Horrible clinical day. Just horrible.

MarySunshine · Apr 27, 2005

My sister had an incident similar to this during one of her clinical. It all boiled down to her miscommunication with the nurse assigned to her patient. She has since become quite careful in checking and cross-checking things with the nurses. I think its better to have them think you're a little slow on the uptake (double checking things with them) than to have them angry at you for neglecting duties.

It sounds like an unfortunate miscommunication with the medication. As far as the charting goes, I think it was understandable that it wasn't finished (it sounds like you have short clinical hours?). That patient is ultimately the nurse's responsibility and charting because a student didn't have time to do it is the way it sometimes goes. It sounds like she was very stressed but it makes no sense to me that she was "livid."

Take away more careful communication skills from this incident, like my sister did. It is SO important in nursing! For instance, when you realized the EEG was taking a very long time, could you have excused yourself for a moment to check in with the nurse? Please don't be discouraged, you sound like a conscientious person who will make a good nurse. Let us know how things work out!

live4today, RN · Apr 27, 2005

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take away more careful communication skills from this incident, like my sister did. it is so important in nursing! for instance, when you realized the eeg was taking a very long time, could you have excused yourself for a moment to check in with the nurse? please don't be discouraged, you sound like a conscientious person who will make a good nurse. let us know how things work out!

i agree with you on this marysunshine. :)

although it is a wonderful experience to observe procedures as a student nurse that a student nurse has never seen before, it is more of a priority to be there for your patients, and to stay in frequent touch with the patients nurse who oversees you during your clinical time at the hospital.

just chalk it up to a day of "positive learning". that brings you one step closer to becoming a fantastic nurse one day! :icon_hug:

Jenneu · Apr 27, 2005

but I was wondering, who did you report off to when you left the floor? Did the nurse know that you were going to leave while she was at lunch? Did you report off to anyone before leaving the floor, in addition to your note? That, above all the other picky things that nurse chose to complain about, seems to be the issue at hand - at least to me.

It sounds to me like you and the nurse had some miscommunication. Personally, I would not leave the matter of the po meds not being taken in the hands of a student without discussing what should be done instead (ie - the student giving the IV med instead or if I would be doing it) - no matter how close to graduation - its still my license on the line if something happens. I think that the nurse should have been more attentive to you while you were taking care of these people - especially if you were tied up for 3 hours. (By the way, you had other things to do - could you have stepped out after 90 minutes to take care of them without causing a problem with the EEG?) Ultimately, the nurse assigned to those patients is responsible for their care - whether being given by herself or by a student or other unlicensed staff member. I hope that it gets straightened out.

I haven't been an RN for very long, and I hope you don't take my input as putting you down in any way, because that is not my intent. It wasn't too long ago when I felt like I was spitting in the wind when it came to some of my clinical experiences! Good luck with the rest of school and I'm sure that it will all blow over soon.

J

redwinggirlie · Apr 27, 2005

Next time, leave the extended procedure.... another, shorter one will come along.

Also, when you make these oral agreements with another nurse, be sure to tell them that you plan to chart what you told them, what they told you and why it is happening, etc....

Sorry you had a bad day. Better now, than later. Also, something I've learned listening to students on the floors where I work is that most of them go into rooms asking the patients things like: Do you want your meds now? Do you want to turn now? Do you want to do your ROM now? Don't pose it as if they have a choice, which they do, but instead say, it is time for your meds, treatments, whatever. If given a choice posed like the above, patients almost always say no.

When they do say no, document, document, document. You can even fill out an incident report in these cases.

Again, next time leave the long procedure unless it's something you are actually doing yourself. You can take a peek during these long things and read up on it later. Be well.

sharann, BSN, RN · Apr 27, 2005

You are the student, there to learn alot in a very short time. You are not there to do the staff's work. The nurse is the licenced one and is ultimately responsible. She should have been afrer you to do those things. I am sure that it was a miscommunication. As far as observing procedures, this is the only time you will probably be able to see procedures, I encourage you to go to as many as possible once cleared with your instructor.

nrse2B2005 · Apr 28, 2005

One of my pt's was a VERY non-compliant girl with anorexia. I presented her meds to her WHILE she was eating her breakfast b/c that was our "agreement", and she still refused to take them. It's not new for her to refuse the nurse told me. A couple minutes after the initial refusal, the pt told me that she will probably take them during lunch. Cool beans. I told the nurse and she said "ok, good."
This nurse was very meticulous, and I admired that about her. I felt like I could really talk to her and ask her q's. She watched me pull every med, asked me the class and what I was giving it for, etc, etc. She was on the BALL. she was also the nurse of another one of my patients....
This 2nd patient that I'm now speaking of was due for an EEG at 0900, in her room. I have never seen one, and our instructor likes us to watch anything we can AS long as were not neglecting our patients care. The EEG ended up taking a good 3 hours d/t interuptions - even the technician performing it said that in his 8 years of doing EEG's, he has NEVER had one take so long. A few seconds after he said that, his supervisor called him to see what was up. Obviously, I didn't get to take a lunch break, but that is fine.
When the EEG was over, I had about an hours before I was suppose to leave, so I started my charting, but of course, i got my interuptions as well. I ended up doing 2 narrative notes on both of my patients, but only 1 "WDL" charting. My nurse was at lunch when it was time for me to give her a report off, so instead I just left her a note...
reminded her to check Patients XX pain at 1300 b/c I gave her a Vicodin at noon.
Reminded her that XXX said she will take all of her PO meds at noon with her lunch
Told her i didn't get 1 WDL charting done
WELLLLLL, apparently when she came back from lunch she was LIVID at me and called my instructor b/c..
1)I didn't do a WDL charting. "why couldn't she have gotten that done??"
2)and b/c I didn't give the anorexic patient her IV Solu Medrol that she was suppose to get if she refused her prednisone.
I was practically in tears trying to expalin it to my instructor that I was under the impression she (the nurse) wanted to wait to see if she, the pt, was going to have her prednisone at noon - which is why I didn't give the SOLUMed. Like I said, when I told the nurse that the patient said she may take her meds at noon, the nurse said "ok, good." Besides, she was meticulous and I highly doubt if she would have wanted me to give a drug without her first checking it - she checked all of my meds. As far as the charting is concerned, I honesly didn't have time to do 1 chart - I was in a EEG. My instructor then said..."well, she is saying that you told her that you would give it in the late morning (The solu), which is a LIE...she knew I was going to be watching the EEG, so why would she say that???? My instructor also asked why I had time to take a lunch break, which is what the nurse told her, and I'm like "WHAT - I DIDN"T TAKE A LUNCH BREAK, ask any of my classmates."
Oh my gosh it was horrible. I hope my instructor believes me.
What is our opinions on this?

I know the feeling. I am in third semester and have all sorts of similar stories. One of the things you can take away from this is the following: 1) chart on the med sheet that the pt refused the medication and the time(CYA-you may have already done this); also chart it somewhere that you let the nurse know and the time you told her 2) let the nurse in charge of the patient know that you are going to be off the floor for a procedure and you will let her know when you return. in other words, the ball is in her court until she is notified otherwise. 3) when you leave, if she is gone for break or lunch, report off to the charge nurse, as well as the fill in, that you are done and gone. Good luck. I have not had many instructors who will stand up for their students, so I hope you have the exception. If not, don't worry. Its all how you learn how to CYA.