Advice for student nurse regarding staff RN problem

[RADIATION_RN]

Hello all,

I wanted to post this in the nursing forum because I wanted nurses opinions and advice on the problems I encountered during my clinical last Friday. I am just starting level 2 of an ADN program and we have 12 hour Friday clinicals from 0630-1830 on a busy 60 bed Med/Surg unit. Background on myself, I have been working in the medical field since I was first out of high school in 1997 doing unit clerk/clinical assisting on a busy GYN/Oncology unit until 2003 when I moved to Austin and got a job at an outpatient radiation center and have been there ever since. I also do PRN work on an oncology floor at a hospital also while attending school. I felt the need to say this because I have worked around nurses for years. I know how crazy the job can be. Here's my awful experience in a nutshell :

Friday I get to the floor early so I can see if there were any new orders/meds on the patient I chose the night before. I called and listened to voice report to get the update from the night shift and waited outside my patient room for the primary RN to come by. When she did, I introduced myself and told her what I would be doing that day and the skills I was able to perform. I also wanted to make sure she knew of my experience so she would hopefully have a little faith in me and I would try to stay out of her way but still keep her updated. She cut me off and tells me "Yeah yeah, I don't have time for this, I have three other patients to see." Okay, so I just shrugged it off as maybe bad timing on my part, or she just wasn't a morning person. I then asked her if I could have her cell phone number in case I needed to reach her during the shift. She replies "no, no, I hate that thing, if you need me come find me." Once again, okay, whatever makes your shift easier, I only have one patient and you have four. From reading all the nurses on here talk about students and what a pain they can be it gave me a better understanding of how much extra burden we can be.

The day goes on and my patient is doing great. Going to be discharged some time after 1700. I asked her if I could help her do anything and she kept telling me no. She then proceeds to sit down next to me outside my patient room door and tells me "I don't think you students realize what a tough job we have as nurses". Then tells me all the hospital drama and how bad their nurse manager was and "even though I have been a nurse for 15 years I still get called into the principal's office for things I didn't do." Adding to it how unhappy most of the nurses on the floor were and how many nurses they had lost in the last few years. I just kept nodding and smiling.

The day kept going up and down in moods. One minute she would be in a bad mood and then the next she was inviting me to watch her start an IV. So I asked her what med she was drawing up and she tells me "oh no, you don't see this". Confused, I asked why and she tells me "this is lidocaine and we are supposed to have a doctor's order for it but I'm not doing that, I'm just going to give it because this IV start will hurt the patient because I need a larger needle". So I followed her in the room and watch her stick the site with Lidocaine...no gloves...then swab the site with alcohol still thinking she was going to stop and put on goves...nope, she starts an IV in the mid bicep area which was a gusher. She then yells at me to run and get gauze. Still...no gloves. WOW!!

Later on when our patient was getting close to discharge the doctor wrote an order for Mag Citrate po x 1 then DC to home after BM. (She hadnt had a BM in 4 days even with Milk of Mag and Surfak). I went to chart that we had orders from MD and was going to give Mag Citrate when I see the nurse charted in quotes : 1230 - "I already had a large BM", MD notified. Confused, I went in the room and asked if she had a BM. She said no, so I give her the Mag Citrate and in 15 minutes...SUCCESS!!! The patient was so happy. I still charted what I did and the success it gave.

The RN then asked me later if I could take out her foley. I said I could but I needed my instructor in the room. I found my instructor and she asked me if there was an order to DC foley. I said no, there was an order to DC to home. She said she would not let me DC the foley without a specific order. I dreaded telling the RN but I did anyways. She sighed heavily and flipped to the order sheet and wrote "DC foley" in the space above the MD signature. She sees my face and just tells me to nevermind she would do it.

In post conference I told my instructor everything that happened and shockingly she didn't seem surprised. So after this long rant I ask ya'll....at any time did I ever have a right to question the RN on these things? Do I as a lowly nursing student have the right to question a "veteran" nurse or is that a no no? I have to be on this unit for another 14 weeks and I don't want to be "that student who told on the RN". Are the things that happened everyday occurences that I am just not used to? What should I do if I am ever with her again? Thanks in advance.

