Dilemma in clinical?

netglow, ASN, RN · Mar 24, 2012

Op, you did fine. Remember nursing school is something to be endured...

Most likely your instructor and that RN don't at all have the patient or your best interests in mind most of the time. If you had done what the nurse and your instructor hindsightedly told you and the patient complained about it, you would have been blamed faster than you can say, what the heck. That RN, and your instructor both know that the "complaint" made about you was childish. Maybe just an aside by your RN was enough. Telling "mommy" makes that RN a joke in my eyes. Your instructor admonishing you makes her also a joke in my eyes.

Your RN for that day is one not to trust. One of those who is a child in an adult's body.

dudette10, MSN, RN · Mar 24, 2012

OP, what you did wasn't a big deal. Just a few things:

1) You said nothing in your posts about the depth of knowledge you have on the patient's personality and behaviors. Possibly the patient had a habit of demanding things, and the nurse was implementing a legitimate nursing intervention called "limit setting." That said, I wouldn't judge her too quickly on what she said to the patient.

2) The nurse ran to mommy, and that is one of my biggest pet peeves in this profession. Because what you did wasn't a big deal in the great scheme of things, it could have been an opportunity to talk to YOU a little bit about limit setting with patients, if that's indeed what she did. Instead of a teaching opportunity (which takes all of a couple of minutes), it turned into a "complaint." That's ********. And before anyone tries to tell me, "It takes tiiiiiiiime to teach students," I have to point out that there was probably more time spent venting to the preceptor about the student. Time that could have been used in a much more constructive fashion.

3) What is missing from your replies, though, is your preceptor's reaction when she spoke with you about the nurse's complaint. I'm curious to know how that conversation went.

mazy · Mar 24, 2012

Patients do have the right to refuse care. It is also possible to find a way to handle a situation like this but it usually takes some floor experience and a knowledge of the history of patient/staff interactions and strategies and interventions staff has in place to deal with that patient.

I work with several patients who become explosively angry if their routine is disrupted. We have years' worth of documentation on those patients and a morass of interventions, care planning, care conferences, and strategies to deal with those behaviors. And also, a list of staff who no longer work with those patients because of concerns about the way the patient reacts to those staff members.

I would not expect a student or a new staff member to be aware of that and would encourage them to talk to me if they had a problem with the patient.

We go to nursing school to learn. So the OP made a mistake. I don't even think this was a mistake. She did what I would have wanted her to do. This was a "teachable" moment and the nurse did not handle that well.

I'm not sure if the nursing student talked to her preceptor about what was going on with the patient before talking to the nurse, but that probably would have been the way to go.

Barnstormin' PMHNP · Mar 25, 2012

Dealing with difficult patients successfully takes experience and is a learned skill. I don't know the age of the OP, but I would think it's fairly hard for a younger student to be able to stand their ground with a difficult pt than an older student who has had more life experience in dealing with difficult people. I wouldn't worry about it too much, I feel the primary could have given you some better guidance on how to handle the pt and sent you back in to try again. We are in school to learn, unfortunately quite a few nurses find us a bother, take it in stride and try to get as much out your experiences with RN's who care enough to teach.

Jolie, BSN · Mar 25, 2012

I agree with the previous poster, but would like to encourage all here to look at the primary nurse's actions from a different pespective:

She saw a weakness, probably due to lack of experience, in the actions of the student. She did not address that directly to the student, for reasons that we are not aware of. Maybe she was too annoyed by the student to speak constructively with her. Maybe she had a number of other pressing patient issues to deal with and didn't have the time. She did bring the issue up to the instructor, whose job it is to teach the student.

I love having students and enjoy teaching, actually far more than I enjoy most patient care situations. I am the rarity among staff nurses. Most have students assigned to work under them regardless of their training, interest or desire to participate in the education process. I don't think it is fair to bash the staff nurse for not taking a significant amount of time to work thru the issue with the student when she likely had a full load of patients and had no say in precepting a student (or multiple students.)

