Clinical instructor punishes patient instead of me *rant*

[Murse901]

Hello all,

On September 9th, I called in late for a clinical rotation due to vehicle problems (I broke down on the way to the hospital, so I couldn't exactly call in an hour before the scheduled time). Clinicals started at 6:30am. I called the instructor to let her know what happened at 6:45 (had to walk awhile just to find a payphone). Once it was all said and done, I got to the hospital at 10:30am.

When I got there, I immediately went to my patient to check in on him. When I entered the room, I was immediately hit with a strong odor of urine and feces. I proceeded to bathe him, change his gown/diaper, changed bed linens, and did an assessment. I asked my patient how long it had been since he had been checked in on. My patient, although in a nursing home, is alert and oriented x3. My patient stated to me that the last time he saw a nurse was when he was given his morning meds. This was at 6:00am.. My patient went over 4 hours without so much as being checked up on. The instructor knew I wasn't going to be in, but failed to let a CNA or another student know to check up on my patient.

Initially, I had thought that it was perhaps simply an oversight on her part. I understand we can all be overwhelmed, and maybe it had just slipped her mind. However, yesterday, I was speaking to a classmate about the issue. She told me that she asked the instructor if she (the student) should check up on my patient. The instructor told all of the students specifically not to check on my patient whatsoever. This instructor deliberately denied care to this patient simply because she was (apparently) upset at me for being late.

I don't mind doing work and getting my hands dirty. If I did, I wouldn't want to be a nurse. I don't mind the fact that I had to come in and do all the AM care for my patient. I would have had to anyway, had I shown up on time. But why should the patient suffer because I was late? Why not punish me by making me help with other patients throughout the rest of my shift? Plenty of patients are pooping their diapers and need other types of care. Why not just make me do extra work rather than force a patient to lie in feces and urine for 4 hours?

Thankfully, the patient was a PEG feeder, and his feedings were scheduled for 6am and 12pm. What if this patient were to receive a normal feeding? Would he have to go hungry just because I was late? What if we were allowed to push meds? Would she withhold medication because I was late?

This is ridiculous. Again, I don't mind doing the work. What I do mind is a clinical instructor who feels it's okay to withhold care from a patient simply because a student is late for clinicals. I'm strongly considering writing a formal complaint to the program director. If the hospital found out what happened, we probably would no longer have that site as a clinical site. If the state found out what happened, the instructor would likely be brought up on willful neglect charges.

ARGH! :angryfire:

[DZcarrie]

first off, good for you for looking out for your patient!

4 hours is way too long for anyone to go without being seen by any staff, period.

another thing that is bothering me about your post is that YOU had to do the assessment. assessments should be done asap in the A.M. weren't there any nurses concerned about how this patient was doing for HALF A SHIFT?! yowza....

[jasonn]

first off, good for you for looking out for your patient!

4 hours is way too long for anyone to go without being seen by any staff, period.

another thing that is bothering me about your post is that YOU had to do the assessment. assessments should be done asap in the A.M. weren't there any nurses concerned about how this patient was doing for HALF A SHIFT?! yowza....

And like i said.... i bet ya anything there is a note every hour in the chart

[NurseFirst]

And like i said.... i bet ya anything there is a note every hour in the chart

Not all states require hourly charting on nursing home patients.

However, did this patient not have medications?

NurseFirst

[NurseforPreggers]

I think that what you have described is completely innappropriate and I would absolutely follow the chain of command to report the behaviour of your clinical instructor. You sound like a very caring person who will make an excellent nurse. Please please please tell someone of authority about the situation. Then let us know what comes of it, I'm interested to find out.

[Murse901, MSN, RN]

However, did this patient not have medications?

Yes, the patient had meds, but they were given at 0600 and he wasn't due for more meds until 1200. I'm just starting out in my program, so thankfully I wasn't responsible for his meds.

