Nursing Student's breakdown moment - page 2

Hello everybody. I'm a second semester nursing student. I am currently having clinicals in the SNF unit. Today I had my breakdown moment....I gave a PRN pain med after the PT told me my patient... Read More

  1. by   mauxtav8r
    BTW, as a nursing student myself I have found that nurses working may do things that you as a student cannot do. You still stick by your guns and sweetly say to the patient "I've got to ask you, how is your pain right now?" Blame it on the "school rule" or say something like that so the patient doesn't think you are being a nuisance, but do what you know to be your job.
  2. by   JulieRN07
    We've all been there-it can be a humbling role to be a nursing student. won't be long before you will be on your own and making your own decisions. We all make mistakes, and in your case, that mistake was hardly life threatening which is a blessing. I am pretty sure that you will always remember to do a pain assessment from now on, even if its just a quick one-and that is probably the lesson your instructor wanted you to learn.
    So hang in there, learn from your mistakes, and keep telling yourself that you do have what it takes!
  3. by   jojotoo
    Quote from CC918
    Hello everybody. I'm a second semester nursing student. I am currently having clinicals in the SNF unit. Today I had my breakdown moment....I gave a PRN pain med after the PT told me my patient was feeling pain. I told the RN. She instructed me to give a Darvocet. Now, on the patient's notes, it saids to give 1 Darvocet for pain scale 1-5, and 2 pills for pain scale 6-10. It crossed my mind to ask the patient what was their pain level. But the RN said "Just give her one, she doesn't need two" and I stupidly did that.

    Then my instructor came to grill me. "So you gave the PRN med?" yes. "How much did you give?" One. "What was your patient's pain level?" *me standing there looking stupid* i don't know. "Did you do a pain assessment?" *feeling stupid-er* NO.

    I just feel so stupid for doing that. We've been told...YOU are the one giving meds, YOU do the assessment. That was my breakdown moment when I felt so incompetent and questiong whether I'd make a great nurse, or even a good nurse.

    Then, I couldn't get my patient to let me bathe her. She insisted she got a good one yesterday and wants one tomorrow. But not today. I told her I have to give her a bath. She just kept telling me to leave her alone and if I tried to touch her with the wipes, she'd try to move away. So I gave up.

    As a student, we are expected to do the AM care, including bathing and brushing. But what do you do if your patients just refuse to even after I persisted? The instructor always says "You should've been more assertive" . What else could I do, suggestions anyone?

    Thanks for listening to my complaints.

    Your instructor sounds like an a**. I don't know why she would intentionally set you up for failure, but that sounds like what she's doing.

    Since I've been reading this forum, I've heard of a lot of nurses and students that really enjoyed nursing school and got a lot out of it. My school wasn't like that. My best advice to you: Keep your mouth shut, your head down, study hard, and resign yourself to the fact that you won't be able to please this instructor. Get through this semester and on to the next.

    Your patient has a right to refuse AM care. And if you touch her against her will, you will have committed a battery. Did your instructor tell you that?
  4. by   mikethern
    Don't freak out. You gave a safe dosage of the correct medication to the correct patient. It could have been A LOT worse. Hundreds of patients have died from getting the wrong med.
  5. by   bigsyis
    Quote from suzy253
    I agree with the others; sounds like you are doing just fine to me and you'll make a great nurse.
    I'm voting with the others, too!
  6. by   banditrn
    Quote from CC918
    thank you everyone for your support and advice.

    I'll continue to work hard and find a balance between doing what the instructor wants and what the RN wants and what I want/can. I'll eventually get used to things within the hospital. It's just so scary since it's my first clinical semester!
    That whole experience may have made you feel stupid at the time - and we've all been there - but I'll bet you'll never forget to assess the patient on your own after this.
    Just remember - you're a student!! You aren't supposed to have all the answers. So pull your chin up, girl - you learned something - you're gonna be fine.
  7. by   classicdame
    Well, you learned something and that was the purpose of clinical. As for baths - offering to wash face & hands might be a good compromise. In fact, our skin care nurse tells us that the elderly should not be bathed but EO day as their skin dries out quickly. So lotion and a little extra attention to certain areas may be all that is necessary. I am glad to see you are thinking for yourself!
  8. by   scattycarrot
    [quote=classicdame;2453511] As for baths - offering to wash face & hands might be a good compromise. [quote]

