Dealing with nursing staff (RPN's)

[Mito]

Hello All,

As a senior nursing student on a med/surg floor we have a great deal more responsibility than we did in first year (no real suprise there). With multiple tasks to do ie meds, treatment, prn's for pain and ng tube insertion and management , some things like am care have to wait until later in the day.

We had a very busy day today and my pt's had to wait until late am for their am care (you know hands face, peri back etc..) and ofcourse this is fine with our teacher as long as everyone gets their care before we leave in the early afternoon.

So at the end of the day the RPN for that zone says to my teacher that it is a real problem that the pt's didn't get their am care first thing in the morning. My rationale was that their meds , vital signs, assessments and prn's for pain come first and then the am care.

So I informed my teacher that I didn't not need the help of the RPN and that I was capable of managing my patients and all of their care. I really think this particular nurse was looking for a problem where there was none. Does this sound familiar to any of you guys? How do you deal with this situation?

Mito

[mzmckim]

You guys seem so cool! I hope when I get into clinicals that I have instructors/nurses like yous guys - and not someone that leaves me out there to flounder!!!

Judy

[OBNURSEHEATHER]

C'mon Judy! We'd love to have you!

Good luck!

Heather

[mzmckim]

Thanks, Heather!

Judy

[Fgr8Out]

The whole idea behind "Clinicals" is to begin to establish and develop your managment skills... among other items. When, in the course of your duties, you neglect to offer a patient a washcloth, etc... until late in the day... there IS an issue with your organization... and it's something that needs to be worked on.

I often see nursing...students, experienced nurses and the like... so focused on the one "task" that other things that could also be addressed... are forgotten or placed on the back burner. As you begin to perfect your organizational skills... you'll find that whenever you enter a patient's room... you'll be considering not only your most important task (be it trach care, dressing changes, ng placement or medication administration)... but also a few of the other care options that a patient might need. So, in addition to bringing in the AM meds... you could also bring in a few washcloths or anticipate setting your patient to brush their teeth... sit up in a chair or whatever else may be required.

Particularly with regards to offering a patient the ability to have their hands and face washed... or peri care... ESPECIALLY if that patient has a foley or is incontinent...it IS important... and it doesn't take all that much additional time in the general scheme of things to do.

Grouping tasks is a skill every nurse needs to have some familiarity with... and I believe Clinicals is the perfect place to begin to learn to develop these skills....

Peace:)

[Mito]

Hello All,

An RPN is a registered practical nurse which is the US equivalent of an LPN. To answer a few questions yes I do live in Canada, and yes organizational skills are important to all nurses. Our teacher and RN's for our zone have made it very clear that it is their liscence that is on the line if we screw up. This not a responsibility I take lightly. Most of the time, there is never a problem with the nursing staff at this hospital.

Fgr8out

But sometimes not all tasks can be done together. I have taken basins and washcloths into pt's while passing meds but in this case it was not possible.

The pt's in this case needed other interventions done first before the am care, which is ofcourse a legitimate expectation of any nurse, student or otherwise. I may have not clearly stated that in my original post. I felt this situation was one that required me to prioritize what to do first and when to do it. If I had to do it over again would I make the same decsion? Yes, because I feel my rationale for this decision was correct and defendable. This ofcourse is just my opinion and does not make it neccessarily the right opinion for someone else.

Mito

[Gator,SN]

I thought this thread was interesting......

I don't know who is doing all the DRILLING at some of these schools but at my school we are ABSOLUTELY working off the instructors license. That is why she supervises every proceedure and every medication administered. She is taking the responsibility of training...mistakes and all. I appreciate her being there and giving us all this opportunity. She signs her name behind ours on the chart, she supervises all meds hung and is there to ensure that all foleys, NG tubes etc are placed properly.

On the other hand, the staff nurse who TAKES REPORT in the morning is legally responsible for this patient by law in the state of PA and they have a right and responsibility to make sure that the care given to a patient meets the standard of care for the unit. THIS is what we have been told. We are encouraged to work WITH the staff nurse and to keep her informed of any and all care, complications, finding, etc...that involve her patient.

We have been encouraged to report to her regularly and ESPECIALLY if we are leaving the floor. (for break, or post-conference etc..)

We respect the staff nurse and we usually ask them during the day, "what can I do to make this easier, or faster" and we are really grateful for her input.

I have yet to see a staff nurse who was not a bit uneasy when she comes into work and finds out one of the students are assigned to her patients....(last week one of the nurses had to deal with 3 of us) GOD BLESS THEM! We are more of a pain some days and take twice as long to do things that she can do in her sleep.

My suggestion for all students is not to be easily offended. If a staff nurse thinks that something should be done a certain way that is usually because years of experience has proven his/her theory.

Gator

Also wanted to add that since I work on the med/surg floor I agree that the bath/am care should be done ASAP, first thing in the morning because then the patient is ready to recieve visitors, go to therapy, or x-ray, whatever~ and they look good and feel even better

[fergus51]

That's what I thought. The LPNs here are not responsible for RN students, they are responsible for their job, and I don't think it's fair to call Mito cocky for not needing an LPNs help in bathing clients. The RPNs liscence was not on the line at all (and I don't think anyone can lose their liscence for not giving a bath early enough) so I really don't see what the big deal is.

