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?

Specializes in ICU, telemetry, LTAC.

This is a "you had to be there" moment. Tone of voice, manner of pulling the tape off, etc. were not conveyed in the original post, as well as a complete picture of this student's performance up to that point.

On the other hand, I've pulled mountains of tape off people, as well as all kinds of other stickery things (ekg stickers are worse) and never had the urge to say something like that to a patient. "I'm sorry" seems to come out of my mouth a whole lot, you really can't go wrong with that. Besides, I'm a baby and if I don't like it, I know the patient shouldn't have to like it.

The incident as reported seemed to point at a lack of empathy on the part of the student. So the root of the problem, if that is what it is, can be a serious deficit for a nurse. Not that we are all models of caring but we can show some basic consideration for patients as people.

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Specializes in Emergency Dept, M/S.
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.

Well, technically you are not the RN, you're the SN.

I just question a first-year SN doing discharge teaching without supervision. My school strives a high degree of excellence also, but we would not be unsupervised to discharge a pt w/a GSW, like it sounds this one was.

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Specializes in Critical Care, Pediatrics, Geriatrics.
Well, technically you are not the RN, you're the SN.

I just question a first-year SN doing discharge teaching without supervision. My school strives a high degree of excellence also, but we would not be unsupervised to discharge a pt w/a GSW, like it sounds this one was.

you know what I meant. That there is no nurse supervision. The student acts as if they are the nurse and responsible for all nursing duties. If the facility we are at has CNAs, we still do the work that they would do...total pt care.

The instructor/nurse can't supervise EVERYTHING a student does and it seems to me that discharge teaching should be simple enough to allow the student to do it on his/her own, whilst the instructor watched another student perform an invasive procedure or the nurse was attending to another patient.

Obviously, if this student cannot appropriately complete this task without supervision that is a red flag.

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i think the school did the right thing. and that iv tape hurts commign off. and how the hell does the nurseing know how a gun shot wound fells . he doesnt know how the guy got the wound maby the guy was mugged or something. pluse he was aussuming that the guy was a crimal or something if he was like if you can take a bullit then taking some tape ioff sohuldnt hurt. anyways skin is senstive espical wehn you take hari off witht eh tape.

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this student should have definately been expelled. We had students do way less harm than that at our school and were let go. I would not want that student to take care of anyone in my family and what would it say about a school who allowed them to graduate, They have a responsibility to graduate nurses who treat the patients with respect and empathy. The instructors did the right thing

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Specializes in Urgent Care.

oops

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Specializes in Urgent Care.
this student should have definately been expelled. We had students do way less harm than that at our school and were let go. I would not want that student to take care of anyone in my family and what would it say about a school who allowed them to graduate, They have a responsibility to graduate nurses who treat the patients with respect and empathy. The instructors did the right thing

Sorry, I dont see the harm the student did here. Not the correct way to deal verbally with the pt, and certainly not PC to be making judgements of the pts friends.

If there was "harm" to the pt, can someone please point out the SPECIFIC harm done?

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I'm with you, Balder, I'm having a hard time identifying the actual "harm" that was done to the patient. It was very poor bedside manner and the advice (though sound) was somewhat flip & beyond the realm of what the student probably should have offered.

As for the patient being a traumatized victim of crime, the OP was up front about not knowing the circumstances of the gunshot wound. It could just as easily been a hunting accident or even self inflicted by careless gun cleaning technique. It seems we have all jumped to some conclusions also.

If this student was expelled from school, instead of being educated about what to do (or not do) in future interactions with patients, then I hope there were previous existing problems that weighed heavily against him in this decision. Otherwise, I think the school & instructor fell far short of their responsibility to teach him to be a better nurse. None of us entered school on day one already being perfect care providers. It took hard work on our parts and on the parts of our instructors, but together, we made it.

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