HELP!! Tell me where I can buy some confidence!!

Nesher, BSN, RN · May 24, 2005

Ok, you are not a bad person or bad nurse - you just need a little work on priorities.

That said - try to do your assessments first- you do want to know how their lungs, heart sounds etc - baths, bed changes can wait.

RNsRWe, ASN, RN · May 24, 2005

Okay, I'm in my second semester and I'm doing great as far as grade wise in my classes. I'm even doing okay in clinical except for today!
Last week in clinical I had the pt from hell. NOTHING I did was right. He was cold, crabby and basically criticized everything I did. I couldn't even rub lotion on him right.
Today I had a nice patient. I took care of her bath, changed her bed sheets and told her I would be back in to listen to her lungs, heart, etc and to ask some questions. Well, when I go back in she was sleeping. How do I get over not caring if I'm "bothering" the pt or not??? I mean, I clearly had assessing that I needed to do, I just have this hang up on not wanting to bother the pt. The end result was that I helped other people with their patient but never got the full assessment on mine because she was asleep. Obviously that didn't go over well with my clinical instructor and I can't say that I blame her. I'm extremely disappointed in myself.
I know that in the real world there will be a ton of things that need to get done and it's not going to matter what the patient wants to do. I need to grow a pair, find a backbone or something!
Please someone tell me that you USED to have this problem but got over it quick! I'm a good student and want to be a nurse really bad, I've just got this one little problem!

nesher is right: priority is assessment of pt's condition, the rest can wait. Practice doing a head-to-toe assessment in five minutes or less. Learn how to get vitals quickly, and go in an orderly fashion to be the most productive in a very short amount of time. Give yourself a mental rundown of what you need to assess before going in to see that pt, and make sure you hit it all.

Don't think of it as bothering the pt (unless, of course, you have to keep going back--then you are!). Don't ask "may I check...?" Just check. Matter of fact, professionally and pleasantly, before they have time to even think about what you're doing. No unnecessary chatter if getting distracted is a problem for you. Smile alot, but keep moving!

twinmommy+2, ADN, BSN, MSN · May 24, 2005

I don't like bothering people either. Just think of it this way, if you don't bother them, then you won't be fully doing your job and helping them. If you miss something because you didn't bother them, then that may come back to bite you and her. You sound like a sweet person, keep at it!

Tweety, BSN, RN · May 24, 2005

You've learned some lessons. You're not a total failure because you got some criticism from your instructor.

Why not assess just prior to the bath, or during the bath, or after the bath while you have their attention. The more you get done at once, the better (in the real world that is).

Hang in there. Best wishes.

grinnurse, RN · May 24, 2005

With that being said, next time you wil know what "not" to do!!

You might give this a try: after you get report on your patient, go and do your "down and dirty" assessments on them 1st thing. This is probably called something else by each instructor, but to us, it was assess the problem that they are in the hospital for........example: pneumonia-of course resp assess and any other thing pertinent such as IV sites, foleys, etc. and of course chart. Then, as the morning progresses ie., during bath, bed changes, go totally in depth etc.........on your patient with everything-skin. Of course, in your down and dirty if the patient has sugar checks do that then too..........I am sure you get my "jist". That way you have enough information to begin care on your patient. The more you assess the quicker you become. This is also something you can do on family members and friends (of course it will drive them insane :eek: ) but, you will get quicker. You could even time yourself with them. It helped with me.

Anyway, hope this helps in some small way. Just don't beat yourself up, you will do better next time :roll

sleepymom · May 25, 2005

I definitely appreciate the advice and will take it all into account next week during clinical. :) I'm also going to stop asking if I can listen to bowel sounds, heart, etc. I totally do that alot and that gives the patient the option to say no and then I would really be stuck! :lol

Catys_With_Me · May 25, 2005

I had this hang up at first too... I didn't want to bother them by waking them up. Then I started thinking, when I'm a nurse I'm going to have several patients and I will not have the luxury of waiting until they're awake. I will have duties to do, important assessments to make, and I will need to do them. After that I began approaching the patient with much more confidence and I found that just entering the room and setting my clipboard down was often enough to wake them. Often, they're not sleeping as much as they are just resting.

And yes, stop asking if you can do things. I learned that with my two year old. "Do you want to come eat your lunch?" After hearing "No thanks" a few times I realized it was best to say "Come to lunch now sweetie." Same thing at the hospital, it's not: "Do you want your morning medications?" It's: "It's time for your morning medications.."

RNsRWe, ASN, RN · May 25, 2005

And yes, stop asking if you can do things. I learned that with my two year old. "Do you want to come eat your lunch?" After hearing "No thanks" a few times I realized it was best to say "Come to lunch now sweetie." Same thing at the hospital, it's not: "Do you want your morning medications?" It's: "It's time for your morning medications.."

Bingo! I said something about this earlier. I think it was my first clinical instructor who advised the "don't ask, just do" policy.

I had a patient once who had been in the hospital five days, and had refused baths and showers. He was in for complications for hepatic encephalopathy but had a host of other issues, including DM and advanced breakdowns in skin integrity; when his ammonia levels were brought back to WNL and he could be reasoned with he still wasn't reasonable . He was morbidly obese and let's just say that the occasional lotion spray that the CNA gave him wasn't cutting it for cleanliness purposes :uhoh21: . He was fully capable of walking into a shower and washing himself!

Walking into the room, you could just about choke on the odor. Learned how to hide the gag reflex! After a fast initial assessment, I said "ok, I'm going to go check on my other patient and then I'll be back with supplies for your shower. Do you want to use the one in your room, or the larger one in the hall?" He hesitated, then said that he hadn't yet used either shower here; I said "I know that, and it's time to go ahead with one." That was that. No more discussion. He said he preferred his room shower, I got him everything he needed, and when I returned I even turned ON the shower to "get it nice and warm for you....I'll answer the call bell when you're done"! LOL....

Trust me, the rest of the staff was happy as hell that day, and the CNA did a little bow-down, rofl....