[kids]

Originally posted by OBNURSEHEATHER

Thanks SherRN! But, I do find fault with the phrase "somewhat anal." I'm pretty much completely anal about my duties! :chuckle

Heather

I prefer to describe myself as being "detail oriented"...looks better on a resume;)

[AppyHorseFan]

originally posted by obnurseheather

ok. let's say, hypothetically of course, that you are taking care of one of my patints and you do something that kills her. are you saying that you think i would suffer no consequences from this?

from what i have been told and from what i understand the npa to say, certain things do not apply based on the rn to "professional nursing student" status.

when i delegate to you, the job becomes yours. but the responsibility to make sure it was done is still mine. you forget to pass a med. overlook a blood sugar. it's still my name on the incident report, and it's still my ass in my supervisor's office.

yes, the job becomes mine, but what i have been told is that it is the rn's job to follow up with me and make sure i give the med. or do the blood sugar. my name would be on that incident report also, as my school has us complete not only all necessary hospital paperwork, but school work that would relate to these incidents as well.

i'm not saying you won't suffer any consequences, i'm sure you do. but i definately will.

i'm glad you've had great experiences with nurses. i always try to give my students great learning experiences, and enough room to make them feel like they're running the show, even though i'm keeping a close eye. but i am watching, because it is my ass on the line too. and i won't go down for someone else's mistake.

heather

it appears that i have stepped on some toes based on what my instructors have told me. with a couple of replies i began to research the situation. so that if i misunderstood what the said, or they told me incorrectly, i could apologize to everyone and go on. but based on what i have read and "interpreted" from the npa, i am not wrong. i will be happy to look further into what i have found if necessary, but will explain what i have found fist. forgive me if this gets lengthy, but i don't want to misquote and would like for others to tell me if i a misinterpretting what i've read.

in section 218 of the npa it discusses "delegation of selcted nursing tasks by registered rofessinal nurses to unlicensed personnel." first let me give the definition of an unlicensed person.."(4) unlicensed person - an individual, not licensed as a health care provider, who is monetarily compensated to provide certain health related tasks and functions in a complementary or assistive role to the rn in providing direct client care or carryig out common nursing functions. the term includes, but is not limited to, nurse aides, orderlies, assistants, technicians, home health aide, medication aides permitted by a state agency, and other individuals providing personal care/assistance of health related services." the key words i see here are "moetarily compensated." as a student, i receive no money for providing care to patients. now, i will admit that the latter portion of the last statement could include students.

the next section i would like to bring to everyone's attention is "218.4 application of chapter.

this chapter does not apply to rns who:

(1) supervise or instruct others in the gratuitous nursing care of the sick;

(2) are qualified nursing faculty or preceptors directly supervising or instructing nursing students in the performancy of nursing tasks while enrolled in accredited nursing programs;

(3) instruct and/or supervise an unlicensed person in the proper performance of nursing tasks as a part of an educatin course designed to prepare persons to obtain a state license, certificate or permit that authorizes the person to perfrm such tasks;

(4) practice in situations in which the unlicensed peson is directly assisting the rn by carrying out nursing tasks in the rn's presence; and

(5) assign ask to or supervise lvns or other licensed practitioners practicing within the scope of their license.

as i understand this paragraph, if you are a qualified nurse (and i'm assuming that you are if you are licensed), and you are teaching me as a student who is enrolld in an accedited program, then the entire chapter 218 does not apply.

we must have either an instructor or pre-approved nurse with us when we do procedures, until we are checked-off to do these on our own. our instructor does not sign our notes behind us, but the nurse that we have worked with for the day reads over them and she signs off behind us. they are usually very helpful in giving us tips on our notes, what we shoud add next time, what was unnecessary this time, etc.

well, i have another post to make additional notes to, so i will close this one for now.

[AppyHorseFan]

originally posted by mark_ld_rn

appyhorsefann-- you are so wrong! who ever is handing out that info is out of their ______ mind. you are unlicensed as a student and are not( let me repeat not) working just against your application. the rn is responsible for the patient even if you are caring for it. your instructor is responsible for you and the patient, i am an instuctor and know this for a fact. so don't be so confident and cocky to think you don't need the rn's help or oversight because you have it all under control. be respectful of the nurse you are working under learn what you can. if they seem unjust let your instructor know.

please read my previous post concerning the first portion of this paragraph. concerning your statement "don't be so confident and cocky to think you don't need the rn's help or oversigh because you have it all under control." i never once said that i was confident or thought i didn't need the rn's help!!! in fact, if you will notice i said i have had some great experiences with my floor nurses. i am not confident nor am i cocky in anything i do, much less in my clinical setting, where i don't know very much at all.

but it is time to get redrilled and learn that the rn and instructor is responsible they have a share of things to loose if and when you screw up. especially if they did nothing to oversee that proper care was given.

does your instructor even bother to sign off after you in charts ,narcotic logs,and so on. you are a student nurse and bythe agreement made between the school and hospital you are allowed the privelage to learn and practice your skills there while being instructed and overseen by your instructor and or nurse.

