I am a second quarter student in an accelerated BSN program in my second clinical rotation. My clinical is a preceptor-style -- I am paired with an RN, I have one of his/her patients, but am allowed to assist with other patients as my time and the RN allow. I can do pretty much everything on my own except a few skills, anything brand new, or anything I feel I need supervision for, so I am a pretty low-maintanence student. I am always prompt about letting the nurse know what I have done to make sure everything gets covered. Usually this all goes well and I have never had a negative experience until Friday. I'm very frustrated by it and am just trying to get an idea if I acted inappropriately or if it was just a bad day.
The nurse I was paired with was having a bad day. Night shift dropped the ball on several tasks so she and I played catch-up for several hours. Issues arose on my patient, her other two were critical... it was nuts. My patient was relatively easy to care for, and not very time-consuming. She had a few IV push meds, mostly pain killers, about one every hour. I did the assessments, the charting, but there were times when nothing needed done and the patient was resting.
I helped a few of my classmates with their patients since I was caught up, and every once in a while (maybe once every two hours) I would ask my RN if she needed me to help with anything, and she always said no. Finally toward the end of the day I asked her "Is there anything you'd like me to do" and she looked at me and simply said "I could say something right now, but I won't" and went into a patient's room. I was somewhat hurt by this (I can only assume what she wanted to say was something along the lines of "leave me alone"), and I tried to stay out of her way. However, my day on the floor was coming to an end and I never leave without reporting off to my nurse to let her know of any issues with the patient, the patient's status, etc. I feel it would be irresponsible of me not to. But after the comment she made, she avoided me like the plague.
Had the patient been totally fine, I guess I wouldn't have worried as much, but during a chaotic moment my nurse had turned off the pt's TPN infusion, and didn't turn it back on. I assumed she had a reason for turning it off, I didn't realize what a potential problem it could be at the time, so when I mentioned that it was off before I left, she panicked. She asked me to flush the pt's PICC line (there were 2 ports... one was running TPN and the other was running the carrier for the pt's PCA). I tried, but it was occluded. My instructor and I changed the port valve, but it still wouldn't flush. The nurse did tell me to switch the lines (because the TPN was more important) but I was concerned that now my pt was without pain medication (that she had been using regularly). So I needed her to know that the line was still clogged, the TPN was resumed, but the pt now had no pain medication. Every time I opened my mouth she would just say "I can't handle this right now." Finally I told my instructor about the communication problem and SHE told my nurse what I had done and what we tried. Once again I tried to report off and started out with "Well, we're leaving the floor, so--" and she cut me off and said "Thanks for the help" and turned around and walked away.
So I guess I'm trying to figure out if I was the cause of my nurse's avoidance of me, or if she was simply scrambling and was not intending to behave this way. She did commend me twice (and told my instructor) for how I behaved/acted around the doctor who had to come help my patient with an emergent situation and barked orders left and right. I was only asking her if I could help because I was caught up on my work and thought I could be of use. I wasn't asking for anything in particular -- if she wanted me to clean bedpans or get supplies, I would have done so. But I felt like my asking was just an annoyance.
So, back to my title -- was I wrong to offer my assistance to the RN? Should I have simply minded my own patient and, when nothing needed to be done, read the chart or go sit in the breakroom until it was time for the next assessment or med pass?
Usually I'm good about "leaving clinical at clinical" but this has been bothering me all weekend, and I'd like some perspective of what you want (or don't want) a student you're working with to do, so I know how to handle this type of situation in future clinicals.
