Nurse Help

[summertx]

Hi, I have clinical that starts on Monday and I wanted to know how I can best help the nurse as a nursing student. Anything small or big. I have copied and pasted from a recent thread, I don't want to bother the nurse, how can I help the best? I do not want this posted in students, as they cannot answer the questions better than experienced nurse. 

Quote

Here is what I walked into at the beginning of my shift:

1 Unasyn hooked up, not infusing/ clamped off- patient allergic to penicillin. Dx rectal bleed- no hat for stool collection. Nauseated all day, Zofran not given.

2. Late on pain med by 42 minutes (patient counting). No IVF infusing per orders. No IV site. Needs restart.  S/P hip- No pillow between legs.  Old OR IVF in room hanging LR.

3. Call bell removed within patient reach. Pt asking for someone to be with him.

4. Pt D/C'd on previous shift still here. No CNA available. I took this pt out and did the discharge paper work.

5. Another patient- Family member states the nurses aid said the family is allowed to press the PCA Morphine button. This pt had no IVF infusing per orders. Found pt had IV Lasix- I wasnt told.

6. Other issues: **Taking MD calls. **Aids are missing. Pt's calling for aid work. Am happy to do that work but am behind. Have not seen all patients, since report at 1500. **Meal intakes are wrong for the 3 patients I saw. Found a vial of Ativan on a WOW in the hall ! ! ! **Another family states they have been asking for a Nicotine patch all day. **Continuously paged out of patient rooms. **Short an nurses aid. **Meds not scanning from pharmacy. **Cardizem po is ordered and family states patient is unable to take po. This was not followed up by previous nurse. **Leg dressings are off a patient and not redressed all day. **Hot ice machine has NO ICE in it/ water is warm. **Family called me in as patient is incontinent and not diapered. **Another patient was ordered routine bladder scans, not ever done. Voided 400cc and scanned for 800cc. Cathed patient. **Starlix not given for 7AM. Asked WHY? The nurse stated, "I don't know." Am still NOT FINISHED making first rounds. **Tele patients. (Big $$$ maker.)

 ........ A supervisor stated, "Do the best you can."  Is all about corporate money. I kept the information above to remind myself how bad it is and to never ever go back.

Any thoughts?

[Wuzzie]

You need to realize that the post you quoted from is from a frustrated nurse dealing with extremely short staffing. Your job as a student is not to fix this as it is the result of years and years of mismanagment and hospital adminstrators with only one goal....maximize profits. Your job as a student is to be open to any learning opportunity you can get your little hands on. You need to be willing to step in and do the tasks that many students think are beneath them. Watch the skilled and experienced nurses. Ask your questions. Listen to what they say. Recognize that the ivory tower nurse you've been taught does not exist. These are the trenches. Things may be done differently than textbook. If the rationale and intent are solid, the process does not matter. Ears open, mouth closed (well except to ask questions). Wipe butts, change sheets, feed patients and learn why all of these things matter (we can break it down for you if you want). Be present, be visible, be available. Ask for experiences. Thank your nurse for her time and the extra work it takes to educate you. Do these things and you will be fine. 

[JBMmom, MSN, NP]

2 hours ago, Wuzzie said:

Be present, be visible, be available. Ask for experiences. Thank your nurse for her time and the extra work it takes to educate you. Do these things and you will be fine. 

This. If you read through the list that you posted in your original post, how many of those things could you realistically impact on your own. I saw maybe two. One, you could make sure the patient's call bell is within reach. Two, you may be able to help with personal care (aid work), depending on what your school allows for independent patient care. But you're also not responsible for putting your learning aside in order to provide care. You are balancing your need to learn and become a proficient nurse, with the desire to help improve conditions for the patients and the staff. Nurses and aids that are used to working with students are also usually cognizant of what your goals are how to incorporate them into your day.