    I personally disagree with this. I do not see why the student should have to compromise the wishes of the patient in order to appease her instructor, who should frankly know better.
    CC918, the patient is obviously alert and knows what she does and doesn't want and this should be respected. Her wish to be left alone today after having agood bath yesterday is both reasonable and understnadable. I don't see why you should be more assertive, when you were only respecting the wishes of your patient and acting as her advocate.Which is after all part of our role? If you need to be more assertive in any way, it would be to tell your instructor that you are respecting your patients wishes and think it would be unresonable to push her to do something she doesnt want to do (I do appreicate that thats easy for me to say, I have been a student and I know thats its extremely difficult to cross an instructor!).
    You were right not to give personal care, just remember to ALLWAYS document document document if a patient refuses anything, including patient care, meds, food, drink, etc... Then when they come back and say..'nurse so and so , never even bothered to make sure I had a drink or make me comfortable, than you can go to your documentation and prove them wrong! Documentation is there to cover your butt!! Sorry, I digress.....
  9. by   wooh
    If a patient has dementia, I frame the question like you're supposed to do for toddlers, give them a choice, but still get the answer you want. Not, "Do you want a bath?" but "Would you rather have your bath now, or after breakfast?" And there's always a good ploy, "Now come on, if you don't let me get you bathed, I'm going to get in really big trouble!"
    But in the end, if they're A&O, they have a right to refuse.
  10. by   Zookeeper3
    Here's a broad perspective, Try to find the good lesson that I'll try to assume is there (devil's advocate here).

    The instructor wanted you to know to never just do any nursing task "because you were told to", I KNOW you KNOW this... but still let the experienced nurse sway you from what you knew (we've all done this don't worry!)

    Be more assertive- yes, it takes alot of experience to learn how to sweat talk patients into getting care done. For some, accepting care and participating is a huge part of their nursing diagnosis. We all know the patient can refuse, it's more of ... did you demonstrate behaviors that showed you having good communication to try several different methods to provide basic care? Vrs a nurse who thinks 'you say no? okay" does that make sense?

    You're doing fine! Clinicals is the best time to gain these learning experiences and incorporate them into practice with a smile... lord knows you'll be learning the rest of your career! Best regards, you're FINE!@!!!!!
  11. by   eamon66
    You really didn't do much wrong. So you forgot to ask what her pain score was. The important thing is to learn by our mistakes. You'll remember next time. As for her refusal to wash.....that is every patient's right and must be fully respected. We, as nurses, appear to be obsessed with daily washing of patients and at the same time are taught to follow the patient's normal routine. As someone else commented, the elderly rarely tend to have full daily washes. Check what her normal routine is. Suggest that she lets you know if she changes her mind or would she rather that family members helped her when they visited. Good luck and all the best
  12. by   november17
    It's not a big deal. Your instructor was just reading off a preset selection of questions to try to make you think on your feet. She probably asks those same questions to every nursing student that passes a pain med. You didn't make a mistake, you just forgot something. And really, if the patient was still in pain after the 1 pill, you could have probably given a second. Even though the order maybe didn't specifically state it, it's generally okay to do. If it freaked you out, you could have called the physician and I can almost guarantee you could get them to change the order.

    You really more or less did the right thing, even if you didn't assess the pain first.

    This reminded me of something that happened when I was in clinicals; One of my fellow students gave digitalis to a patient without assessing the heartrate first. It turned out that the pt had a heartrate of 60...She was crying during the post-clinical conference. She thought she was going to get ejected from the program, that she'd be a terrible nurse, blablablabla. The patient was fine in the end. The nursing student? I work with her...we hired in together to the same unit in May, and she does great and holds her own on the floor.

    Just take it as a learning lesson. You didn't hurt anyone. Don't beat yourself up over missing a pain assessment.

    If the patient didn't want a bath, she didn't want a bath. Just document that she refused it and move on. It's not like the patient is probably that dirty. I mean, she had a bath yesterday, and what did she do all day but probably sit in bed. It's not like she was outside making mudpies. I have patients refuse stuff all the time, it's not that unusual. Your instructor knows that, she's just trying to make you into a better nurse. Just an alternative though, you might have tried giving her the washcloth and washbasin and asking her to clean herself, then given her 10 minutes of privacy.
    Last edit by november17 on Oct 19, '07
  13. by   Hellllllo Nurse
    In the real world, I find that the numbered pain scale just confuses most pts. When you ask them to rate their pain on a scale of 1-10, one being...blah blah blah, they mostly just stare blankly- Huh?

    I say "Do you have pain?" If they say yes, I say "A little pain or a lot of pain?" I then medicate accordingly.

    I hate it when instructors and other nurses try to make us feel that if we were better/more assertive/smarter/caring or whatever, we would always be able to get our pts to do what we want them to do.

    By insisting that you should have been more "assertive" in convincing the pt to have a bath, the instructor turned the focus of care away from the pt's needs and towards her own needs/wants as an instructor.

    So, instead of stimulating students to think "What can I do to meet this pts needs?" Instructors encourage "How can I get this pt to let me do what my instructor wants, so I won't look bad?" type of thoughts.

    I do understand that you have to do things the school way, and not the real way in clinicals, though.