Does this sound like a typical Clinical experience?

llg, PhD, RN · Dec 4, 2009

Yes. You need to learn the basic care-giving skills of providing hygiene etc. first -- before you move on to the more advanced and "glamorous" skills.

1. There are not always CNA's around to help with those things.

2. Those things are VERY important

3. You will not be respected as a nurse who supervises such activities if you yourself can't do them well.

4. As a first semester student, your knowledge of the patient and his/her care needs is probably at a VERY BEGINNER level. You are probably not yet skilled enough to move on to the more advanced course content. Your school's plan is to build upon the skills and knowledge learned each semester -- starting with the basics and moving upwards in sophistication.

5. If you can't do the simple stuff really well ... you're not ready for the hard stuff.

Focus on mastering each step along the way so that you will be ready to move to the next step -- and you'll be fine.

anon695 · Dec 4, 2009

Thanks for your input. I can perform the tasks just fine (they are not hard),the issue is more time management and being able to convince some patients to let me. I think those two aspects should be at the front of my mind for when I start clinical next semester, which is something I'm going to ask my instructor for advice on during evaluations next week. I did better yesteray, I had a different patient who also said he didn't want a bath (and this one was a psych patient) but I was more assertive this time in pushing for it. The patient agreed and I did the bath and change, but this still wasn't perfect because it happened later than was ideally supposed to. But I was really proud of myself for convincing the patient! I think I'm growing into the role, I'm motivated and always trying to do better, I just hope my school isn't looking for 100% perfection just yet!

murphyle, BSN, RN · Dec 4, 2009

When I went through Med-Surg I, we had to have bed baths done by 1200 for those patients who required total care. If the patient was a self-bather, they could decide when they wanted to do it as long as they did it before we went off shift. What you might try doing is rather than asking your patient if they want a bed bath, ask what time they want it. That way, you've reinforced that they are getting a bath, but still allowing them control over the timing.

Hope this helps!

Debra ACRN · Dec 4, 2009

As a nurse who is older then dirt, I ask you to reconsider the humble bed bath. I have found that it can set up an intimate relationship with patients that can really help illicit true feelings. It is a magnificent time to really thoroughly examine the skin and it's a great time to do patient teaching. When I was a student I would narrate my head to toe assessments and found the patients to really respond well to what I was doing, it was a great time too for questions. Never forget that despite evidence to the contrary, nurses really are respected out there and what we say and do can really make a huge impact! Good luck to you in all your studies. Debra

anon695 · Dec 4, 2009

The fact that the bath is a great time to assess skin is a large part of why it was so frustrating to me that I was having a hard time convicing that patient to do it. I don't consider it a "humble" task - not at all - although the issues I ran into this week seemed to lead people to quickly assume that I do (another source of frustration). Our first clinicals were in a nursing home and I bathed/fed/linen changed every patient I had, no problem.

It was luck-of-the-draw that most of the med-surg patients I had this semester were ambulatory and self-care. So they didn't need help bathing and I changed their linens when they were in their chair eating breakfast. I like the idea of TELLING the patient they'll be getting a bath rather than saying it in a more asking way. I never said "would you like a bath?", I would say something like "after breakfast and vitals I can help you with your bath", but now that I think about it that still gives a little leeway for them to say no to it.

I wish I didn't have to wait until second semester starts in January to demonstrate to my instructor that I am motivated and improving, and that I *can* convince the patient to have the bath, and get it done by 10:30am along with vitals, assessment, linen change, reports to primary nurse and instructor, and anything else they need.

Maybe I'm worrying about this way too much. Nursing school is so important to me, as are the patients, and if I'm not the best nursing student I can be, then I'm not satisfied.

Supernrse01, BSN · Dec 4, 2009

As a Registered Nurse, you can never assume that a nurse's aid will be available to do the bath, linen change, bedpan, etc... If you do, you will quickly become one of those team leaders that the aids dread working with.