I would caution you, this is a tough time to be a new nurse or a nursing student. If your assigned nurses and techs don't appear to be bending over backwards to welcome you with open arms, don't take it personally. If there are times where they are a little short tempered or curt in their responses, or they seem annoyed if something takes you longer than it might take them, know that they (most likely) don't mean that personally. They're dealing with higher acuity patients and larger patient ratios with less staff for support. Those that can rise above it will appear to float through their shift, accomplishing tasks effortlessly and you'll feel like you'll never achieve their level of skill and grace. But you will. Learn what you can from EVERYONE. Techs have many valuable patient care tops that will teach you and save you time- and maybe your back. There's no place for "not my job", if it needs to be done and it's within your scope as a student, then get it done. Always put yourself in the patient's position, if that were your loved one in the bed or chair, how would you want them treated?

Good luck with your clinical. You're not expected to be the white horse riding in and saving the day. You're joining a tired and stressed out workforce, but you will be appreciated for what you choose to contribute. Best wishes.

[RNNPICU, BSN, RN]

This sounds like how it is everywhere right now. Meds are delayed because of delays throughout a hospital, you don't know that maybe the pharmacy has already been contacted 5 times. As for scans etc not getting done, perhaps the scanners are being used by others or maybe aren't working. Lots of things are delayed because there might be higher priorities that you aren't able to understand quite yet.  

As for complaints from the family members, Don't believe everything they say.  Family members often are trying to get what they want regardless of what has previously been explained to them.  As for family members pushing the PCA - that typically isn't allowed as it should be the patient. 

Things to do to help - DO THE CNA role jobs. Learn about how to turn your patient, learn who can be diapered and who can't and why. Learn about how things flow and what is the cause of a delay. Talk to families and listen to them, but listen cautiously as people under stress tend to exacergate and try to pin one against the other for the slightest different wording. 

Understand that operating short-staffed things can get missed or delayed as the nurses are trying the best to prioritize and still meet everyone's needs.

[Dani_Mila, BSN, RN]

Reading your post I was like whoa! You did more than I did when I was in nursing school. That just sounds chaotic!! I agree with the other poster said. Your job there is to be present, learn, experience and just be a sponge that absorbs the knowledge and retain it. You cannot fix the entire shift. The shift was a mess to begin with. Having a student that is willing to learn and help is more than enough trust me and this is coming from a nurse that had to precept new nurses.

[amoLucia]

Wise response, Wuzzie. That must have have been a horrendous day for staff. My sympathies to them.

I guess my concern is why OP is focusing on all the things that were wrong? I'm disturbed by that. I'm sure staff were doing the best they could under whatever the circumstances were.

Good things do occur also altho they just don't jump-out and are harder to measure.

[Tweety, BSN, RN]

A simple "do you need help with anything?" "let me know what I can do for you" "can I do that?" will suffice.  Make yourself available to learn.

As far as that other stuff you posted, leave that in the trash can and focus on your experience and learning all you can.  

[turtlesRcool]

Sounds like a dumpster fire.  Also sounds like a lot of shifts in a lot of hospitals these days.

If you want to be helpful, then just help. Don't focus on getting in on a "big" skill. Show that you are willing to work, and you'll find things to do. It doesn't have to be complicated.  If there's something that you know how to do (like ADLs) then do it. Maybe there's a call light going off, and you can take a patient to the bathroom.  Maybe there's a patient who has been incontinent and needs a linen change. Maybe there's a patient who needs to be fed.

Is this your first time at clinicals? What have you learned how to do that doesn't require the floor RN to stop and teach or oversee you? Do that.

Based on what you copied and pasted, you can easily answer some of the call lights. Assuming your instructor is there with you, you might be able to ask if the instructor would supervise you doing the dressings for the nurse. If you've learned to use a bladder scanner, you could do that. If you haven't learned to use it, you could ask your instructor to give you (and maybe a few others from your group) a lesson in it. The floor RN would probably be really happy to have the instructor do that for him/her.

I'm not suggesting that you spend your whole semester working as a CNA. But as a floor nurse, taking time to coach a student, teach a student, or even narrate what I'm doing for a student slows me down. If I'm overwhelmed, I simply won't have the time because I have to prioritize my patients over the students. But if you can take some of the burden off the floor nurses, then that frees up time for them to be able to teach/show you something more interesting. You can also learn important information while engaged in ADLs. Sometime an aide will alert me to skin breakdown because they're bathing and toileting the patients.