Crossed the line... or expected behavior?

[traceyw]

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?

[reginahayes]

I feel the same way you do. I work as a radiology nurse and there have been two physicians that had a problem with my speaking to the patient while thay were working. I explained to them that I am there for the patient. They are my first responsibility. I speak as softly as I can But I am not going to compromise my role as patient advocate for them. They feel the need to concentrate on their work and forget that are working for a human being. And shame on your instructor for not supporting you! She may have needed to have counseled you how to care for your patient without distracting the physician BUT she should have stood up to the doctor for you and supported you....mentoring you thru this process. We need caring supportive nurses please don't leave.

[TerpGal02, ASN]

I was actually in this same situation with a patient a few weeks ago, and I think the MD AND tech really appreciated the fact that I was there to talk the pt through the whole thing. She was a very sweet lady who was suffering from Alzheimer's. One of the more pleasant patients I had taken care of, but she was really not oriented to place or situation at all, but generally responded appropriately if nothing invasive was going on with her, and had a very poor short term memory. You could tell her something and 5 minutes later she wouldnt remember what you had said, so you had to keep reminding her of things. She had the thoracentesis on my second day caring for her, and the day before she had gotten VERY agitated and started flailing around when the RT came to try to get ABG's on her.

I left all the explaining to the MD and tech, but I was there with her, constantly reassuring her that I was there and wasnt going to leave (she was very nervous that I was just going to leave her down there with people she didn't know) and that if it hurt to just squeeze my hand. I kept re-orienting her and asking her if she was doing alright. I DID stay quiet during the actual insertion of the cannula though. If I HADNT been there to do those things, likely she would have started moving around again, and the LAST thing you want in a procedure like that is a flailing pt. I don't think that anyone down there realized just how confused she really was. They knew her hx, and knew she was confused, but not to that level. She was very thankful to all of us after the procedure and even told us that it hadnt hurt at all! It made me feel good to be there to comfort her and to quell her anxiety.

[elle27]

I think it's just differing perspective. Although being a student nurse you must understand that you are an idiot and can't possibly know anything and you are always wrong.

I'm sorry. It sucks. I had my confidence betrayed by an instructor and have NO RESPECT for any of them--all I see now are the flaws. I was so idealistic when I started my program.

I have come to accept what a complete idiot I am and will continue to accept it until I Finish. Then I'll take my exam & go back to doing the best I can.

Realize that those who can, do. Those who can't -- teach. They have no other means of control so they slam you instead of having a conversation.

Being stuck in a fear engendering negative atmosphere is sad. Especially since we are to be nurses; and how sad that a physician can't communicate his wants or needs to those assisting.

Don't let it get you.

Study harder and learn to read minds.

:)

Don't stop keeping the patient's needs front and center!

[Ciale]

Just curious...what did your nursing intructors tell you exactly? Did they offer any suggestions or advice?

[talockett]

I have not read everyone's post, but I would say that the procedure should have been explained to the patient before you all started, and all questions should have been answered. I'm not sure from your post how it was done, but waiting until a procedure is in progress to explain to a patient what is going on is probably not be the best approach. And, the physician probably was distracted while trying to concentrate if you talked through the entire procedure. Listen, you are not perfect, and you will make mistakes. Just make sure you learn from them and don't repeat the same one twice.

[gardengal1, ASN, RN]

My take on this would be that everything as far as explanations were properly done prior to the start of the procedure. It would be that there was silence while the procedure was taking place and this poor student tried to fill the void with a blow by blow account, not knowing, because of lack of experience, that exact information is not needed, only general support. I believe the only thing that might need done here is teaching on how to support a patient through a procedure, nothing else.

[jjjoy, LPN]

My take on this would be that everything as far as explanations were properly done prior to the start of the procedure.

What you're saying is totally reasonable; but I think it distracts from the main issue here.

Even if the student's comments to the patients were too loud, too long, and/or too detailed, before criticizing I think the student ought to be given kudos for being concerned about the patient and doing something about it as opposed to just thinking "if the physician's here, I only do what I'm told to" and "if the physician doesn't seem concerned, that means everything's okay." Could the student have done a better job at it? Probably. There's almost always room for improvement in any situation. I don't know if the student was inappropriate or the instructor was overly harsh or neither or some combination.

In general, though, unless it's an egregious mistake or a very clear & precise guideline that wasn't followed, it seems more constructive to me for instructors and colleagues to instruct and advise on how something might have be done better as opposed to rebuking the person for doing it wrong and suggesting that they should've known better. I'm not saying that's what happened here but I've witnessed a lot of it.

[PedsRN9999]

The procedure requires a signed concent form. The Physician has the obligation to inform the patient about what is involved in the procedure as well as the risks and benefits before it happens. By the time the procedure takes place the patient should know what to expect. Perhaps he thought you were being out of place when explaining things to the patient. Dont get discouraged; there are many opportunities for patient teaching. Good luck

[FranEMTnurse, CNA, LPN, EMT-I]

Isn't the patient given versed, a hypnotic anesthetic prior to the procedure? If given the adequate dosage, the patient wouldn't remember the procedure anyway, and would only come out of it with a sore throat. If that is the case, then there was no need to talk to the patient, but to only hold her in position while the radiologist performed the procedure.