see previous post concerning instructor sign-offs.

as an instructor i watch out and sign off on all my students stuff. i do have a few nurses that i will allow to oversee my students or teach them things .but those few i know well and feel very confiedent in the fact that they will teach my students well.

our instructor signs us off on clinical procedures. we must do each skill a minimum of 2 times in front of her or a pre-approved nurse. once she and i feel that i am able to do the procedure competently then we are checked off for indepence on that procedure. we are never allowed to do blood transfusions or iv pushes without an instructor present. we must also have our instructor check all of our injections. she watches us draw them up and double-checks the dosage. so, yes, she does sign off behind us on narcotics. the program is a tough and stringent one, they don't just let us loose to do as we wish...no matter what one might think.

and just as heather said, i will not go down for another persons screw up. so while i really enjoy students and love working with them usually. you need to remember youare a student and do not know it all yet. again, i never once said i did know it all!! i hold my students to the same high standards i hold for my self. and if they think that is to horifice then they need to find another profession or another school.

i apologize if i sound "cocky" i don't intend to and normally would just let this whole thing roll off my back and respond that perhaps i made a mistake...and perhaps i have, i will be discussing this matter in great length with my instructor on tuesday. i am only a student and i don't know it all, i will never know it all, but to be accused of being "so confident and cocky" by someone who doesn't even know me, irritated me. i asked if any other students had been told the same thing, i was asking for information not a lashing!!!!

[RNConnieF]

I would like to bring in another piece of the origional post that I think may have been lost in the debate: as a senior nursing student Mito organized the day based on her assessment of patient needs, resources, and time available. Sounds good to me. Then she has an RPN rat out on her to the clinical instructor because the RPN didn't like the way things got done (in her view) Rather than addressing the licensing issue Mito, ask your instructor if your thinking based on your rational was on target or not. If your instructor agrees with your assessment and intervention than leave it alone, you did what had to be done in the order it had to be done and that's all that matteres no matter what the RPN's motivation was- either to bust your shoes or to protect her license. I just told a student this week that if you already knew it all you wouldn't be a student, would you? If your instructer tells you that he/she had a problem with how you timed your day than listen to his/her evaluation and replay what the RPN said based on your new mind set. As a student I ran into both situations, where I was on target and where I was way off. My first stop was always my instructor, if I was wrong in my thinking I had to suck it up and go along with the primary nurse, if I was right my instructor would allow me to present my rational to the primary nurse and intervine if necessary. Not every nurse you work with will be great, just as not every student will be good. Have a rational for what you do, run it by the primary nurse AND your clinical instructor and learn from both of them. Good Luck to you in your Senior year!

[mark_LD_RN]

appyhorsefan--- explain from your post how that eliminates all responsibility of the nurse if you screw up.

if you cause a patient harm while that patient is being cared for by me as a nurse or as an instructor. Ihave shared liability check that out with any lawyer or jurist expierienced in health care laws and responsibilities. I have been a professional witness in numerous cases where that has been the case and no matter what, the responsibility in some form or quantity always comes back to the nurse or instructor. How ever you read into it, your instructor is still responsible for you, if she thinks not and chooses to let you run free i wish her well when she ends up in court.

and sorry but your post did seem cocky,( as you appeared to be agreeing with Mito's statement that he did not need the nurses and can handle all the care on his own) I know it is hard to convey things over a BB. maybe it was not went in a cocky manner. But one making statements that they don't need the nurse seems to convey that meaning.

I also feel your instructor is placing to much responsibility on the staff nurses it is not their place to verify what you have done or charted is correct. she needs to go behind each of you and check for her self. and sign off on it. by not doing so shows lack of supervision and increases her liability. it is in hers and the students as well as the schools best interests that she do so.

in your own words in above post you even state the nurse has responsibility even if tasks weredelegated to you.Ido not see how that is much different from what i had posted. RN's delegatebut delegating a task does not release them from totalliability, they had to delegate to competent person and areresponsible to see it wasdone and wasdone correctly.

another point of the nursesover seeing students is that they really can not be sure what you have been checked off on and can do. I often have students with me when i am working asa nurse and do not mind, actually enjoy it. but i have seen to often that instructors will dump off their students and let the staff deal with them.frequently with nurses who are new or who are not comfortable in that position. From a nurses point of view it is not easier having students to help you they often slow you down and make youwork harder and longer. students also need to keep that in mind. you are not really doing us as big a favor as some think by helping.it is the nurse who is doing you a favor alowing you to help and taking the time to show and teach you things.

i personally take the time to help students when ever theyare onthe floor with me even if they are not dealing with my patients.

you can attemt to quote section 218 and other and read into them what ever you like. but remember you are a student and unlicensed, the nurse is licensed and has much to loose if you screw up.

i only posted to this to be helpful take it as you may, but one day you will see the advice i have given is good.

OBNURSE HEATHER thanks for the compliment!

by the way I really do like teaching and love my students, they know i only want the best for them and they are for the most part very gratiful for the attention i show them.

now everyone play nice:)