pt was confused. How so? Did she forget who was taking care of her that day (you)? If so, it is your job to reorient her to who her caregiver is for that shift (you).

Like you've already been told (both here and at the clinical site), you should have taken control of the situation and politely/sincerely explained to the pt that her nurse is busy but you are available to help right now. If she is still refusing care from you after that, clarify whether she is refusing you as her student nurse. If she says yes, then you go to your instructor and explain the situation and let her decide what to do (she'll probably give you a different assignment).

You're a student now, but you should also think about what you would say in this situation as a nurse (because it will happen from time to time). It will not be an option for you to ask a nurse caring for her own set of patients to care for yours, and it will not be an option for you to ask the charge nurse to change the assignment because your patient prefers a different caregiver over you. You will need to find a way to deal with this.

RN/Mom · Mar 24, 2012

I agree, but the patient insisted on having that specific nurse come to him..how could I say no? I tried....What are the possible ramifications of my actions anyway?

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?

loriangel14, RN · Mar 24, 2012

I agree.If the patient really needs to go she's not going to spend time quibbling about who takes her.Sometimes they are just trying you out too.If she discovers she can call the shots she will have you running in circles all day.Fine when you have one to take care of.Impossible when you have 6-7.