WHO wants to hear about my day at clinicals???

  1. Okay.. little background.. I am an LPN student in my second rotation of advanced nursing (which means I am about 3/4 done with school).
    My instructor assigns me to a room with two pts. who are both, and I repeat BOTH positive for C-Diff. You gown in an isolation room. That is the procedure for someone who is in isolation, am I correct?.. You SHOULD be wearing a gown and gloves, a mask is your choice.. but you can wear it if u really want to. The nurses on this floor were going in and out of my pts. room without wearing any protective gown (and yes, they were having DIRECT pt. contact, it wasn't like they were running into the room to drop something off.. they were physically touching these pts.) This is really irritating to me, b/c I am a student and yet I am doing the correct thing? Not only are they not protecting themselves, but they are really pushing the limits of infection control. Like I said, it's one thing if they are not having direct pt. contact, but they WERE. As in putting dressings on the buttock area, etc. Okay.. I think I have stressed that issue enough.
    One of my C-Diff pts. was a quadriplegic.. and he was obese. My other pt. was a bilateral transmetatarsal amputee. He could not move himself..
    Being a student I have classmates that should be able to help me.. especially considering my classmates pt. load was alot lighter than mine. I needed various things, wipes, a new pt. gown, etc. Or I needed help turning these pts. My classmates would say "oh yea, sure I'll be right there!" And then they would NEVER show up. That REALLY irritated me b/c I have ALWAYS helped my classmates, no matter how busy I was.
    Needless to say, I will be letting my instructor know this... Nursing is alot about team work, although we all know that it is impossible to find that team sometimes!
    Then I had the nursing aide who thought she knew EVERYTHING. Gotta love it. She was telling ME how to document something I have documented a THOUSAND times before, and I wasn't documenting anything incorectly.. so whatever!!! Thank god today is over.
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  2. 16 Comments

  3. by   rags
    First off you need to relax and focus not on others performance but rather simply on your own. Don't stress on the things you cannot control. You will find when you begin your nursing career that many nurses DO tend to get a little laxed on the isolation issues. Not right, but it happens...

    As for your fellow students... well.... what was wrong with their pt's? If you pt's were in isolation they are considered 'dirty' should these other students have been in that room with you anyway? Just a thought. If their pt was immune compromised for any reason they needed to remain out of that room no matter what your need was or they would have been putting their own pt's at risk.

    In the nursing world there are many situations that are difficult to swallow on a regular basis. You need to decide which ones are important and which one's to just let go. A good rule of thumb for me is, "did it affect my pt or me?" because if it only affected me or part of my day then it is one to let go. If it affected my pt's safety or well fare than maybe I need to look a little harder at it. After all, it isn't about me, it is about my patient. ALWAYS!

    Your fellow students may have had all the intentions in the world of coming to help you, but things come up. Unfortunately this is an unpredictable career and you never know what is going to happen next. Have you spoke with them and asked what happened. (in a tone that is more concerned than accusing)? If you not, you might want to get the rest of their story before you stress too much on it.

    Clinicals are hard and nerves get thinned. I am sorry you had a difficult day! Hang in there and look at the the bigger picture. You will have as many if not more wonderful days at clinical too and they make it all worth baring!

    Now breath!

    rags
  4. by   KimmieKoo72
    Quote from rags
    First off you need to relax and focus not on others performance but rather simply on your own. Don't stress on the things you cannot control. You will find when you begin your nursing career that many nurses DO tend to get a little laxed on the isolation issues. Not right, but it happens...

    As for your fellow students... well.... what was wrong with their pt's? If you pt's were in isolation they are considered 'dirty' should these other students have been in that room with you anyway? Just a thought. If their pt was immune compromised for any reason they needed to remain out of that room no matter what your need was or they would have been putting their own pt's at risk.

    In the nursing world there are many situations that are difficult to swallow on a regular basis. You need to decide which ones are important and which one's to just let go. A good rule of thumb for me is, "did it affect my pt or me?" because if it only affected me or part of my day then it is one to let go. If it affected my pt's safety or well fare than maybe I need to look a little harder at it. After all, it isn't about me, it is about my patient. ALWAYS!

    Your fellow students may have had all the intentions in the world of coming to help you, but things come up. Unfortunately this is an unpredictable career and you never know what is going to happen next. Have you spoke with them and asked what happened. (in a tone that is more concerned than accusing)? If you not, you might want to get the rest of their story before you stress too much on it.

