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Discussion

Nursing Practicum

I am about to finish my last day of nursing practicum and I'm realizing how difficult this job is and I don't know what to think about some of the things that I have experienced. I just want some guidance or advice or maybe just some understanding of what I'm feeling..... I can't seem to get that from my parents or my fiance because they just don't understand.... I know all of you will.

First of all I have found that no matter what everything is the nurses fault.....

I had a patient who had a fixation of the femur and she was not to have any ROM of the affected knee (she was supposed to have a knee immobilizer on but I guess she got poop on it so the previous nurse threw it away.. she was ok as long as she stayed in bed but if she got up she was to have another one put back on)....

PT got the patient up and sat her in the chair with her knee at 90 degrees..... Great.... and of course the PA walks in and sees it and almost has a heart attack..... NOW.... she said that it was ok and that it wasn't my fault..... but I totally felt responsible because I should have told the physical therapist about the order... X rays showed no changes and everything was fine but I still feel like I should have know better than to have allowed that to happen....

Second..... Other nurses get mad when you don't pick up the slack.... I've experienced this with a dialysis nurse and a pre op nurse...

I didn't know I was supposed to do a pre op check list until my preceptor said did you do the check list..... Right before my patient went to surgery.... so I scrambled to get it done as much as possible and called the pre op nurse and was like I'm really sorry but I didn't get it done.... Then she was like ok well does she have an 18 G Iv site or larger.... No she has a 22..... SO she was mad about that..... Not too mad but I could tell she was aggrevated.....

There was also a form I had to send down to dialysis with my patient stating what meds were held that day and if there were any meds to be given during dialysis and that kind of thing.... well I ended up getting that done at the last minute because the dialysis nurse asked me where it was and I was like Uh... what form? So I did it while I was down there.... It was ok but I felt like I should have been more prepared for that than I was.

This one is bothering me the most..... When I ask for advice I feel like I'm either being bothersome or like the answer I'm getting isn't the one I'm looking for (or something)....

I had a patient that was ordered CPM.... The order was completely unclear.... Know one could read what degree of flexion was ordered..... SO PT called the doctor three times..... still no call back.... So PT says to leave her off CPM and chart that there was no call back.... So I did.... Now I'm thinking that we should have at least put her in at 60 degrees which was the lowest number we thought the order might say.... Everyone knows the doctor is going to be mad about that even though his order was unclear..... The next shift asked me if my preceptor knew about it..... She did but I still feel like I'm responsible....

Another thing with this same patient..... She had VERY low output for the day (150 in 12 hours).... I asked my preceptor if I should call the doctor (she has a foley already; no kinks in the tubing) but she told me that I should push fluids because she didn't really eat or drink much all day..... Which is completely true.... I had a hard time to getting her to eat or drink anything.... So the patient's daughter told me she likes oj and I got her 8 ounces of oj and she drank it right up..... She was working on the next cup when I left.... I'm still not sure if my action was correct.... Maybe I should have called the doctor.... I was working on the advice of a very experienced nurse (who was also responsible for this patient) so I think I'm alright... I just keep going over it in my head.... we have learned in nursing school that if there is less than 30 an hour we call the MD....

Anyway I'd really like some thoughts on this if you could help me please.....

Featured Replies

There are so many situations where the right thing to do is vague. Sometimes it depends on knowing your doc and you couldn't possibly know the doc well enough at this point to make some of the decisions like range of motion or whether or not to push liquids. As for the permits and forms, I think we all learn that one by experience, lucky you, you learned it while still a student, I learned it only while in orientation and I have heard of some who were off orientation and still hadn't been told or shown what to do regarding permits. You sound very invested in being a good nurse, you will do well but the learning curve is steep. Be brave and if you don't feel like you are getting the info you need ask someone else. You always have the charge nurse as a resource and if she isn't focused enough or willing to give you what you need, find a very experienced coworker to go to. Be willing to help them all you can and generally they will be willing to help you. There will be some jerks and you will learn them quickly.

You are going to be a great nurse.

Mahage

Wow, sounds to me like you are doing a great job. All the right critical thinking. Paperwork is a nightmare to learn and is constantly changing so is an enormous challenge for anyone, including experienced nurses. As for the attitudes, the other nurse are reacting to stress. They will be relieved when you don't need to ask questions but in the meantime their attitude is creating barriers that slow down your orientation to the unit. Very self-defeating. I understand but still it is non-productive. The best I can tell you is develop a thick skin, continue to focus on the patient and allow time to cure some of these ills. Also, when you are precepting a new nurse in the future, remember how you felt "back when:. Good luck!

One of the best ways to learn things when you are new is to understand that wherever there is one thing that you missed, (i.e. pre op checklist), that's the time you go to someone and say "ok, now I know about pre-op checklists. What are the other areas that pt's go to that I need to know what papers to send or what actions to take? " Examples: what tests/procedures do patients need to be NPO for? hold certain meds for? get special preps for? need specific checklists? need specific IV access for?

Find out what are "typical" orders for the most common things you see in your area. (i.e. CPM settings). Obviously you don't want to go around making up your own orders for patients, but knowing what is typical and routine will help you recongize an unclear order when you see one, also will hep you recognize an erroneus order.

PT should have checked the patients orders so don't beat yourself up over that one. You'll have enough to beat yourself up over, don't take the blame for others.

There's no question, nursing is hard work, and unfortunately nursing school does not teach organizational skills real well (or at all). Besides learning specific nursing skills and care, go to the best nurses in your area and pick their brains about how they get organized, set their priorities, etc. They all have different tips that can help you.

THe biggest thing to remember is be PATIENT oriented, not TASK oriented. If you are patient oriented you will always have some sense of satisfaction because you can go home feeling like you helped someone. If you are task oriented you will always feel flustered because it will feel like you can never get caught up or accomplish everything you need to in a perfect manner.

  • Expert

I agree with the others. It sounds to me as if you are doing a fine job. "Not knowing everything" is normal. That's what your preceptorship was for -- to help you learn some of those things you had not known before.

It also sounds as if the staff you have been working with have been pretty reasonable. Sure, they get tired or irritated at times, but you can probably understand why -- and don't hold that against them too much. Their days are hard, too.

Just keep 'plugging away" and I think you will do just fine.

  • Author

Thank you so much for your advice.... I'm doing much better now.... I'll be graduating next friday and I'm really excited about that.... I am also assured that wherever I work I will get a good six to twelve weeks of training so it will be like starting from the beginning again which will help me alot.... I tend to learn by repeating things over and over....

My next concern..... Passing NCLEX ;)

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