Paired with horrible nurse today - page 2
I have to get this off my chest- it's been bugging me and YES I told my instructor all of the follwoing. FIRST- I go in and do my assessment...I turn my client and find a stage 2 breakdown on... Read More
Sep 15, '06Wouldn't it be nice if we were actually paired with nurses who WANTED us to be with them? I just don't get this.
Sep 15, '06I appreciate everyone's support!
Unfortunately tody wasn't much better. I had a different nurse but she was just a TAD better. I was on the floor from 3pm-10pm. The client with the stage 2 decubitus ulcer was to be dicharged at 1800 to LTC. At 1600 my nurse who had been on since 0700 came to me and said " did you know she had a skin breakdown"? I said yes, I do. It's in the chart from yesterday. No wound consult was callled though and she said " oh well i wasnt told about it in report". Like didn't you DO an assessment?
Anyway besides that my day was pretty easy. I had 2 clients - the one above whom I gave 1800 meds to right before D/C. I also cleaned and redresed the wound and sat down and had a good talk with her about LTC.
The other was a young man on Heparin drip for DVT who was about to be switched over to coumadin. I did a long teaching session with him about herbs +homeopathic meds that are contraindicated w/ anti coagulant meds. We were just waiting for his PT to get into therapeutic range for D/C.
However I am starting to wonder why I am always done WAYYYY before all my other classmates. My instructor says it is b/c I am so organized but sometimes I wonder what the heclk they are doing that I could NOT be doing. Basically all of us have pretty low acuity clients.
When I go in and have 2 clients this is how my day goes ( BTW this is MEd Surg 1)
Read both charts ( copy down allergies. primary DX, secondary DX, Hx, labs, all meds etc)
Go in and totally assess priority client
Chart vitals + start note w/ 1rst impressions
Go and totally assess 2nd client
Chart vitals + start note
Check in on 1rst client for pain, comfort, needs ( wound care, etc)
Same for 2nd client
Get any meds ready + look them up + recheck lab values that may apply( norm meds on this floor are at 1700 norm)
Go in to do IS and CDB and turn clients- Do fingersticks if needed. Assist OOB or into bed as needed. Ambulate to bathroom as needed. Give sliding scale insulin depending on reading before trays.
Assist w/ trays
Re check vitals
Wait 30 mins and check in again for med reactions, needs
Chart results of meds
Take and Chart 1800 vitals
Document dinner tray intake
Chart 1900 I+O ( policy)
Check in on needs , new orders, anything
Finish shift documentation
** constantly peep in and see if they need something- SOME just want to talk!
OK that may look like a lot but I am ALWYS left with these HUGE gaps where I have nothing to do. Most of my classmates are at least 1-2 hours behind me. I guess it IS because I am organized? I dunno b/c 1/2 the time I feel like Im left with nothing o do.....so I search out other stuff....ask my classmates if they need help...but they are starting act like they are a burden to me. They aren't.
I guess I am rambing now sorry.
Sep 15, '06Thanks TriageRN34 for saying basically what I wanted to say. To all the nursing students, sorry if sometimes you don't get a good preceptor. But keep in mind just because a nurse didn't do something "by the book" doesn't mean it wasn't done. EX: I assess resp status by engaging pt in conversation. If they can speak full sentences, they're ok for now. I eyeball wound size. It would be nice if facilities provided those neat disposable clear plastic measuring cards, but alas I provided my own. The nurse may have intended to notify the MD or wound care nurse about the skin breakdown you found. Of course she should have communicated to you better. As far as the lisinopril, you did right, good call.
Sep 16, '06WOW and I thought I had crappy RNs to follow! That one that charted that she found the bed sore, etc is awful!