    Clinicals are hard and nerves get thinned. I am sorry you had a difficult day! Hang in there and look at the the bigger picture. You will have as many if not more wonderful days at clinical too and they make it all worth baring!

    Now breath!

    rags
    That's all well and good.. and I appreciate your input. However.. It is NO excuse for the nursing staff to get a little "lax" on the isolation issue. Why can they come in there NOT gowned, have contact with a pt. and then go and care for their other pts in other rooms??? How is that any different from my classmates helping me? If anything, I know that my classmates WOULD have gowned and taken all the necessary precautions.. And by doing so, they are cutting down the risk of transmitting it to their pts. I said cut down, Not eliminate, I know things like that are very difficult to control. But back to my previous statement.. how is that any different from the nursing staff going in there NOT dressed for isolation and then caring for their other pts.???
  5. by   Megsd
    I don't think rags was implying it was an excuse or acceptable at all. We know transmission of those nasty bugs is a bad thing and all steps should be taken to avoid it, but sometimes people don't do it. Really, it puts the nurse as much at risk as it does the patient, and I know *I* don't want c-diff! I don't honestly know off the top of my head what the isolation precautions are for c-diff in particular. I've only had MRSA pts so far and that usually requires a mask and gloves, no gowning.

    I think the point that rags was trying to make was that even though these nurses are not following the isolation precautions... there's really not much that you, as a student, can do to fix this aside from make a mental note not to do it yourself. I've seen nurses do all sorts of things they're not supposed to do, but it's really not my place to do much about it (unless it's a blatant problem that endangers my patient). You could bring it up with your clinical instructor if you're concerned about it.

    I am sorry you had a stressful day at clinical. As a student myself, I know it can be frustrating, especially when you do reach out for help and don't get it, but as rags said, sometimes things come up. A few weeks ago I was having a slow morning and offering to help my classmates with things, and 5 minutes later my patient's g-tube had fallen out, her surgeon was in the room (yelling at ME, mind you) and everything I had promised to help my classmates with went totally out the window.

    Regarding the aide you were paired with telling you how to chart something, I would let it go. Personally, as a student I view myself as a guest of the facility (not an employee) and someone who works there probably knows more about that facilities protocols or charting or whatever than I do. The aide may have simply been trying to help, and a simple "Thanks for letting me know" is really all that needs to be done.

    Good luck and hope your next clinical day goes more smoothly.
  6. by   rags
    "I don't think rags was implying it was an excuse or acceptable at all."
    I wasn't.
    I was just simply saying "it happens" and it will continue to happen. I work with a lot of "isolation" pt's, especially this time of year, and try to always gown, or mask depending on what the protocol is, but even I have find myself in a room not properly attired. Say for example you go in simply to reset the beeping pump and the baby's O2 drops drastically while you are in there due to the nasal cannula coming out of the nares, or they pull their IV out and you have to react quickly. You are NOT going to make that situation wait so you can go back out the door and get the proper gear on. You respond because at that time and point the pt takes priority. I understand you are not talking about emergent situations but those are just some attention grabbing examples. There are others that may not 'sound' as urgent to you here but in reality they are at the time.

    Things happen. Learn to accept what you cannot change! Sometimes you have to learn to just ride the wave when it comes. Thats what gets you through an already stressful career successfully.

    Many time isolation precautions are for our protection (rather than the pt's) so don't get to hung up on that part. I understand your frustrations and can empathize with you, however I feel you missed my point.

    Stress is a leading cause of RN's deciding to end their career. If you don't figure out now while in nursing school how to limit it and accept that you cannot change everything and it is far from a perfect text book world, than I fear you will have a great deal of preventable stress not only in your nursing clinicals but as a practicing nurse as well.

    Who exactly was affected that day at your clinics? You or your pt(s)? That is a very important question to ask yourself on a regular basis.

    How did you next clinical day go? I am so sorry that you had a day like you did, but as I mentioned before the good ones make the bad ones much easier to bare.

    rags
  7. by   rags
    "But back to my previous statement.. how is that any different from the nursing staff going in there NOT dressed for isolation and then caring for their other pts.???"

    There are a lot of variables in the question. It would depend on who their pt's were or what they were in for rather. I also feel that as nursing students you should (as the op mentioned) make a mental note to assure you never do these things you find annoying.