[nerdtonurse?, BSN, RN]

You were seeing real world, not school. I've never given a med that wasn't ordered, but I see nurses routinely pull off the fingertip of a glove to better palpate for an IV start -- I don't, but I'm not that good of a sticker, either, so maybe that's why. I've thrown down NGTs on someone with projectile vomiting due to an obstruction and put it to suction, pulled foleys on someone to be DC'd -- they're a walkie-talkie going home, you know the doc didn't mean for them to go home with one, and you call for an order to specifically dc a IV or foley, you will get screamed at by the doc for not thinking for yourself and then probably pulled into your boss's office because you bothered a doc for something "stupid." On a test, you do it by the book. Boards, by the book. Real world's different.

And by the way -- the mag citrate? It makes you have a lot of diarrhea, the poor thing probably pooped all over the car on the way home because the "dam" had let go.

[OCNRN63, RN]

I was thinking the same thing about the Mag. As a student, I would never have given that when you have contradictory information. I would have clarified it with the staff nurse and maybe run it by my instructor.

[xtxrn, ASN, RN]

Yeah, I definitely would have talked to the instructor. You do have every right to ask questions...sometimes of the staff nurse- and if that's not working find your instructor. That keeps you out of the middle of any of the staff nurse drama. I'm sorry you had that experience. :heartbeat:twocents:

[cpl_dvldog]

Here is the situation you find yourself in: You learn to do it the correct safe way in school. The way that is safest for your patient as well as yourself and license. While you are learning the mechanics of how to be a nurse you are constantly exposed to how to do things the wrong way. As a student or new nurse you don't have the skills or experience to side-step rules and know which will bite you in the butt. I can guarantee if you ever screw up, or get caught doing it "their way" not a single nurse on the floor will speak up and admit that is what you observed. I have not called a Dr to clarify an order or asked a Dr about something that may have been left off an order and been screamed at. Maybe it is because I am male and stand about a head taller than many of them, or maybe because they figure if they scream at me something else may happen rather than me go to the breakroom in tears trying to compose myself.

My advice is do what you are taught in school only. If you are asked to violate a policy then decline. As I said before it is your butt if you get caught. Hospitals do mind banning students and schools do not mind dropping students for safety violations. The name of the game is cover YOUR ass.

[Nascar nurse, ASN, RN]

I would like to suggest you scroll down the thread line and find the thread "Should I report this..." by Ruby Vee

Agree with the others about the Mag Citrate. Hope he/she made it home OK.

The foley... No way, No how would I have EVER called the MD to ask if the foley was to be D/C'd prior to discharge. Unless there was some kind of urology procedure involved you know it's a very good chance it was just an oversight on the discharge orders. Every Dr. I know would throw a fit if called for this.

You will see many things during clinicals that you may not agree with. Sometimes you will be right (it is being done wrong) and sometimes you will be just an inexperienced newbie that has not learned the ropes yet. Go to your instructor. Later when you are practicing you will get to decided the kind of nurse you will want to be. But for now, you don't have any say in the practice of others.

[xtxrn, ASN, RN]

here is the situation you find yourself in: you learn to do it the correct safe way in school. the way that is safest for your patient as well as yourself and license. while you are learning the mechanics of how to be a nurse you are constantly exposed to how to do things the wrong way. as a student or new nurse you don't have the skills or experience to side-step rules and know which will bite you in the butt. i can guarantee if you ever screw up, or get caught doing it "their way" not a single nurse on the floor will speak up and admit that is what you observed. i have not called a dr to clarify an order or asked a dr about something that may have been left off an order and been screamed at. maybe it is because i am male and stand about a head taller than many of them, or maybe because they figure if they scream at me something else may happen rather than me go to the breakroom in tears trying to compose myself.

my advice is do what you are taught in school only. if you are asked to violate a policy then decline. as i said before it is your butt if you get caught. hospitals do mind banning students and schools do not mind dropping students for safety violations. the name of the game is cover your ass.

:hhmth:

[CharleeJo.RN]

Yes, they are all right. The bottom line is - ALWAYS - cover *your* ass. That means you ask questions to clarify anything ambiguous or not seeming right, and doing things the correct & safe way until you've reached that point in your career where you know the safe way to sidestep things.

