Hi, Just want to vent pertaining to my community health placement for Uni. I am at an aged carefacility. My teacher requires that I understand the fundamentals of what Community Health nursing is about ie: Health assessment looking at a need whether it be health, psychological or social.

I picked one resident and yah she has two needs where I already one has been implemented to benefit her social wellbeing. The health need is regarding to her knee. I am trying to put forward as a student nurse soon to be RN, for this lady to get a wheelie walker. As the resident is a moderate risk for a fall.

So what is fustrating me is that everyday I feel like a parrot asking if it will get done. Such as phoning physio to come out and assess the residents knee. I only have 3 days left and would so love to see the full outcome.

I guess there is only so much a student nurse can do. I dont want it to seem over my head. I have a fair idea what community nursing is about, however it dont seem to be working to my advantage at this facility.

How do I request interventions to be put into place, without seeming so demanding. How can I provide details with conviction. I am a timid person, sometimes I cant stand hearing my voice, so I just say little but then I have to repeat myself always to get heard. Communication can be a struggle.

Look forward to your responses

Your choices are to speak up firmly, positively and clearly saying "this is what this person needs to be safe" and go through the channels to get it done; or work with the patient's primary nurse or social worker to get them to keep the ball rolling after you leave. Either way, you will have to stop worrying about how your voice sounds and be assertive. You don't need to be rude, mean or nasty, just assertive. It's a fine line to walk and if there are any schools that offer assertiveness training it might be something you could check out. Otherwise, role play with a classmate or family member or even in front of the mirror and practice telling people your findings and your solution.

When you start working in the hospital you will have to package information to get the orders you need for your patient. It's not enough to say "something's not right with her breathing, I think you need to look at her please," you will need to say "pt x's breathing is labored, resp rate is xx, POx is xx%, breath sounds are, pt is pale, diaphoretic, tachycardic HR xxx, pt has Hx of..., was taking..., and needs to have x, y and z done, now please."

Certain things require going through steps to get, the MD probably has to order the PT eval, the PT needs to do the eval, make a reccommendation, then order the equipment. Chances are SW may be needed to get an authorization for something, and the RN has to sign off on each step of the process. Learning the way things get done at the facility is something that probably takes more time than you will be with this patient. This means that you have to use your resources (ie the staff RN).

Good luck and keep trying to make a positive difference for your patients. It is only by making the effort that we can get things done.