I had a nursing student assigned to one of my patients yesterday. I had a very busy day with several issues coming up, and this student was not exactly helpful. She definately was in the chapter of the book to never let the patient be in pain, because the patient that she actually had could have IV pain med every 2 hours, which I was trying to keep on top of the best I could, but I had some other pressing issues with my other patients. I was trying to include the student in what was happening with my other patients too, since she had expressed interest in this. But, she seemed very annoyed with me when I didn't get back into that room soon enough to get him his pain med. The patient was NPO and had a lot of IV BP meds due contantly, in addition to abx and IV Dilaudid, so this was all very timeconsuming, and this student couldn't give anything IV.
The patient was scheduled for a follow up CT scan and had to take oral contrast, and was supposed to go down in an hour after taking it. This student was acting like an annoyingly pro-active family member and became very annoyed when radiology got delayed in by other patients. She insisted I call them even though I told her that they would call when they were ready for the patient, then she was very put out when they didn't come when she expected them, as if they were making her poor patient suffer. The student acted as if I was neglecting her patient. I know she was trying to be an advocate for him, but I needed to prioritize care and had several more pressing issues with other patients. The patient was fine with everything, he'd been in the hospital 15 days and was finally starting to feel a little better.
I told the student that we could change the sheets when he went to CT, but she said that she would be going with him there. She never did let me know that she was taking him, but just took off. She definately wasn't into doing any personal care for this patient. Basically, this student was a thorn in my side all day, I felt. I kept trying to explain some other issues that were going on with patients, but she was disinterested.
Basically, this student was clueless still about the big picture of caring for several patients, and was pushy with me in advocating for her patient, and she definately annoyed me.
eek. sounds like she'll annoy a few more people when she becomes an rn :icon_roll
while it is hard being a student and not really understanding the bigger picture (yet) the one thing that is important is being able to learn as much as you can from the primary nurse ( you in this case) whom is the experienced one.
no, you'll probably find her sitting in the stairwell crying. nursing schools have always been deficient in introducing students to "the big picture", but that's what orientation is for. my daughter is in a program that increases responsibilities as the class progresses, adding patients as the instructor feel the student can handle them. they also rotate through a "charge nurse" clinical, where they are responsible for making sure all the students in clinical are on task. she complained a lot about that class, but i'm confident she'll be better qualified to hit the ground running when she graduates.
If the patient is on PO pain meds and the nurse isn't sure exactly when the wound team will show up, then it would be very difficult to time the pain meds to kick in at the right time. What's good in theory sometimes doesn't work very well in the midst of a busy shift.
i see what you're saying.
when i was in school, the nurses did the dsg changes.
even when i went to school, nurses gave prn pain meds pre-dsg change.
i have to admit, practically all of my clinicals involved top notch nurses.
very lucky to have gotten the education i did.
leslie
That's what I was always taught. I wonder whether the fragmentation of care, with specialized teams to do dressing changes, has made this more difficult to coordinate.
Well, I don't know what the answer is. I just know if the patient was my mother, my loved-one, I'd raise holy hell and tell the staff to figure something out because my loved one isn't going sans pain meds for painful dressing changes.
Maybe a dumb question, but where was the instructor?
I know when I teach clinicals, if the RN is too busy to give a pain med, I am glad to do it myself. If the student couldn't administer IV meds, the instructor could have done it while teaching the student.
But at the school where I teach, all students (except for last semester seniors) have an instructor on the floor the entire time of clinical. I guess it isn't like this everywhere.
Bingo! That could have also been a good moment for the instructor to talk to the student about delegation and teamwork.
For example, I had a patient who would cry in pain when the wound care team came by and tended to her pressure ulcers. So prior to the wound care team rounding the next day, I tried to get PRN pain meds from the RN for the patient. The RN seemed exasperated, acted like I was a fussy and demanding nursing student, and said with "quick pain" like with the wound care team, we don't give PRN pain meds.
So I watched my pt. cry again and I tried not to cry as the tears rolled down her face and she started doing that fish-mouth breathing thing.
What the hell is "quick pain"? Wouldn't want her to be my nurse, sorry had to say it.
When I had my clinical on the ortho floor, we did a LOT of premedicating for PT. There was no way to predict at what exact time the physical therapist would show up, but we had a general idea and would make sure the patient had something on board before PT, then was offered something again after.
I'm actually looking forward to having students (they just started their clinicals for the year), and really hope they don't irritate the **** out of me. I was lucky to have attended a program where the clinical instructors were so supportive, and the school environment was geared toward helping the student identify their strengths and weaknesses and make improvements where needed. Only a few students flunked out because of test scores, and one was kicked out for being unsafe in the clinical environment, after multiple opportunities to resolve the problem.
Most of my experiences with the staff nurses were positive, though I did have a couple who could have been more helpful. The CNAs, though, were the most troublesome. They considered the presence of students to mean that they were off the hook for doing anything for those patients, and were downright rude about it and resentful if the student wasn't able to get to something. I remember one CNA during my entire NS program who treated the students like team members and worked together with us, instead of outsiders there to do the CNA's job for them.
Other than that, my NS experience was pretty positive in general.
I am so glad to be out of NS, though! The stress.....the insecurity....the endless studying.
Well, in this case, it was pain that made the patient cry for about 10-15 minutes while the wound care team did their thing on her multiple ulcers.
There is no reason the nurse couldn't have called the wound care team and asked for an estimate on when they would be there, and premedicate accordingly, letting the wound care team know that she would be premedicating. I know that we have to prioritize where our attention and care should be, but something like that would be high on my priority list. Plus it would be a good teaching experience for the student, to show them how a nurse coordinates interdisciplinary care. We do it all the time, when the patient needs diagnostics and labs, is going for procedures, needs respiratory treatments, and so on. The nurse is at the center of all of this, like an air traffic controller.
There is no reason the nurse couldn't have called the wound care team and asked for an estimate on when they would be there, and premedicate accordingly, letting the wound care team know that she would be premedicating. I know that we have to prioritize where our attention and care should be, but something like that would be high on my priority list. Plus it would be a good teaching experience for the student, to show them how a nurse coordinates interdisciplinary care. We do it all the time, when the patient needs diagnostics and labs, is going for procedures, needs respiratory treatments, and so on. The nurse is at the center of all of this, like an air traffic controller.
Katie82, RN
642 Posts
no, you'll probably find her sitting in the stairwell crying. nursing schools have always been deficient in introducing students to "the big picture", but that's what orientation is for. my daughter is in a program that increases responsibilities as the class progresses, adding patients as the instructor feel the student can handle them. they also rotate through a "charge nurse" clinical, where they are responsible for making sure all the students in clinical are on task. she complained a lot about that class, but i'm confident she'll be better qualified to hit the ground running when she graduates.