Dilemma in clinical?

[mursetudent25]

The preceptor came up to me today and told me that a nurse complained about me. What happened was a confused patient wanted to go to the washroom, I said ok I'll take you but she requested that the nurse (nurse t) take her. I told her that I can take her right now but she still said that she wanted nurse t to come give her the medication and to take her to the washroom. I asked if she was sure and she said yes..So I went to nurse t and told her that the patient wanted her to take her to the washroom. She went to the patient and told her that she has no choice and she does not get to pick her nurses. The patient then said ok and I helped her to the washroom..

The nurse then told the preceptor that i shoulkd have taken control and not called her. Which i did but the patient insted that nurse t came to help her..I think nurse t was wrong in telling the patient that they have no choice and they dont get to pick. seems very rude to me..

Who is right in this situation? Did i do the right thing here or does nurse t have a valid point? is telling a patient that they have no choice is acceptable?

[CompleteUnknown]

I think some posters are being a little hard on the OP. There are some patients who will do this to students - insist on being attended to by the nurse, or even refuse to tell the student what they want, so the poor student has to go to the (understandably) frustrated nurse and say 'The patient won't tell me what they want, but they want to see you. I've tried to get them to let me assist them, but they're still insisting they want you'. I understand the nurse's point of view, of course it's frustrating, but I can't quite see what else the student is supposed to do.

[osdbmom]

This kind of thing confuses me, and might be more clear once I'm into the clinicals part....but, say for instance, right now Im in phlebotomy.

We spent an entire chapter/quizzes/tests learning about assault and battery.

assault: the threat or attempt to touch another person without their consent

battery: intentional touching of another person without their consent

Where is the line? (seriously, not being sarcastic here, i really want to know).

So...if a patient outright refuses care by a student and the student then physically forces them from the bed and to the bathroom, or physically forces them onto a bedpan without the patients consent.....is that assault or battery?

and I realize it is different, but as a mom with three kids who have a chronic health condition that need monthly infusions....we do have certain nurses we prefer and ask for. However....that might be a different situation, bc at the infusion room, there are only a handful of regular nurses usually, and one who has, for close to six years now, been able to get my daughters finicky veins almost always on the first try. Is it wrong to ask for appts on that certain nurses day in clinic?

Just from a patients/families point of view. Once, a few years ago, our nurse was out sick for an extended period of time. We ended up with a float nurse who was very unfamiliar with my childs disease, veins, sensory problems. She screwed up getting in the line, tried to fix it without calling a senior nurse (although I asked her to), ended up spraying blood all over the place and causing my daughter a great deal of pain. My daughter then vomited on the nurse and passed out.

I spent a year paying for a developmental behaviorist and Ativan before every infusion, and a year of weekly therapy for my child after that event.

So there may be good reasons why a patient/family requests a certain nurse. however, I realize our situation is very different from the need to use the restroom....but, maybe she had a good reason that we just don't know about.

[wooh, BSN, RN]

Do any of you remember when you were students?

A whole lot better than you remember when you were a nurse.

Learning to work through situations like this is the whole reason you're in clinicals. This is a good reason to get a job as a tech or CNA while in school, to learn to deal with patients.

[wooh, BSN, RN]

Where is the line? (seriously, not being sarcastic here, i really want to know).

So...if a patient outright refuses care by a student and the student then physically forces them from the bed and to the bathroom, or physically forces them onto a bedpan without the patients consent.....is that assault or battery?

The line? Don't grab the patient and drag her to the bathroom. NOBODY advocated that. THERAPEUTIC COMMUNICATION is what the nurse in this situation expected and what people here are advocating.

Dealing with a disoriented person is like dealing with a toddler.

"Do you want to do this?" will get a NO.

Instead, "Would you like to do this or that?"

[mikala3]

I had something similar. When I was working as an NA. I had never worked on an ortho floor before. I got a call to take a total knee replacement to the restroom. I was not sure of how to get this person safely to the bathroom. I was trained that when you dont know, you dont guess, you go to someone with experience. I asked the nurse if she could help me and show me how, and she went off that her job was meds, not transporting patients. Her job is also to supervise ME, but she didnt seem to care.

