Today when I went to clinical I got there a little later than normal, due to the fact that we students now have to park in another lot, far, far away....
Well, I got lost trying to get back to the hospital unit on time. I went into several buildings before I got turned around and found the right building.
When I got onto my unit finally, I had to choose my 2 pts. I charted meds and stayed out of the way, but then I got report late from my primary nurse. My instructor noticed this and she was not happy!!! Then the Director of the program and my nursing instructor took me to a room and told me that there had been a concern about me during an evening when I went to the unit to select my patients. My instructor had previously told us that we could go to the unit the night before to select a pt if we went in professional clothing and so on. So I did, Well the complaint... as I understand it to be... is that I seemed confused, disoriented, Red in the face, and like I was just really confused and shuffling papers around.
I have been getting a lot of complaints from staff on this unit. I have been told that 5 different people have reported something negative about me since I have been going to this hospital. What's that all about? I don't know. One of the first complaints was from a Doctor who walked in behind me while I was assessing my patient. I had my back to him, and my scope down my patients gown to listen to her heart. Apparently he was upset that I did not leave so he could visit with the patient. I didn't even know he was in the room for a few minutes, then I had my scope down this lady's gown, what was I supposed to DO????? Just snap my fingers and DISAPPEAR?????? I then have ben complained about from other staff who say that I was asking too many questions about my pt rather than going in and assessing her myself. I will admit I am a little nervous about going to see patients right away, but I don't think I need this kind of CONSTANT NITPICKING as I turn EVERY CORNER!!!!!!! I am afraid that when I go to see my instructor tomorrow, they will try to get rid of me!!!! What can I do??????? What Recourse do I have??????? Our Syllabus states in our class that if our instructor chooses to do so, she can kick us out of the program if she sees fit to do so. NOW I AM SCARED!!!!!!!!!
Anyway, my nurse instructor sent me home today, and this will reduce my clinical grade by 10 % right off the bat; but now I am scared that she and the staff and the director are trying to get me kicked out of the program altogether!!!! I am a first year student, and i am not getting the politics of Nursing down! I feel like I will have spent all this money and get kicked out of the program and have nothing to show for it and no where to go!!!! Help!!!!
What should I do? I took A&P in 2005, and I could get into another program, I guess, but should I leave them, or just wait for them to get rid of me? I have worked WAY TOO HARD FOR THIS TO END THIS WAY!!!!!!! There must be some way to give them what they want without me having to get thrown out of school for this! I still do not know specifically what I did that caused others to complain. I was confused! I was shuffling papers! I HAVE ROSACEA, AND MY FACE IS ALWAYS RED AFTER A SHOWER!!!!! What am I supposed to do? Can my school REALLY LEGALLY THROW ME OUT FOR STAFF COMPLAINTS?????????????????????????????????
I remember a couple of years back, we were all having difficulty with hands on head to toe's. We finally asked this really good instructor to do one for us s-l-o-w-l-y. It helps so much. Go into your lab and ask the lab person to go over it with you. Also, think clean to dirty. Start with the head, are the eyes clear, use your pen light to check if the pupils are equal, round, reactive to light and accomodation (PERRLA)? This is the hard stuff because we don't always see this when we go in for a check up.
Anyway, look inside the mouth to see if the gums are pink and moist. Get hands on from this point. Grab your stethascope and listen to her lungs (and heart) in the front. Start on right side and begin to feel for the 2nd intercostal space down (find it from the clavicle) and listen. Move directly over (to the left where the heart is) and work your way down. Listen at that 2nd intercostal space and move down a couple spaces and end with an apical pulse (follow nipple area down). You have to listen there anyway, so count the full minute and that part is done You now have the pulse and have checked the resp rate along with assessing regular rhythm and rate). I usually tell my pt that I'm much slower than their nurse but not to be alarmed.
If possible, listen to their lungs at this point (or before the heart, which ever side they present to you first). Ask them to breathe a bit deeper than usual and really listen. Seriously, I even close my eyes to really listen. Start at the top on one side and let the patient's breathing guide you. Go from side to side so 1-1, move down the side you ended on and 2-2 and down. Also do your skin assessment. Any open areas, is the skin warm, pink, and dry or? If they are lying in bed, also be sure your looking at their bottom (don't touch, just notice). If you do touch, wash before moving on.
Check out the abdominal region. First look, do not palpate until after auscultation! Is the abdomen even? Listen, find the belly button and divide the area into 4 regions that cover above and below. Now listen carefully to each region. Are there bowel sounds? Are they hyper or hypo active or normal? Now percus and palpate for tenderness or masses. Ask questions. Do you feel any pain or tenderness?
Check the legs for edema and tenderness. Gently move down the calf and ask about pain and tenderness. Check the feet, don't forget the heels for redness. Palpate for pedal pulses. This can be difficult. I've had to ask my instructor for help when I first started Also, check capillary refill return on all extremeties Is it less than 3 sec?
Here is a little tip when you first enter the room. After you introduce yourself always check any lines and tubes coming in or going out of your pt. Is the IV running and patent; compare the arms to make sure IV isn't infiltrating. Is the IV and o2 set at the right rate? Make sure the IV is running what the doc ordered. I've seen fluids running that weren't orderd. Is urine passing in the catheter? It gives you something to do while you're getting to know your pt. We were always taught to check on your pt and see Are they alive, pink, and breathing? If yes, then check your tubes and lines. You've now established a relationship so it's a bit easier to move on. Go for your head to toe at that point.
I'm sure you'll get some really good advice here. I hope this is a good start for you. Don't be afraid to be hands on. I think that can be difficult, especially when you don't really know the pt. Good luck and be early, really early (you can always check out the gift shop).
And one thing about doing the head-toe assessment - you're not doing it do impress your instructors, you're doing it to practice safely and effectively. That's their point.
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TinkerNurse
80 Posts
I don't understand why they expect you to be able to perform a perfect head to two in the beginning of your second semester.