Clinical concerns

[motivated2nurse]

Im now in my second year of an ADN program. In clinical we are assigned to do total care on one patient. When I look at the other nurses I feel as though I wont be ready when I graduate because one patient is not reality. I try to follow the other nurses around and find that nurses do not do total care, but pass meds, chart, and call doctors, mostly. I have yet to see a nurse actually have a conversation with the patient. In fact, some nurses get annoyed if the patient talks to them because it "slows them down". It kinda of disheartening. I really want to be prepared when I graduate. I think Im sorta in a reality shock moment. Any advise?

[Daytonite, BSN, RN]

when i look at the other nurses i feel as though i wont be ready when i graduate because one patient is not reality.

i worried a lot about this as a student 30+ years ago. but, believe me, as a learner you need this slower pace to think about and digest what you are seeing and observing. when you go out into the working world, it is indeed going to be so busy that you won't have the time to stop to look up a procedure, or go down to radiology with a patient and watch an interesting x-ray being performed or make rounds with an interesting doctor who is willing to teach you today. enjoy your days as a student and soak up as much knowledge as you can. here's some advice that is given to medical students from

http://meded.ucsd.edu/clinicalmed/thoughts.htm

:

• learn from your patients. in particular, those with chronic or unusual diseases will likely know more about their illnesses then you. find out how their diagnosis was made, therapies that have worked or failed, disease progression, reasons for frustration or gratitude with the health care system, etc. realize also that patients and their stories are frequently more interesting then the diseases that inhabit their bodies.
  
  
• become involved (within reason) in all aspects of patient care. look at the x-ray, examine the sputum, talk with the radiologist, watch the echo being performed. this will allow you to learn more and gain insight into a particular illness/disease state that would not be well conveyed by simply reading the formal report. it will also give you an appreciation for tests and their limitations. caring for patients is not a spectator sport. as an active participant in the health care process (rather then simply a scribe who documents events as they occur) you will not only help deliver better medical care but will also find the process to be more rewarding and enjoyable.
  
  
• follow up on patients that you care for in the er, are transferred to other services, seen by sub-specialists or discharged from the hospital. this should give you a better sense of the natural history of some disease processes and allow you to confirm (or adjust) your clinical suspicions. this is particularly relevant today as patients are shuttled through the system with great speed, affording us only snap shot views of what may be complex clinical courses.
  
  
• keep your eyes open for other interesting things that might be going on elsewhere in the hospital/clinic. if there is a patient on another service with an interesting finding, go over and investigate, assuming it doesn't interfere with your other responsibilities and is ok with the patient and their providers. this will give you the opportunity to expand your internal library of what is both normal and abnormal.

i won't sugar coat the truth. the first year or so out of school will be hectic and a real hair puller. it is part of the learning curve and we all have had to go through it. at this point, you are not ready for it yet. you will be by the time you graduate. organizing and prioritizing will always be a career long goal that never stops and will constantly change and evolve from shift to shift. you get better at it with experience is all.

some nurses get annoyed if the patient talks to them because it "slows them down". it kinda of disheartening.

from the same site i've quoted above: "treat patients as you would want yourself or a family member to be cared for. this should cover not only the technical aspects of health care but also the quality and nature of your interpersonal interactions."

whenever things got hectic and patients were calling for help, i've tried my entire career to stop a second and put myself in their shoes. i would take a breath, slow down, quickly prioritize in my mind who to go to first and get going. i've told the story several times of the lady who i discovered had broken ribs from a fall in x-ray she had been trying to tell the nurses about but everyone was too busy to stop and listen to her--i stopped and listened. it's a personal thing that i decided a long time ago that i would do on the job. i found ways to multitask and work listening in to my interactions with patients. it comes from being a patient many times myself and not liking the way i was treated.

you are the only one who controls the

quality

of the performance of the service you give.