    I feel you have your mind set and don't really want anyone to try to help you see things in a better light. I believe you wanted to post about your clinical day to vent about the 'bad' nurses and fellow nursing students you encountered that day.

    Was this constructive? No. Not usually. Were there any lessons learned from it? That's yet to be seen.

    If I'm completely off on your motivation please set me straight, but as it sits now thats the way your posts read.

    rags
  8. by   not now
    Quote from KimmieKoo72
    That is the procedure for someone who is in isolation, am I correct?.. You SHOULD be wearing a gown and gloves, a mask is your choice.. but you can wear it if u really want to. The nurses on this floor were going in and out of my pts. room without wearing any protective gown...This is really irritating to me, b/c I am a student and yet I am doing the correct thing? Not only are they not protecting themselves, but they are really pushing the limits of infection control...
    I'm sure the nurses on the floor were well aware of what infection control means. Some nurses do get lax after a while, you have to be aware of this and let it go. You are a student, do what you think is right and let them worry about themselves. When you become charge or the infection control nurse you can worry about it. As a student there really isn't much you can do other than complain and if you complain within earshot of the nurses they aren't really going to want to work with you.
    Being a student I have classmates that should be able to help me.. especially considering my classmates pt. load was alot lighter than mine....then they would NEVER show up. That REALLY irritated me b/c I have ALWAYS helped my classmates, no matter how busy I was.
    Needless to say, I will be letting my instructor know this... Nursing is alot about team work, although we all know that it is impossible to find that team sometimes!
    You may think that your patient load was more difficult but maybe they didn't. Maybe they were really struggling that day because their time management skills are lacking. Maybe things just came up and they couldn't get away. Where was the CNA? Where was the nurse? You can always ask them for help. By telling on your classmates you may just piss them off and finding help will be even more difficult.
    Then I had the nursing aide who thought she knew EVERYTHING. Gotta love it. She was telling ME how to document something I have documented a THOUSAND times before, and I wasn't documenting anything incorectly.. so whatever!!! Thank god today is over.
    Throughout your entire post you've come off with this "I know everything" attitude and this quote probably says it best. Where you documenting something that a CNA usually documents? You may have done it a THOUSAND times but that CNA documents it every.single.day. When staff that actually works at the hospital try to help you out at the very least be grateful that someone is throwing you a bone.

    You may be 3/4 of the way done with school but your still not a nurse. When you get your license you'll be a nurse but I guarantee you that you won't know squat compared to the more experienced nurses. Once you understand this and drop the attitude you'll find your peers and staff more willing to lend you a hand.
  9. by   rags
    FYI ~

    I looked up isolation precautions/procedures at work last night for C Diff (after I looked up exactly what the 'C' stood for because I honestly couldn't remember) and our facility doesn't have anything other than standard precautions. I did some further investigating on the internet and found that enteric precautions is the norm when one is implemented. The #1 risk for obtaining C Diff as a nosocomial infection is the heavy use of antibiotics.

    Thought that was interesting so wanted to share with others that may not have known.

    rags
  10. by   JaxiaKiley
    I'm starting clinicals in two weeks, and I'm already getting worried about strange situations, lol
  11. by   locolorenzo22
    Generally, isolation is a case by case basis....i.e. no reason to wear a mask if respiratory site is not affected, no reason to gown up if you have no chance of body fluid to contact you/your clothes, gloves-ALWAYS for sure....
    I'm the same classmate who is always happy to help out people by finding something, helping them learn a skill, demonstrating a technique, showing them how to work with the computer(as 2 or 3 have some trouble). I usually don't have any problems finding someone who will help if I ask, the catch is that if I ask, you say "sure." and then don't show....I'm less likely to help you next time you need it if it's not something major on a pt.
    When it comes to pt. load, when you have to do iso procedures....that eats up a lot of time right there with in/out/gowning, masking/etc.....staff makes their choice, students have none. We all usually have a line snaking out of the med room for 2-3 hours when we first get to clinical for 7AM, 8AM 9AM meds and some don't get given on time.....we give what we can. Then you have to round with doctors, get orders, prep pts for procedures...etc. It's a lot.
    3rd semester, we have to be nurse managers...responsible for EVERY student that has a pt. Little nerve wracking....
  12. by   KimmieKoo72
    Throughout your entire post you've come off with this "I know everything" attitude and this quote probably says it best. Where you documenting something that a CNA usually documents? You may have done it a THOUSAND times but that CNA documents it every.single.day. When staff that actually works at the hospital try to help you out at the very least be grateful that someone is throwing you a bone.