The staff nurse gave the student the guidance needed in the moment, as she should have. The responsibility for teaching the student how to handle a similar situation in the future properly lies with the clinical instructor, where it was placed by the staff nurse.

I don't see the gripe.

mursetudent25 · Mar 25, 2012

OP, what you did wasn't a big deal. Just a few things:
1) You said nothing in your posts about the depth of knowledge you have on the patient's personality and behaviors. Possibly the patient had a habit of demanding things, and the nurse was implementing a legitimate nursing intervention called "limit setting." That said, I wouldn't judge her too quickly on what she said to the patient.
2) The nurse ran to mommy, and that is one of my biggest pet peeves in this profession. Because what you did wasn't a big deal in the great scheme of things, it could have been an opportunity to talk to YOU a little bit about limit setting with patients, if that's indeed what she did. Instead of a teaching opportunity (which takes all of a couple of minutes), it turned into a "complaint." That's ********. And before anyone tries to tell me, "It takes tiiiiiiiime to teach students," I have to point out that there was probably more time spent venting to the preceptor about the student. Time that could have been used in a much more constructive fashion.
3) What is missing from your replies, though, is your preceptor's reaction when she spoke with you about the nurse's complaint. I'm curious to know how that conversation went.

The instructor suggested that I maybe tried to 'dump' the patient onto the nurse and did that to not have to take her to the washroom, she then asked me if this is an issue of me not wanting to 'do this'..This is actually what got me a bit worried. I told her that I told the patient that I could take her multiple times, that it's not a problem and that the patient requested the nurse so I got her since I don't want to tell the patient that they cant have a choice of who's caring for them (consent issue). She told me I could have controlled the situation better and asked what I would do if I was a nurse, I told her that the other nurse wouldn't be there then and it wouldn't be a problem...Anyway, I'm still pretty annoyed with the nurse and that the instructor went straight to thinking that I may have tried to pass off the patient as soon as possible to do less work. I guess I need to be more careful now.

loriangel14, RN · Mar 25, 2012

But the patients don't have a choice of who cares for them.If they have a nurse they like one day and the next day that nurse has a different assignment the patient can't demand the assignment be changed.You have to set limits when it comes to patient demands.If it was an issue such as a female not wanting a male employee to toilet them,that's fine.But if it's just because they like someone better then you have to draw the line.

ivikatasha · Mar 25, 2012

But the patients don't have a choice of who cares for them.If they have a nurse they like one day and the next day that nurse has a different assignment the patient can't demand the assignment be changed.You have to set limits when it comes to patient demands.If it was an issue such as a female not wanting a male employee to toilet them,that's fine.But if it's just because they like someone better then you have to draw the line.

They do when it comes to student nurses.

nurseprnRN, BSN, RN · Mar 25, 2012

i keep coming back to the fact that in the original post, the patient wanted pain medication and a bathroom trip. perhaps this patient thought that if she asked the nurse (as opposed to the student) she could get that too. op: was that really not such an issue, and did you also tell the nurse the patient wants her pain med, or just a bathroom trip?

otherwise, great ideas for better communication/limit-setting.

MN-Nurse, ASN, RN · Mar 25, 2012

The nurse then told the preceptor that i shoulkd have taken control and not called her.

If any student working under me decides to "take control" when my patient is asking for a nurse and/or medication (if the situation has not previously been addressed), they - and their instructor - are going to get reamed.

mindlor · Mar 25, 2012

If any student working under me decides to "take control" when my patient is asking for a nurse and/or medication (if the situation has not previously been addressed), they - and their instructor - are going to get reamed.

Get reamed? Is that not a little severe? Why not just a calm discussion regarding your preferences?

mindlor · Mar 25, 2012

i keep coming back to the fact that in the original post, the patient wanted pain medication and a bathroom trip. perhaps this patient thought that if she asked the nurse (as opposed to the student) she could get that too. op: was that really not such an issue, and did you also tell the nurse the patient wants her pain med, or just a bathroom trip?

otherwise, great ideas for better communication/limit-setting.

not to split hairs but i dont think the type of meds were ever mentioned......not that it matters.....i could be wrong......as i often am :)