Appropriate Action?

Nurses General Nursing

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I am Nursing student with just over a semester until graduation, and I want your opinion on a situation that happened in clinicals.

A first-year student was discharging a patient who happened to be a gun shot wound victim. While he was removing the patient's IV, he was overheard telling the patient to "stop acting like a baby" when the patient complained of pain. He then told the patient that "if he was a big enough man to take a bullet, then he should be able to handle a little tape being pulled off his skin."

In the discharge papers the student prepared for the patient, he wrote down that perhaps in the future, the patient should avoid his current friend set, and stay outta trouble to avoid being shot at again.

This student knew nothing of the circumstances of the shooting; just offered his "helpful" advice.

The patient was, of course, outraged and reported the student to the unit manager. The clinical instructor who is a MSN, NP, was livid. She failed him on the spot and he has been expelled from the nursing program.

Although I thoroughly agree that his actions were wrong, I am wondering if the actions taken by the school were appropriate or not. Whaddya think?

This was what my school considered a Critical insantant. We were told on the frist day to NEVER document appoinons on pts. #1. and if we were to talk to a pt that why our director's head would have spun. She could look like the girl in the exersist when she was ticked off.:roll

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Specializes in Critical Care, Pediatrics, Geriatrics.
where I live it's illegal to shoot people, may be different where you live.

what? the student didn't shoot the patient just gave very poor judgemental advice. that is not a crime

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what? the student didn't shoot the patient just gave very poor judgemental advice. that is not a crime

Lordy .... you need to reread the OP. Ask yourself...Why is the patient in the hosp?

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what? the student didn't shoot the patient just gave very poor judgemental advice. that is not a crime

Here is a hint

A first-year student was discharging a patient who happened to be a gun shot wound victim.
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The fact is that as nurses we are not their to provide judgement towards are patients. We are there to provide the best quality of care we are capable of in a nonjudgemental and unbiased manner. It's one thing to vent with colleagues, it's another thing to convey that negativity towards a patient.

he was overheard telling the patient to "stop acting like a baby" when the patient complained of pain. He then told the patient that "if he was a big enough man to take a bullet, then he should be able to handle a little tape being pulled off his skin."

I think we have all met patients who we did feel were acting like babies or drama queens. It's one thing to think it, it's inappropriate when we convey that attitude or express it towards the patient.

In the discharge papers the student prepared for the patient, he wrote down that perhaps in the future, the patient should avoid his current friend set, and stay outta trouble to avoid being shot at again.

My concern with the original post in regards to that situation, is that the student is conveying his own negativity and judgment towards patients at this point in his career. It doesn't matter if the patient was shot committing a crime and has police stationed outside/inside his room. How would this person respond to a victim of domestic abuse? Would he write in his discharge instructors to "leave abuser," "stop asking for it," or "don't anger your abuser?"

Chances are this was not a first time incident with this student, which was why he was expelled.

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Specializes in Emergency/Trauma/Education.

Where was the RN? I wouldn't think a student would be doing the "discharge teaching" without supervision!

And other respondents are correct: we probably don't know the entire story. I've joked with a patient for being timid about getting blood drawn...you know, the patient with the ump-teen piercings & tattoos! It all depends on your rapport with the patient & being aware of their feelings.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
The fact is that as nurses we are not their to provide judgement towards are patients. We are there to provide the best quality of care we are capable of in a nonjudgemental and unbiased manner. It's one thing to vent with colleagues, it's another thing to convey that negativity towards a patient.

Wow. The voice of reason!

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Specializes in Emergency Dept, M/S.
I have to question whether or not those discharge orders actually made it to the patient. Our instructors never allowed anything in writing to go anywhere near a chart or a patient without their prior approval. Makes me think that there's more to this story...

I question that myself. As a first-year student, I NEVER wrote any discharge instructions. I was present WHEN the RN went over them with the pt, but never wrote any. And why would they let a SN discharge a pt. w/o the instructor or RN be present?? Strange.

But, I do agree with his dismissal from the program. It's not our place or duty to pass judgment on how these people live. I've taken care of a pt. recently with a GSW, and only found out from news reports that this person was totally innocent in anything. My job was to take care of them, not delve into the law enforcement aspect of it.

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Specializes in Critical Care, Pediatrics, Geriatrics.
Here is a hint

May I remind you that this discussion is about the acts of the student towards the patient. No one from what I have read has addressed that the gun shot wound was not a crime. Some posters implied that the actions of the student were a crime. Am I missing something here?

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Specializes in Critical Care, Pediatrics, Geriatrics.

Very Plain Jane,

Ah...I misread your post. Much apologies. By crime, I thought you were referring to the student's actions, not the gunshot wound. Of course the gunshot wound is a crime:wink2: haha.

you said:

I agree with the actions of the school. This patient was a victim of a crime! The nursing student totally disregarded the emotional trauma that the victim may be suffering from, and open the hosp. and school up to litigation.

In this case, I am in total agreement with you. The pt had suffered enough trauma and the actions of this student were extremely inappropriate. But the dismissal....well I am still on the fence about this one. IF this was his/her only offense then I would think it was a little harsh. But if there was a history of odd behavoir and contradiction/disregard for what is taught in school about being non-judgemental and accepting and documenting properly, well then dismissal is absolutely appropriate.

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Specializes in Critical Care, Pediatrics, Geriatrics.
Where was the RN? I wouldn't think a student would be doing the "discharge teaching" without supervision!

during my clinicals we do. We ARE the RN. Instructor may do a quick run thru with you before you go into the room, but if she feels you are competent or have done it before she turns you loose. But my school strives for a high degree of excellence and they make it clear to that should we deviate from the principles taught when communicating with a patient that serious consequences will occur as a result.

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Specializes in Emergency & Trauma/Adult ICU.
during my clinicals we do. ... Instructor may do a quick run thru with you before you go into the room, but if she feels you are competent or have done it before she turns you loose.

I also discharged a number of patients as a student nurse. My instructor and/or the RN assigned to that pt. would go through the d/c instructions as I was putting them together, making sure I had all prescribed meds, follow-up appts. etc. ... but the actual wording was left up to me and it was assumed that I would word things appropriately.

I deal w/crime victims on an almost daily basis. For some, the word "victim" would have to be used very loosely. It's part learned skill, and part art ... communicating in a way that is non-judgemental but also acknowledges the pt.'s lifestyle in a straightforward manner, in order to suggest possible alternatives. Most often, these suggestions go "in one ear & out the other", as my grandma would say ... but you have to persist. Once in a while, you're in the right place at the right moment & someone will be receptive to what you're saying.

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