What is the working RN's expectation of the nursing student?

[mlauren]

I had a bad experience with a nurse the other day and I'm just trying to figure out how I can avoid that in the future. Let me just share some of my day. My patient had a N/C and did not want to keep it on at all. I was literally putting it back on every 2 seconds while she continued to pull at it and say she wanted it off. So, I went and told the nurse. She told me to take it off for 15 minutes and check the O2 sat. I let her know that I had just taken all vital signs and the O2 was 95% after having the oxygen off and on for about 30 min. I also let her know that I was supposed to be in post conference in 15 minutes and still had to chart everything. She did not like that obviously, because she didn't say a word and just walked off looking very mad. I really don't know what I could have done, because my instructor was going to kill me if I was late on charting and to the conference. So I felt very overwhelmed and incompetent. Anyways, since the nurse did not go and check my patient after I told her that, I went to let the family know that I had told the nurse what was going on. At that time the patient had gotten very agitated and was pulling at her IV's and pretty much everything on her. I had no idea what to do next and the family was starting to worry. So I went to find the nurse and tell her this. When I told her she said nothing to me and just made this face like "why are you telling me this". But at that point she did actually go into the patient's room, because I was headed to post conference. My question is, what did I do wrong? We really haven't been taught what to do in certain situations like this. I don't know what I could have done to be more help to this nurse. I just don't want to have this problem again and I'm wondering if it is unavoidable. I realize that the nurse was very busy and probably didn't even understand why I was asking her these questions about what to do. So, what would you guys suggest? How can I be less of a bother? I'm feeling really down since then and am pretty worried about my next clinical there.

[decembergrad2011, BSN, RN]

I believe that you implemented in ways that were to be expected for a student, and that you attempted to communicate and ask for help when you felt uncomfortable with the way a patient was acting. 95% O2 on room air would be ok with me to leave a patient off oxygen if they had capacity and had no other symptoms.

It sounds like the patient was extremely agitated. She possibly needed Ativan to calm down, or did need the oxygen that she kept pulling off (hypoxia can manifest as restlessness). If she disliked the NC, you could try a face tent - they don't plug up the nostrils the same way.

Where is your clinical instructor in all of this? You should have some guidance, and the primary RN should continue to do their assessments, ensure that medications are given and interventions completed. I will say that student nurses are held to the same standards as the RN in my state, but that does not mean that you should be expected to know everything. Always ask for help when you feel unsure. I think the RN probably was busy and just thought "Oh god, another problem" but unless she continues to be outright mean to you, chalk it up to that. You did what you could.

[nurseprnRN, BSN, RN]

You did fine. You may not have known what other reasons this lady had for restlessness and refusal to keep her O on, but the nurse is the one to assess that. Options: hypoxia (which can still be up and down-- it doesn't "average out" over time on and off the nasal prongs), sepsis, pain, alcohol withdrawal (o yes, even sweet little old ladies...), impending CVA, dementia, and there are more.

Your nurse was busy, and she wished she could just sit down and chart and leave in 15 minutes. :) Don't give it another thought. Although the next time you're back there, seek her out if it's a quiet moment and ask her about that. "Whatever happened to that lady...? What else would it have been good for me to do? How did you know that ...? Thank you so much for helping me to understand, I know you were busy!"

[mlauren]

Ok, the patient was not hypoxic. She had been put on oxygen, because on admission her O2 sat was low. But this was two days after that. She was NPO when I arrived, because they needed to do a swallow test. So, she was very agitated, because they couldn't administer her medications. I think the nurse was just busy, but I literally felt like crying after talking to her just because I didn't know what to do. My instructor was all over the place helping other students with medications. And honestly, I'm more afraid of her than I was the nurse. She expects a lot from us and told us to ask our nurse any questions. But next time I'm not able to find the nurse when I need her I will definitely check with my instructor, because this patient's family was completely stressed out. I would be too if my mother was trying to jerk IVs out. I guess they would have to get an order for restraints until she was able to take her meds.

Thank you for your response!

[nurseprnRN, BSN, RN]

There are plenty of alternatives to oral meds for someone whose agitation is deleterious to her health. Restraints seem like a handy solution, but most of the time they aren't.

You will learn (will have to learn) how to assess the situation better as time goes by, how to identify when a good moment comes up to ask the nurse these questions. That's a skill your clinical means you to acquire too. Even if it's just a quick moment in passing, "I know we're busy now-- when we have a minute later can you explain ... to me? Thanks!"

[classicdame, MSN, EdD]

you did not do anything wrong. The nurse was just irritable. Many are overworked and feel the students get in their way (forgetting when they were students). As for what they expect, that is not the issue. YOU expect them to be cooperative and polite. The staff may expect you to know what is safe and what is not, but they have no idea what concepts, skills you are trying to accomplish this semester, unless you have told them. My experience is they do not read the objectives when I post them for student nurses. So get out of the experience as much as you can, do not focus on the staff nurse's attitudes, and when you get your license please try to be a better example.