Jump to content

Crossed the line... or expected behavior?

Posted
traceyw traceyw (New) New

Specializes in Med/Surg, Clinic, and Mental Health. Has 5 years experience.

As an LPN to RN transition student, I had a patient who had to have a thoracentesis done in Radiology. During the procedure, I was placed in the supportive position for the patient and made sure her shoulders were in the proper position. As the procedure was taking place, I began to inform the patient of what was happening and what to expect (pin stick, etc.) HOWEVER... the radiologist later complained that I "talked the whole time." Um... nobody was providing inforormation to the patient and I felt it was my role to be the patient advocate and give her information about what was taking place to her during this invasice procedure.

Can someone PLEASE tell me if I acted inappropriately?

llg, PhD, RN

Specializes in Nursing Professional Development. Has 43 years experience.

I think it depends on "how" you did it. If the physician actually performing the procedure felt you were "taking over" the communication with the patient, I can see where he/she may have felt you were inappropriate.

On the other hand, if you were repeatedly giving ample opportunity for the physician to talk to the patient without interrupting you ... and you were talking quietly into the patient's ear ... then it may have been totally appropriate.

I can pictue it either way, depending on the specific details as to "how" you did it.

traceyw

Specializes in Med/Surg, Clinic, and Mental Health. Has 5 years experience.

I was face-to-face with her. He began the procedure without any type of communication with the pt. After it appeared he was not going to tell her what he was doing, I thought it was then MY role to provide that ongoing information and support.

traceyw

Specializes in Med/Surg, Clinic, and Mental Health. Has 5 years experience.

It appears that it's a matter of perspective. Unfortunately, my clinical instructor perceived it as being "disrespectful" and this has cause a major issue with my continuing on in my current program.

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

Personally when I am with a room with a practitioner and patient I tend to follow the practitioner's lead and allow them to perform how they feel most comfortable.

If the practitioner wants quiet then I stay quiet, some practitioners like a lot of noise and music when performing, some want silence. Personally when I am performing a procedure I like silence and limit my distractions.

traceyw

Specializes in Med/Surg, Clinic, and Mental Health. Has 5 years experience.

Unfortunately, I am not familiar with the physician. I was in a clinical setting and didn't know his preferences. It never showed on his face that he was disrupted and he never gave me a cue to be quiet.

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

Unfortunately, I am not familiar with the physician. I was in a clinical setting and didn't know his preferences. It never showed on his face that he was disrupted and he never gave me a cue to be quiet.

Him not saying anything WAS the cue to be quiet. Would have been embarrassing for everyone if he had to tell you to shut your trap lol.

Think about if one of your CNAs started to describe a dressing change you were performing or describe a foley change to a patient. How annoying would that be?

traceyw

Specializes in Med/Surg, Clinic, and Mental Health. Has 5 years experience.

Well, so much for being a patient advocate and providing instruction and emotional support for my patients. I'm so discouraged and my spirit is definitely broken. I guess I should've let my patient be left totally unaware that an 8 inch long needle was getting ready to be inserted into her pleural space.

cant really answer if you crossed the line..it depends on several things..more importantly at this point are you getting kicked out the program because of it?

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

Well, so much for being a patient advocate and providing instruction and emotional support for my patients. I'm so discouraged and my spirit is definitely broken. I guess I should've let my patient be left totally unaware that an 8 inch long needle was getting ready to be inserted into her pleural space.

I understand your frustration and please do not allow this event to discourage you. You seem very genuine and gung-ho. There is a time and place for everything, don't be a bull in a china shop. Allow the practitioner to describe their procedure but definitely provide the support.

Being a nurse you have a different perspective on procedures. Most people do not want to know an 8 inch needles is about to be plunged into their back.

I am imagining, "Ok, now he is pulling out an 8 inch needle that looks similar to a knitting needle. He is going to plunge that into your back and scewer you like a roasted pig, don't worry though he is only going to puncture your lungs with it. Wait, wait, he is going to stab you...right about...NOW!"

Cheer up, take it as a life lesson, you're human and you make mistakes. You were not totally wrong but just take a step back and allow the "Gods" to do as they wish. Remember you are a student yet, you're standing on shaky ground.

You are assuming that the patient wanted to know everything that was happening. You can certainly be supportive and follow the lead of the one performing the procedure. Can you imagine the concentration it takes to perform a thoracentesis? Part of the critical thinking required of a nurse includes seeing things from the perspective of others before acting. Please do not let this break your spirit, don't even take it personally. Take it for what it is, a learning experience Grasshopper. Be a little more open minded to those around you, you are part of a team now. :loveya:

~Mi Vida Loca~RN, ASN, RN

Specializes in Emergency Dept. Trauma. Pediatrics. Has 6 years experience.

Well, so much for being a patient advocate and providing instruction and emotional support for my patients. I'm so discouraged and my spirit is definitely broken. I guess I should've let my patient be left totally unaware that an 8 inch long needle was getting ready to be inserted into her pleural space.

