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Discussion

How do you handle??

Hi everyone,

I'm a brand new nurse and this week was my first week working at an internship program at a hospital. I wanted to get your opinions on some things.

First I had a patient who was "difficult" oriented to pp&t, my first interaction with her was I went to get a set of vitals on her and she SCREAMED that the BP cuff was hurting her as it was inflating.:o I had felt her leg earlier to check for pedal pulses and there was nothing wrong with it and my preceptor did tell me that she was a screamer. I attempted to explain to her that it would be tight for a second and then would loosen and that we needed to get the vitals so we could give her her meds to which she SCREAMED more saying if I didn't take if off she would call the SBON. So thinking she does have the right to refuse I took it off and got my preceptor who proceeded to get her BP. EVERYTHING was an issue with this lady, she didn't want to take meds, didn't want to feed herself (altho capable she wanted someone to do it) I went out of my way to cater to her thinking she needed extra attention and that didn't help either. SO HOW do you handle these pateints? HOW could I have gotten the BP w/o getting my preceptor? I'm asking because I KNOW I will hav pts like this in the future and I can't just NOT get a BP especially on a cardio floor where bps & hrs are required for meds.

Second, on my third day with my preceptor (and these weren't even full days b/c it was the first week) she told me she didn't think I was as far as long as I should be skill wise. She said she called education to let them know because otherwise I guess they or the floor would expect her to still carry a full load of pts plus because their argument would be that she has an extra set of hands (me) when in actuallity she doesnt because she has to slow down to train me. I can understand and I really do like her I think she's very good. I just think that was a little unfair considering again it was only my third day on a new floor, and I just had been trained on how to input check orders on the computer etc.. and I was trying to pull everything together. As it was I was doing assessments, vitals giving meds. I am a little hesistant when it comes to some of the skills that I didn't get to do alot of in nursing school and I do expect her to be there for me AT FIRST but I think thats pretty normal. Also we do have other interns on my floor and I do not see them doing 1/2 as much as me at this point. Don't get me wrong I'm glad I AM getting to do more, its just yeah I'm a little nervous the first time I do things (i.e. hang blood) on my own. Any thoughts on this would be appreciated.

thanks, good luck to all those also starting.

Featured Replies

  • Experts

Hi there Healer! What a week, hunh?

1. If you use an automatic BP cuff, ensure that the pump up pressure is within normal parameters for the individual patient. For instance, my BP usually runs 110/60, so pumping up the BP cuff to 160 is reasonable. However, pumping it up to 210 is going to hurt. If you have a pt who has higher BP, doing it manually is more efficent and often less painful for the pt.

2. This is your THIRD day as an RN? This preceptor is nuts to expect you to carry a full load of patients! They are not doing you any favors. How long is your orientation? What kind of floor is this?

In re-reading your post - this internship is for nursing students or new grad RNs? That would differentiate what tasks/skills you are developing and also your role on the care team. Take care.

  • Author

Hi, thanks for the advice on the bp cuffs i didn't realize you could regulate the pressure like that.

Yes, it is an intership for new grads. It's a telemetry floor I'm on now. You do a total of 18 weeks of training, 6 weeks on three different floors.

I realize I will have to everything for my patients, BUT i thought they would realize that I would need some time to smooth out my skills and get comfortable with organizing my day etc.. But I guess I shouldn't complain from what I heard years ago as an RN you were just put out on the floor and expected to just go do it whether you were comfortable with a skill or not. To me that sounds kind of crazy though and I don't know how mistakes werent' made!

  • Author

Oh one more thing - does anyone have firm yet appropriate statements to use to try to "motivate" patients who are giving you a hard time, (basically because they can!)

What I'm trying to say is, I'm a bit mushy at times and since I'm new altho I try not to I'm probably not coming off as confident as I could. My preceptor was telling me people can read that and some if they know your not firm, will try to give you a hard time (like my patient in above email). I never know what to say other then to educate the person on why I have to perform something or why they should take a med, etcc at these times. I guess I'm just looking to see how others handle or have handled difficult patients

  • Experts

Confidence comes with experience and comfort level. Give yourself a break...it'll come with time. I am a mean ole lady (at least that's what my kids say), so I come across as pretty no-nonsense even though I'm smiling. In time, you will get the hang of reading folks and be able to tell how to approach them.

  • Author

thank you - :thankya:

  • Experts

You are so welcome. Thanks for joining us as a nurse. (We need to treat you and our fellow new grads with compassion and respect, so that you'll stay around to take of us!).

  • Author

Thanks AGAIN; I wish more nurses would consider that line of thought with us "baby" nurses.

Even though we (or in this case I) may look like a deer in headlights at times, its because I'm still learning and I'm in a new environment. I made it through nursing school and my nclex so I don't think any person who can survive that could ever be considered not smart.

I wish preceptors/teachers/other nurses would recognize this more and give us a chance to show them before easy judgements are passed. I give ALOT of credit and respect to you and all nurses who have alot of experience under their belt. O.k. I'll get off my little soapbox now. :)

  • Experts

When I have to be "firm but kind," I try to acknowledge the legitimacy of the other person's feelings but then re-state what it is I have to do.

For example, "I can understand why you don't like this _____, but I still have to do it so that we can _____." (Fill in the blanks for whatever unpleasant task you need to do.)................"Yes, I know it is uncomfortable, but I still have to do it." .......... etc.

llg

Healer, how did the preceptor go about getting the BP?? Did you have a chance to observe her dealing with the difficult patient??

Sometimes it helps to kinda do it as you're talking to them..distracting them a bit while you're putting on the BP cuff, for example.

For what its worth, give it a few more days. You'll feel so much better when things start to "connect" :)

  • Author

TrueRN,

I didn't get a chance to see my preceptor go in a deal with getting the BP, BUT she had had her the previous day so the women knew her, and the lady screamed when she took her BP as well but let he do it. I hope things will connect. BUT like you said it was only my first week soo..

Hey there,

I am new too (about 7 weeks into orientation). I still feel totally stupid and helpless some days. But it does get better and it sounds like you're trying the best you can and doing a good job.

As far as the patients who want you to do every little thing for them- I try to say something like "It's important you do this for yourself so that you can be as independent as possible when you go home. We want to see that you can handle these things when you go home" or something to that effect. Also set limits in terms of time spent in their rooms- say "I have other patients who need care, but I will check back in with you later (or in an hour, or whatever)".

Some patients will never be satisfied with the amount of attention you give them, some will complain about every little thing. Don't take it personally, and just try to act confident and in charge (even if you don't necessarily feel like it). good luck :)

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