Seems like you are having a typical clinical experience. I don't agree with the instructor that she would be embarrassed because your patient wouldn't let you bathe him. Patients are people and need to be allowed to make their own decisions and should be allowed to follow their normal routine, to an extent.

CDeniseGo · Dec 4, 2009

I also do not believe that you should have to convince those that are alert and oriented x 3 that you have to bathe them. If someone says no, then that is their choice, as we should focus on patient autonomy, yes? Anyways, in my clinicals, there have been those instructors that believe that things should be their way or it's wrong. It's best not to argue, just do what you can the best you can and don't worry about the rest. I'm sure you are doing just fine! -love: a newly second-year student...

jjjoy, LPN · Dec 4, 2009

How do you bathe a self-care patient? How do you do a full skin assessment on such a patient?

My experience was that nursing school tended to emphasize the care of frail, immobile and unstable patients. We were taught step by step exactly how to give a bed bath as if it were brain surgery (I can get that we need to fold the washcloth a certain way for testing purposes, but my instructors wouldn't explicitly admit that there may be other just as good and safe of ways to bathe). We were taught to use the bath as a time to get a full skin assessment done - what a great tip! But when we ran across self-care patients, our instructors wouldn't give any guidance, saying "when you're the nurse, you'll have to figure such things out yourself."

Looking back, I can see that perhaps the instructor was looking to see if the student was able to adapt their nursing care to particular patient, such as by making sure a very independent self-care patient has towels and toiletries and saying things like "Your things are ready for you to bathe. How did you bathe yesterday? Do you need any assistance? I'll be back to change the sheets while you're bathing." However, it's quite common that the student has frequently experienced being scolded and shamed and having their intelligence questioned for even asking if something could be done another way than what they were explicitly taught. That doesn't do much to encourage students to creatively problem solve.

So when the student is sent back into a room with a self-care patient with the mandate to "get that patient bathed"... they may easily figure that means they are supposed to insist the patient has a sponge bath. They may even figure that it's supposed to be a bed bath if they were never explicitly taught how to bathe a patient sitting up in a chair. And how in the world can they complete the required full skin assessment if they aren't right there to witness every last skin fold and crevice be bathed? This lack of creativity may not be because they didn't think that there was probably another way to meet these patient care goals. Instead, some may have been discouraged from ever straying even slightly from what was taught them after previous negative experiences with trying to think for themselves.

tbell2 · Dec 4, 2009

I have found that it can set up an intimate relationship with patients that can really help illicit true feelings.

I agree. I had a pt last year in my med-surg 1 class who was almost completely self sufficient, but he was a big man and needed help washing his back and shoulders. When I brought a warm basin over and really scrubbed, he was so grateful. He had been in the hospital for almost 2 weeks and said it was the not the first time someone had helped him, but the first time he felt really clean and that it felt to good to have someone rubbing his back after being in the hospital bed for so long. Not every pt will be as vocal, but 99% of them will appriciate it just as much!

kcochrane · Dec 4, 2009

Many places are going to primary nursing - which means you do everything for the patient and there are no techs/CNAs. Even without primary nursing, you may have to do this tasks. So please don't listen to those that suggest they aren't important. A feeling or well being from good ADL care cannot be put into a pill.

I do understand it is challenging to get some people to agree to care. Sometimes just telling them that as a nursing student you need to get it done before you leave or "what time is a good time to do this" is all you need. It is a skill that you will get better at as you get seasoned. And yes you will still be required to do all these things in your last semester.

If you find yourself not able to get that task completed ask your instructor for some advice on what to do. Since this is a skill, she should be able to help you improve this skill and she won't be caught at the end not knowing it wasn't done.

rachelgeorgina · Dec 4, 2009

I haven't read all the responses but I'm guessing they're of a similar train to what I'm going t say.

In Australia we don't have CNAs on the floor all the time. In fact, we barely have CNAs at all in a hospital setting. So guess who has to do all these little things, the dirty jobs if you will? It's the RN. & if you can't provide these things or recognise how critical they are to good nursing practice, I suggest you step back and reconsider a) what nursing is and b) whether you have what it takes to be a nurse.