I don't really know if you were out of line or not because I wasn't there to see how the whole thing went down. But speaking to this part, I am assuming the procedure was explained to the patient prior and she signed a consent. I as a student was in on one of these before and the Dr was for the most part quiet and concentrating, the nurse would say a few supportive things like "take a deep breath" or "it's almost done." and I assisted with the collection. But prior the patient had to sign a consent after it was thoroughly.

Speaking for myself, when I am going through something painful, like an epidural. I like it quiet, I like a heads up right when the needle is about to go in so I am not taken by surprise, but I am a breather for pain and I need to be able to focus and breath and I can't do that when someone is talking.

I think you are a prime example of what new nurses of today and nurses of the future should be. These nurses now are old school, washed up, still scared of the doctor type nurses that would have kept quiet and let the patient experience pain before being informed of it. What if something happened and the patient said, "no one told me it would feel that way", and they decided to sue, which from what I hear, they can do. I feel you did the right thing. You are a good nurse, the new nurses of today think like you. :)

~Mi Vida Loca~RN, ASN, RN

Specializes in Emergency Dept. Trauma. Pediatrics. Has 6 years experience.

I think you are a prime example of what new nurses of today and nurses of the future should be. These nurses now are old school, washed up, still scared of the doctor type nurses that would have kept quiet and let the patient experience pain before being informed of it. What if something happened and the patient said, "no one told me it would feel that way", and they decided to sue, which from what I hear, they can do. I feel you did the right thing. You are a good nurse, the new nurses of today think like you. :)

I don't think nurses now are how you described. I am sure the patient knew there would be pain, I mean did they think that a big needle going into their chest would feel good? I have never heard of being able to sue because something didn't "feel" the way you expected. If I was having this procedure done I would NOT want my nurse talking the whole time.

llg, PhD, RN

Specializes in Nursing Professional Development. Has 43 years experience.

I think you are a prime example of what new nurses of today and nurses of the future should be. These nurses now are old school, washed up, still scared of the doctor type nurses that would have kept quiet and let the patient experience pain before being informed of it. What if something happened and the patient said, "no one told me it would feel that way", and they decided to sue, which from what I hear, they can do. I feel you did the right thing. You are a good nurse, the new nurses of today think like you. :)

No one in this thread said anything about being afraid of the doctor. There are many other reasons to respect the choices of the physician AND THE PATIENT other than fear. The OP made assumptions about what was best for this patient without asking the patient or the other professionals involved in the procedures. That was not wise -- and she is now taking some flak for that.

No one should make assumptions like the OP did ... particularly not a student. We should all get the facts before taking action. The OP did not get the facts first. She did not know if the patient wanted to hear a running commentary or not. She did not know what the physician wanted or planned to do or say.

Chaos is caused by a lack of coordination among team members. The OP did not coordinate with the rest of team. That's not good -- and can be dangerous.

No one in this thread said anything about being afraid of the doctor. There are many other reasons to respect the choices of the physician AND THE PATIENT other than fear. The OP made assumptions about what was best for this patient without asking the patient or the other professionals involved in the procedures. That was not wise -- and she is now taking some flak for that.

No one should make assumptions like the OP did ... particularly not a student. We should all get the facts before taking action. The OP did not get the facts first. She did not know if the patient wanted to hear a running commentary or not. She did not know what the physician wanted or planned to do or say.

Chaos is caused by a lack of coordination among team members. The OP did not coordinate with the rest of team. That's not good -- and can be dangerous.

You are right though. I read too much into it. But man, the stuff they drill into us in nursing school but I hear so many people saying it will be different when you get out. I mean they drill, drill, drill us about being the patient advocate, but that is right, collaborating with the team is important! Nursing is an abstract field!

noyesno, MSN, APRN, NP

Specializes in Family Medicine. Has 10 years experience.

It appears that it's a matter of perspective. Unfortunately, my clinical instructor perceived it as being "disrespectful" and this has cause a major issue with my continuing on in my current program.

Your program is thinking about kicking you out for this?

Your intentions were pure. I think a simple apology to the physician would suffice. He does understand you are a student, right? You are still getting adjusted to the role of the nurse, he should understand that (if he is a reasonable human being).

Asystole RN, BSN, RN

Specializes in Vascular Access, Infusion Therapy.

You are right though. I read too much into it. But man, the stuff they drill into us in nursing school but I hear so many people saying it will be different when you get out. I mean they drill, drill, drill us about being the patient advocate, but that is right, collaborating with the team is important! Nursing is an abstract field!

I 100% understand nursing school drilling the idea of being the patient's advocate. I would agree that is something that sometimes is lacking on the floor but one has to differentiate between advocating for their patient and being adversarial and argumentative with the rest of the healthcare team. I have had my far share of throw down fights with the practitioners but we have to reserve those times for when it is really necessary, know your battles.

A practitioner can be your best friend or your worst enemy. See the practioners like stream, the naive nurse throws themselves in front of the stream in a vain attempt to stop the flow. The smart nurses guides that stream to work for for her to make her job easier.