Assigned to patients with conditions VERY unfamiliar to you

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  1. This is a discussion on Assigned to patients with conditions VERY unfamiliar to you in Nursing Student Assistance, part of Nursing Student ... Here's the situation... Suppose you're a new nurse and, at start of shift, you're assigned to...

    by Jan 15, '11
    Here's the situation...

    Suppose you're a new nurse and, at start of shift, you're assigned to patients with illnesses/post-op procedures/diagnoses/etc. that you are very, very unfamiliar with (or, worse, you haven't even heard of these conditions before).

    It's start of shift and the rest of the health care team is busy organizing for the day which means they probably don't have time to help you. How would you best proceed? Remember, you're a new nurse and not a student any more so that means...no preceptor to run to and you're on a busy unit.

    I know it's a general question so, I'm not expecting specific answers but it's a situation that is bound to happen to nurses at some point.

    I was actually asked a very similar question during an interview (I JUST graduated, which is why I'm posting in the "student" section). I had difficulty answering this question and, even after coming home, I'm still not sure.

    What might be an appropriate "job interview" answer? Would you do a quick Google search before you saw your patients? Request a change in assignment (not always possible)? Any comments/thoughts with rationale would be much appreciated.

    Thanks.
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    by winzer Jan 15, '11 6:17 pm
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  3. 11 Comments so far...

  4. Jan 15, '11 by
    The nurse you get report from should be able to give you some information. Occasionally it happens, a patient gets admitted with a diagnosis (or has a chronic condition) where your response is "UHhh, what the heck is that?" The previous nurse should be able to fill you in a little, and then when you get a chance, you look it up on the internet.

    I always ask wikipedia. It typically has the best, most comprehensive information, with links at the bottom to other pages and the references. I've seen our newer docs/NPs use wikipedia, too.
  5. Jan 15, '11 by
    The hospital I do my clinicals in has older nursing textbooks lying around - in an interview, I would respond that I would refer to them for the patho-phys and nursing interventions. When getting report from the nurse, I would ask him/her to briefly explain the condition if I were unfamiliar with it. I would also Google it and use a reputable medical website for a quick run-down prior to meeting the patient.
  6. Jan 16, '11 by
    If you're going to use wikipedia, just use it as a starting point. If you're reading a page and you see an edit button, think about it: any clown on the whole planet could have just inserted factual errors right before you clicked on the page.
  7. Asst. Admin
    Jan 16, '11 by
    The correct thing to do is to refuse the assignment, since you are not safe to care for these patients. (This is probably the answer they were seeking.) Patient safety is always number 1! If you must, call the nurse manager to come to the unit to straighten things out, but do not accept care for these patients. The shift assignment needs to be re-arranged with a group of patients more appropriate to your level of skill and expertise. At the very least, another nurse should be assigned to be alongside you to help you with the unfamiliar skills and the intricacies of the patients' medical diagnosis. What you don't know can KILL your patient. (For instance, you never give a child with a cyanotic heart defect and corrective shunts high-flow oxygen - it can kill! If a child with Tetrology of Fallot, for instance, starts turning blue or purple, instead of giving O2, you push the thighs/ knees up to the chest.)

    As for consulting Wikipedia... bad idea. This is not a scholarly source, but one that literally anyone on the Internet can edit or add to... full of inaccuracies. Trust me, they will not be impressed at all if you give this answer. http://www.msnbc.msn.com/id/17740041/
    dudette10 likes this.
  8. Jan 16, '11 by
    Wikipedia is a great resource that is probably more up to date and reliable than most textbooks. True, anyone can edit. However, the self policing on wikipedia is amazing, fast, and accurate. Frankly, anyone can write a book, too.

    However, I would like to amend my previous statement. I would not state I would reference wikipedia in a job interview. I would say that I would ask the previous nurse, check the H&P, and use the available unit reference. Most units have multiple texts available, and some even have online resources for staff (our hospital has it, but only the physicians have passwords).
    VickyRN likes this.
  9. Jan 16, '11 by
    Quote from VickyRN
    The correct thing to do is to refuse the assignment, since you are not safe to care for these patients. (This is probably the answer they were seeking.) Patient safety is always number 1! If you must, call the nurse manager to come to the unit to straighten things out, but do not accept care for these patients. The shift assignment needs to be re-arranged with a group of patients more appropriate to your level of skill and expertise. At the very least, another nurse should be assigned to be alongside you to help you with the unfamiliar skills and the intricacies of the patients' medical diagnosis. What you don't know can KILL your patient. (For instance, you never give a child with a cyanotic heart defect and corrective shunts high-flow oxygen - it can kill! If a child with Tetrology of Fallot, for instance, starts turning blue or purple, instead of giving O2, you push the thighs/ knees up to the chest.)

    As for consulting Wikipedia... bad idea. This is not a scholarly source, but one that literally anyone on the Internet can edit or add to... full of inaccuracies. Trust me, they will not be impressed at all if you give this answer. http://www.msnbc.msn.com/id/17740041/


    im not sure they would be seeking that answer.. how would a new nurse be able to grow and learn if they deny all new experiences.. of course you would have to do some research and always ask a more experienced nurse for advice.
    QBoroRN, ktliz, and BluegrassRN like this.
  10. Jan 16, '11 by
    Quote from ashleyisawesome
    im not sure they would be seeking that answer.. how would a new nurse be able to grow and learn if they deny all new experiences.. of course you would have to do some research and always ask a more experienced nurse for advice.
    But a new grad nurse's need to learn does not supercede the patient's need for a nurse who knows what to do. For a new grad nurse, just taking care of a full load of patients with more common conditions is the "new" experience. It's baby steps to experience, really.

    Maybe the answer they were looking for was a combination of refusing the assignment but showing a commitment to researching the condition and nursing interventions so that one could be prepared for a similar assignment in the future.
    VickyRN likes this.
  11. Jan 16, '11 by
    Thank your for all the replies. I think when it comes to situation like this, you really have to fall back on the basics and one of the fundamental concepts I was taught in nursing school was patient safety (remember the rights of med administration? Right reason, right knowledge, etc. etc. same applies to this situation I think).

    I don't think anybody wants to hear that the new grad nurse "can't handle it" and wants a reassignment but, as another poster suggested, that's probably what might happen in reality. But combine that with what dudette10 said about showing commitment to research and prep for next time gives a more well-rounded answer as well.

    During my interview, I answered that I would seek help from my fellow RN colleagues and, failing that, would bring up the issue with the charge nurse. However, I didn't elaborate enough and didn't go so far as to say I would decline the assignment and request reassignment nor did I say I would research it for next time...a pretty so-so response on my part.
    noyesno and BluegrassRN like this.
  12. Jan 17, '11 by
    I think they were looking to see that:

    1. You aren't afraid of challenges

    However:

    2. You wouldn't take on a challenge if it would jeopardize patient safety, if the health care team is too busy to help, you would make them, make time

    I would have had a hard time answering that question well on the spot.

    You emphasized safety in your response so that's good.