Advice for student nurse regarding staff RN problem

Nurses General Nursing

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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.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

the nurse documented that the pt had a bm that the pt said they did not. who knows why....maybe she could dc this pt faster?

patient's do not always tell the truth. and some patients are bowel-obsessed . . . they come into the hospital with a bagful of laxatives and are discharged wanting more. the op didn't know the patient . . . i'm betting the nurse did. and even if the nurse was charting falsely, does the student really want to get mired in that whole situation?

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i have a quick comment to make about the foley (i must admit, i did not read every sentence of every other post, so i apologize if this was brought up before). after the foley comes out, you need to make sure they can urinate on their own. the foley cannot be d/cd and have the pt immediately discharged. as for removing the foley, i would not have done what the nurse did (squeeze another line--her own order--in before the doc's signature), but i would most likely not have called either, unless their admission was gu related (turp for instance) or they had some other issue with it while they were there.

i don't know how often it happens, but patient's are discharged immediately after a foley is d/c'd -- with instructions to call the doctor and/or return to the hospital if they don't void within 8 hours. i've got personal experience with that one.

Specializes in Radiation Oncology.
I commend you for handling the critique (which I agree with) so well. When you work as a nurse you will have these same types of issues and your attitude makes all the difference. I have a feeling you will be a really good nurse.

Thank you! I really should've proof-read my post before I posted. I was just flustered because I had typed out a long post stating everything and then when I send "submit" it had an error. :confused: So again, I apologize if it made it look like I did something behind the back of my primary RN.

It's not that students are an inconvenience, because they are not. I had RNs each me, and its my turn to do it in return.

Don't let this rub off on you, just learn from it.

It is a good thing you noticed what this RN did was wrong. because it means you won't be doing it in your practice.

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I call B.S. on this- give her a few more years to become an expert and watch her make her own call/judgments, but this time informed judgments.

Specializes in Cardiology and ER Nursing.

Show up, keep your mouth shut, and do what you are told (within reason.) Is a pretty decent strategy for approaching clinicals.

Specializes in Emergency, Telemetry, Transplant.
i don't know how often it happens, but patient's are discharged immediately after a foley is d/c'd -- with instructions to call the doctor and/or return to the hospital if they don't void within 8 hours. i've got personal experience with that one.

certainly not going to argue about what is or is not done, but doesn't it seem easier and less of a drain on healthcare resources if the pt does not have to make an er visit because they could not void?

Certainly not going to argue about what is or is not done, but doesn't it seem easier and less of a drain on healthcare resources if the pt does not have to make an ER visit because they could not void?

How often does that happen? Hold a patient for 6-8 more hours than necessary, tying up a bed, keeping them someplace they don't want to be, or send them on home and on the off chance they can't void, then they come back.

Besides, it's easier to pee at home when you don't have someone coming back in the room every little bit, "Have you peed yet? Yet? Yet?"

We don't make all of our patients take a dose of PO antibiotics, "just in case" they're allergic or throw it up. We send them home and tell them to call if there's a problem.

I want to see some EBP on this!!

Specializes in FNP.

I want to commend the OP for taking her licking and learning from it. Do't see that often, and it is really refreshing. You will go far, grasshopper.

Specializes in ICU.

I have noticed some nurses on here seem to forget as nurses we do not make medical decisions, such as DC a foley or IV. That is outside the scope of our profession. If you make a medical decision of any type and it is the wrong decision who is going to back you up on it? The Dr? Nope. The hospital? Ha! fat chance. If it ends up in court they will supply an attorney to protect them, not you. As sue happy as people are today I would not take a chance, no matter how small it may seem.

Specializes in LTC, Psych, Hospice.
I want to commend the OP for taking her licking and learning from it. Do't see that often, and it is really refreshing. You will go far, grasshopper.

Ditto! It takes a big woman to admit when they are wrong. Kudos to the OP

Specializes in ICU, Telemetry.

The OP has one of the traits of a successful student and successful nurse -- they asked for feedback and evaluated in light of it. That's how you learn in the time after school!

Unfortunately, I see a lot of students who are so sure they're right they'll sit there and argue with you that metoprolol is for nausea and metocloprimide (reglan) is for BP. I've seen it, and was completely floored.

Good luck to you, OP!

Specializes in FNP.

Nerd: Yup, I agree.

cpl: I never worked in any environment that required an order to do the obvious.

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