I've been in similar situations too, as I'm a fairly new nurse and recently finished with my ADN. You just have to always go by your comfort level and if you know that something is being done that isn't "by the book" then DON'T do it. It will be your butt, not anyone else's, if something goes wrong or someone catches wind of it. And everybody else will be satisfied with your role as the scapegoat, so long as they are safe and sound.

Good luck to you and don't let yourself be jaded by other people's misery. Some people truly don't belong in the nursing profession. Just do what's right, safe, and ethical - your patients can only benefit from it.

[Ruby Vee, BSN]

many of us learned to start ivs without gloves . . . shocking, i know! of course, you're learning how to start ivs with gloves and that is definitely the better practice. don't always need to have a doctor's order to use the lidocaine -- sometimes it's part of a protocol. the wise thing would be to pretend you didn't see either one of those things.

taking a foley out of a patient going home is just common sense . . . unless, of course, the doctor actually meant for them to be discharged with it. if that were the case, there'd be an enormous amount of teaching, supplies and preparation. your nursing instructor may not be allowed (by what ever protocols cover her) to take out a foley without a specific order. i'll bet the floor nurse is.

as far as the mag citrate . . . let me get this straight. you went behind the nurse's back and gave mag citrate to a patient about to be discharged? i hope she didn't have far to go -- or that she had plastic seat covers on her car.

as near as i can see, there's a student nurse problem, not a staff rn problem. you're going to school and learning the way things ought to be . . . if there were plenty of staff, lots of time to do things the right way and the doctors all wrote the orders they were supposed to. when you get out into the real world, things will be different. you're seeing that now. get used to it, or you'll be on here complaining about being "eaten".

[wooh, BSN, RN]

I'm VERY laid back. You can get away with about anything when I'm around. But don't you DARE go behind my back when it comes to MY patients.

However much experience you have doing whatever, THAT nurse was the one LEGALLY responsible for THAT patient. If anything, YOU should have your a$$ kicked out of nursing school for going behind the nurse's back and doing something she didn't want done. I don't care what she's doing or not doing or how wrong you think it is. I found out about that on my unit, you'd not set foot on my unit again.

Something bad happens to those patients, you know who is responsible LEGALLY and ETHICALLY? The nurse. You're a GUEST in her world. You only get to touch those patients, go near those patients, practice on those patients because she allows you to do so. I don't give a flying rat's petoot how much you're paying your nursing school and how smart you think you are. YOU WERE DEAD WRONG. And EVERYTHING you want to say about that nurse lacks any credibility coming from someone with such poor judgment as to go behind the staff nurse's back on their clinical rotation.

IF you get out of school and pass your NCLEX and have your own patients, how would you like it if some stupid person off the street went behind your back and did what you did?

[SummitRN, BSN, RN]

My outlook as a SN:

You gave the med without the approval or verification of your assigned staff nurse or instructor???? On top of that it was unclear whether it was indicated??? What you did would be either impossible (secured meds) or an automatic failure at any facility I've been to.

As to your implication that the RN lied in her report that the pt had a BM when the pt stated otherwise, that is a perfect example of when to ask your preceptor.

That said, it sounds like your nurse was just a real world nurse from the old school who was either having a bad day or just has an attitude.

Everyone tells the basic rules of clinical like "show up on time, be professional, accept criticism as learning, be pleasant" etc etc. Here are MY personal practical rules to maximize clinical my experiences:

1. Don't ever do things you aren't supposed to as a student, but do watch.

2. Don't expect a RN to operate in NCLEX fairytale land. But do ask them about it later.

3. Learn while being helpful, not burdensome, and you'll get more opportunity to learn.

4. Problems follow the chain of command, otherwise you get beaten with said chain. (Corollary: crap flows downhill)

5. Overwhelmed RNs often become super enthusiastic to teach you things if you offer to do tasks you don't have to do and they don't have time/want to do. They pay back your time with their experience.

I'm sure my list is imperfect, but it works pretty well.

[linearthinker, DNP, RN]

WT-Ef? Students are giving med independently now? Oh he// no, not to any of my patients they are not. I have never heard of such a thing. That would be the last time you took care of any patient of mine.

Students don't get it. You are not entitled to be there. You are not entitled to anything. It is your privilege to be there; abuse it like this and you are going to lose it.