Due to the mixed responses I've gotten in this thread as far as whether or not I should report, I don't think I'm going to report her. In my gut, I know that I should, but I'm just a lowly nursing student, and I'm in a very vulnerable position. All it takes is a little number-fudging, and my future is out the door.

[military spouse]

The facility is still responsible for providing adequate care, even when students are in the building. That being said, many SNFs would consider a 4 hour period with no care adequate--Sad! I would think long and hard before potentially getting on the bad side of an instructor. That's a tough battle to win!

[Marie_LPN, RN, LPN, RN]

The clinical instructor KNOWS this pt. needed personal care, and tells the students not to do it, therefore denying care for this pt.

Wonder how well she'd like it if a nurse did this to HER???

[Daytonite, BSN, RN]

Normally, I would be chomping at the bit to report your instructor, but in this case I think there's a couple of issues to consider. For the next months of your student life it is important that your instructors have a good impression of you. You will need their recommendations in order to get your first hospital job as you come out of nursing school. You can't afford to have any instructors holding a grudge against you. Just so that you know, in most schools all the instructors have weekly meetings where they discuss the progress of the students. It is quite likely that your tardiness is also known to some of the other instructors by now.

The first thought that went through my mind when I read your post was that the patient might be wrong about when he had been incontinent. A strong odor to BM and urine does not indicate that it has been fermenting for awhile. Some people have stinky BM and urine. Also, BM and urine start to dry around the edges when the patient is left to lie in them awhile. So, there would have been physical evidence that the patient had been lying in BM and urine for 4 hours. Also, if he urinated multiple times the urine might be dripping out of the edge of the diaper. It is quite possible that although the patient seems to be alert and oriented he is, in fact, a bit confused. When you find a patient lying in BM and urine as you describe it and the patient tells you he didn't want to bother anyone and that he knew someone would eventually come, you have to wonder about his mental processes. Look at this from a common sense point of view. . .how long would you lie in BM and urine waiting for someone to come? Four hours is a pretty long time to patiently wait for a clean up in my book.

The other thing that went through my mind is that you really don't know if the instructor checked up on your patient or not. It's quite possible she did and that the reason he was lying in his own incontinence is because it was fresh. You just don't know and a lot of your thoughts are assumptions on your part that have gotten you emotionally charged up.

I see two ways to handle this. Say nothing and go about your business as a student. Or, go to this instructor and tell her how awful you felt about coming in late and that you will, in the future, have a back up plan if this situation with your car happens again. The final thing is that the patient wasn't harmed. And, the fact is that you were late to your clinical assignment and you really have no proof to back up any neglect on the part of your instructor. I would be very, very careful around this instructor in the future.

[jaramilm]

This sounds very bad. But when a hospital has students there, is not just the student's responsibility to check but the nurse, the aid and the supervisor. Perhaps your instructor meant not to do the assessment until you get there. It sounds like there is a lot of tension between you and your instructor or your classmates. When this happens, is best to report it right away so it can be solved.

I had a pretty mean professor that had dropped a student for being late!!!

[jaxmom63]

I don't know about your nursing school, but at ours, if you are not at clinicals at the set time, (6:45 am) you might as well not show up. Even if you are behind an accident, etc. If you show up late, they send you home. And if you have more than two absences per semester, you are dropped from the program. But all in all, we have clinical instructors that have the patients care at heart. They are hard on us, but the first thing they teach us is that the patient comes first.

[meownsmile, BSN, RN]

I understand if you are assigned the patient then you take that patients care. However, she should have told the regular staff that you were late and she would let them know when you had arrived and could resume their care. Your instructor is the one responsible for this,, however, the regular staff ultimately have responsiblity to see that care is done for a patient PERIOD. The facility is the one who would be fined if the state walked in or had that reported, so ultimately they HAVE to tend a patient regardless, students or no students.

They still should be checking that the patient is tended too,, and if they werent they shoud have gone to the instructor and reported it,then she could have told them you were goingto be late.

Geesh,, was that a big crack to fall into or what?