Sep 16, '06Wow, Boonersmom! I'm in med/surg 1 also and I have been trying to find a way to be better organized. I am an organization freak! My clinical starts at 0645 and on the floor by 0700. We get report from the nurses going off shift (if they are ready or sometimes we have to wait while they finish report with the oncoming nurses). After that, check in with pts and right to meds. If your pts were d/c'd, you now have 15 mins to look up info on your new pts for the day. Last week, both of my pts were gone. One of the new ones that I was assigned was leaving for tests. I don;t feel like I did much with him. That's never good. My other pt was pleasant and I was able to spend some time with her while the other was gone. I gave her an subcut and didn'g get the needle all the way in. I was soooo upset and really felt bad having to push it in. (not far though). I felt lost that day. My instructor noticed. That's not good either. After assessments/meds/vitals, then its baths/beds. Charting, meds again, procedures....I don;t know where all the time goes! Plus, we don't get any breaks. Not even 10 mins. I know that in the real world, that is happening in a 12 hr shift, but its hard to not get a chance to regroup when everything is new. I also can't eat at 5am. By noon, I'm dragging with 2 hrs to go. With the long summer, I feel like my skills are lacking. I have been studying up on previously learned skills, but there are so many to re-study that I can't do it all in one day. Our 7 hour clinical is on Tues, but preclinical worksheets and visits to the hospital for pt info takes up a minimum of 8 hours on Monday (plus a class). Then Weds we have to turn in about 10 hours worth of postclinical paperwork by 3pm. So, my clinical seems to last for 3 days. Then with the other classes on top of that...there isn't much time for skimming the books to refresh. After reading your "day" in clinical, I feel like I'm way behind. It was very motivating info, and Kudos to you! You have your stuff together! Last semester I was told by my instructor that there was nothing negative to say about my clinical experience (during eval time) and she wishes all students were like this. I was on cloud nine, but now...I just feel like I missed a link somewhere. Posts like yours motivate and inspire me and I just wanted to thank you! You are going to be one terrific nurse!Last edit by Race Mom on Sep 16, '06
Sep 17, '06i would just like to comment, as a few other posters have done, that sometimes an experienced nurse can assess without going through the same motions that you were taught in school. i am not willing to comment on another nurse's practice (and how horrible she is) when i was not there as a witness. i would just say this to students: sure there are some careless, sloppy people out there; but the majority of us really are competent, educated, and well intentioned. if we do things differently than you are taught in school, it is because experience has taught us. i wish that some of you were not so quick to judge. it seems as though some people need to make themselves feel good by cutting others down. i bet that some day when you are more experienced, you will look back and blush when you think about the arrogance of all the "those stupid horrible mean nurses" comments. take from this what you will. btw- i'm fireproof. :flamesonb
Sep 17, '06I can certainly see where you are coming from in that I shouldn't have called her "horrible" in the sense that I'm saying she's like that everyday. I could have said "paired witha nurse who demonstrated subpar care on a client on this day XXX".
I may only be a student but I know a few things (*wink*). I know that this patient had been lying on her NC tubing for hours and hours- which means she was never turned ( yes she was immobile). I know that it was only found upon my assessment which was at 150O- and it wasn't hard to miss if you kwim.I know that a stage 2 breakdown gets cleaned before it's dressed. I know that a band-aid is not the proper dressing. I know wound consult gets called ( thats policy). These things- I do know.
Yes you are right- she most ikely can assess the size and measurements of a wound by eyeballing it- I was wrong to insinuate otherwise.
I also know you hold BP meds when the BP is way low- especially compared to a clients baseline. If i had been wrong- my instructor would have also told me to administer it. So, obviously I wasn't wrong.
I certainly don' like to cut others down..and that was never my real intention. I cringe when I see subpar care....and while that can always be up for debate- since my instructor agreed with me ( and yes she spoke to the DON) - I can only assume my opinion wasn't too far out there.
I am in no way saying that this nurse is a horrible person- or that she is always like this. I was just venting about what I saw- because it bothered me. I felt bad for my client. That's all.
Sep 17, '06Quote from cardsRNI love this post. It's so true. I was awfully arrogant as well, espcially when I was a tech. I'm embarrased by many of my actions and comments I made towards nurses who I thought I was better than. Live and Learn.i would just like to comment, as a few other posters have done, that sometimes an experienced nurse can assess without going through the same motions that you were taught in school. i am not willing to comment on another nurse's practice (and how horrible she is) when i was not there as a witness. i would just say this to students: sure there are some careless, sloppy people out there; but the majority of us really are competent, educated, and well intentioned. if we do things differently than you are taught in school, it is because experience has taught us. i wish that some of you were not so quick to judge. it seems as though some people need to make themselves feel good by cutting others down. i bet that some day when you are more experienced, you will look back and blush when you think about the arrogance of all the "those stupid horrible mean nurses" comments. take from this what you will. btw- i'm fireproof. :flamesonb