[osdbmom]

The line? Don't grab the patient and drag her to the bathroom. NOBODY advocated that. THERAPEUTIC COMMUNICATION is what the nurse in this situation expected and what people here are advocating.

Dealing with a disoriented person is like dealing with a toddler.

"Do you want to do this?" will get a NO.

Instead, "Would you like to do this or that?"

Okay, thank you for explaining that. So, if this were a small child I would say something like this:

"Okay, I understand what you are saying, but Nurse so and so can't come right now. If you need to use the bathroom, I can take you. If you aren't ready right now, thats fine. Just let me know when you are ready, and I will come and take you."

Would that be right?

[mindlor]

A whole lot better than you remember when you were a nurse.

Learning to work through situations like this is the whole reason you're in clinicals. This is a good reason to get a job as a tech or CNA while in school, to learn to deal with patients.

Wow always the snide comeback eh? Well I reckon its always good for a chuckle :) Anyway Wooh, I think you missed my point. Please go back a few pages and reread what I wrote, in context please....

Do you really remember when you were a student? Out of the gate you were the expert that you are today? I suppose it's possible.......

I really do see things from both points of view. I get that nurses are stressed and I get that adding wide eyed students into the mix just really can send the day over the tipping point.

However, I really do think that a small minority of seasoned nurses may forget now and then what it was like to be a student.....

That said, I have worked with some really wonderful experienced nurses, and I will never forget them. Some were hard on me, but in a nice way. They grilled me and I really liked it because it exposed my many weaknesses.

So, to my fellow students I say this. Do try to see things from the nurses point of view. They have an EXTREMELY difficult job. If you sense that a nurse is stressed, assess if you can help them in some way. If you sense that it is not going to be a good time for the nurse to have a student to deal with, communicate with your cliinical instructor.

To all the experoenced nurse out there. Thank you. I know how hard it is to have to deal with 7 or 8 pts, with a student or TWO in the mix. We students really really do appreciate and respect you VERY MUCH!!

[mindlor]

Okay, thank you for explaining that. So, if this were a small child I would say something like this:

"Okay, I understand what you are saying, but Nurse so and so can't come right now. If you need to use the bathroom, I can take you. If you aren't ready right now, thats fine. Just let me know when you are ready, and I will come and take you."

Would that be right?

By my reckoning that would be outstanding :)

[osdbmom]

Thank you.

I really do want to learn to do this the right way. :)

It can be hard to apply class learning to real life situations. In class, we are told, "Even looking for a vein or putting on a tourniquet w/o consent is battery. You will be sued. You will get fired. Don't touch a person ever w/o consent."

Sometimes it feels like any step you take might get you in serious trouble.

[mindlor]

A really great starting point is to strive to treat the patients how you would want to be treated if you were in their shoes.....

[wooh, BSN, RN]

Okay, thank you for explaining that. So, if this were a small child I would say something like this:

"Okay, I understand what you are saying, but Nurse so and so can't come right now. If you need to use the bathroom, I can take you. If you aren't ready right now, thats fine. Just let me know when you are ready, and I will come and take you."

Would that be right?

Exactly right!

[Meriwhen, ASN, BSN, MSN, RN]

I think the OP was in a catch-22: by doing what they did and getting the nurse for the patient, the nurse complained. But had they not gotten the nurse for the patient and insisted that they could help the patient with toileting, the patient would have complained. Either way the OP would have been raked over the coals. Damned if she did, damned if she didn't.

Sorry it happened to you, OP. But I agree with a lot of the posters here: tell the patient that the nurse isn't available and that you'd be happy to assist her with her ADLs. If the patient refuses, you can't force her to accept your help but tell her when she is ready you can come assist her. Some patients think they can pick and choose their caretakers and sometimes limits need to be set.

Most importantly, tell the nurse--and your CI--that you did offer assistance to the patient but the patient refused it so you're just letting the nurse know. That helps to cover your rear.