    You may be 3/4 of the way done with school but your still not a nurse. When you get your license you'll be a nurse but I guarantee you that you won't know squat compared to the more experienced nurses. Once you understand this and drop the attitude you'll find your peers and staff more willing to lend you a hand.[/QUOTE]

    I'm sorry.. I forgot that you were BORN WITH YOUR LICENSE. You're only 26... you have not been doing this too long yourself. I guess you must be "one of THOSE nurses." I also guarantee that YOU don't know squat compared to more experienced nurses.. and I am not saying that I know more than they do in any way shape for form.
    I guess that might piss you off that I am making that assumption about you... but you are making that same assumption about me. You know nothing about me, you have no idea what my demeanor is, or how much I do actually know. I think you need to drop the attitude. You didn't have not reply to this post... perhaps you were trying to vent as well?

    The nurses that day were no where to be seen when I needed them, perhaps they were busy.. okay I completely understand that. The CNAs were also MIA when I needed them. They had other pts., and I understand that.. I'm not frustrated with the staff for their lack of help, but in my fellow classmates. My classmates were in the hall drinking coffee and talking.. either that or they were behind the nurses station reading charts. And yes.. I did talk this over with my clinical instructor. Their pt. load was not very heavy either.. out of the 9 people in my group 7 of them had pts. that were fully ambulatory and able to care for their own needs. (we are not passing meds yet, so no, they were not busy getting meds, etc.) I asked for help, they would agree to come help me and then never show up. I would then have to de-gown and de-glove to go see if I could possibly find them, or someone else. EVERYTIME i found who ever I asked to help me behind the nurse's station reading charts! So no.. please stop making excuses for them, there were no excuses.

    As for isolation precautions.. our instructors tell us that we MUST gown and glove before entering a C-Diff room. This made it more difficult for me when I am trying to do pt. care, realize I have a holy mess to clean up and I can find no one to help me. Not to metion isolation gowns on that floor were hard to come by. To find help I have to de-gown, de-glove and go searching. You all know how c-diff is.. you all know what a mess it can be.. and how often you will have a mess to clean up... this is how my day was.
    We all have a bad day.. sorry I thought I could vent to other NURSES about this.. but instead I am having my ass chewed out, and told that I have an attitude and that I don't know squat. Very professional.
  13. by   rags
    Kimmikoo72 ~ This is a sad situation from the beginning. I am sorry that you were unable to see the advise offered to you from the posters who responded. I reread all the posts to be sure I remembered them correctly and still see advise rather than 'a@@ chewing'. It is too bad you couldn't see it for what it was and instead just became very defensive.

    I don't know how long 'not now' has been nursing but I can say that it really doesn't take too long to figure out what you learn in nursing school only makes for a good foundation and nothing more. Your true leaning will come when you with your first nursing job, from the nurses around you, when you are willing to let them give you advise and share their knowledge. "Not now" doesn't need to be a seasoned (with years of experience) nurse to have learned this valuable lesson already.

    I replied to you more than anyone else so feel you must be referring to my posts as well when you generalize what you feel you got as responses to your clinical day. What I offered you was sincere advise that will allow you to get through nursing school and be able to sustain an enjoyable career as well. You HAVE to learn to pick you battles and how to manage the stress. If you don't do that you won't enjoy nursing like you should.

    I would suggest you take a deep breath (number reliever of stress), open your mind to what exactly could have made this day a little easier to bare and realize what you need to let go, so your future clinicals are not a repeat of this one. Then I would go back and re-read the replies you received. There are some valid and invaluable advise in them.

    Good luck to you! I know you can calm down and see what is before you. You seem to be a bright student that truly cares about your pts. Now you need to concentrate on your own emotions and how to lower the stress level as well as how to work with others that may not do as you think they should at all times. They will be your coworkers and possibly your mentors some day and you will need them and what they have to offer!

    rags
  14. by   rags
    Quote from KimmieKoo72
    Not to metion isolation gowns on that floor were hard to come by. To find help I have to de-gown, de-glove and go searching.
    If the hospital protocol called for this pt to be in isolation there should have been an isolation cart with the items outside the pt room as well as separate container for their dirty linens.

    To me... this explains why the nurses on the floor were not gowning when they entered your pts room.

    rags

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