Nursing Student's breakdown moment

rn/writer, RN · Oct 18, 2007

You could have asked the patient to rate her pain. 1-5? No problem with giving just one, and you would have been able to answer your instructor's question. You might also have mentioned what the RN told you and asked what you should have done had the pain number been higher.

If the initial rating had been, say, a seven, you could then go to your instructor and present the conflict. You know what should be done, but it's nice to have the official okey-dokey when you're caught in the middle between two authority figures.

Remember to document both the pain rating and the follow-up an hour later (if it is an oral med).

Experienced nurses are not perfect. Exercise your best judgment about your practice and don't let yourself do things that you know are wrong. "She told me to do it," is not an adequate defense if you know (or should know) better.

File this under learning experiences. Clinicals are not only for honing your skills, but for sharpening your thinking as well. You're right on schedule, and I'll bet you'll never make this mistake again.

mauxtav8r · Oct 18, 2007

BTW, as a nursing student myself I have found that nurses working may do things that you as a student cannot do. You still stick by your guns and sweetly say to the patient "I've got to ask you, how is your pain right now?" Blame it on the "school rule" or say something like that so the patient doesn't think you are being a nuisance, but do what you know to be your job.

JulieRN07 · Oct 18, 2007

We've all been there-it can be a humbling role to be a nursing student. But...it won't be long before you will be on your own and making your own decisions. We all make mistakes, and in your case, that mistake was hardly life threatening which is a blessing. I am pretty sure that you will always remember to do a pain assessment from now on, even if its just a quick one-and that is probably the lesson your instructor wanted you to learn.

So hang in there, learn from your mistakes, and keep telling yourself that you do have what it takes!

jojotoo, RN · Oct 18, 2007

Hello everybody. I'm a second semester nursing student. I am currently having clinicals in the SNF unit. Today I had my breakdown moment....I gave a PRN pain med after the PT told me my patient was feeling pain. I told the RN. She instructed me to give a Darvocet. Now, on the patient's notes, it saids to give 1 Darvocet for pain scale 1-5, and 2 pills for pain scale 6-10. It crossed my mind to ask the patient what was their pain level. But the RN said "Just give her one, she doesn't need two" and I stupidly did that.
Then my instructor came to grill me. "So you gave the PRN med?" yes. "How much did you give?" One. "What was your patient's pain level?" *me standing there looking stupid* i don't know. "Did you do a pain assessment?" *feeling stupid-er* NO.
I just feel so stupid for doing that. We've been told...YOU are the one giving meds, YOU do the assessment. That was my breakdown moment when I felt so incompetent and questiong whether I'd make a great nurse, or even a good nurse.
Then, I couldn't get my patient to let me bathe her. She insisted she got a good one yesterday and wants one tomorrow. But not today. I told her I have to give her a bath. She just kept telling me to leave her alone and if I tried to touch her with the wipes, she'd try to move away. So I gave up.
As a student, we are expected to do the AM care, including bathing and brushing. But what do you do if your patients just refuse to even after I persisted? The instructor always says "You should've been more assertive" . What else could I do, suggestions anyone?
Thanks for listening to my complaints.

Your instructor sounds like an a**. I don't know why she would intentionally set you up for failure, but that sounds like what she's doing.

Since I've been reading this forum, I've heard of a lot of nurses and students that really enjoyed nursing school and got a lot out of it. My school wasn't like that. My best advice to you: Keep your mouth shut, your head down, study hard, and resign yourself to the fact that you won't be able to please this instructor. Get through this semester and on to the next.

Your patient has a right to refuse AM care. And if you touch her against her will, you will have committed a battery. Did your instructor tell you that?

mikethern · Oct 18, 2007

Don't freak out. You gave a safe dosage of the correct medication to the correct patient. It could have been A LOT worse. Hundreds of patients have died from getting the wrong med.

bigsyis · Oct 18, 2007

I agree with the others; sounds like you are doing just fine to me and you'll make a great nurse.

I'm voting with the others, too!

banditrn · Oct 18, 2007

thank you everyone for your support and advice.
I'll continue to work hard and find a balance between doing what the instructor wants and what the RN wants and what I want/can. I'll eventually get used to things within the hospital. It's just so scary since it's my first clinical semester!

That whole experience may have made you feel stupid at the time - and we've all been there - but I'll bet you'll never forget to assess the patient on your own after this.

Just remember - you're a student!! You aren't supposed to have all the answers. So pull your chin up, girl - you learned something - you're gonna be fine. :)

classicdame, MSN, EdD · Oct 18, 2007

Well, you learned something and that was the purpose of clinical. As for baths - offering to wash face & hands might be a good compromise. In fact, our skin care nurse tells us that the elderly should not be bathed but EO day as their skin dries out quickly. So lotion and a little extra attention to certain areas may be all that is necessary. I am glad to see you are thinking for yourself!

scattycarrot, BSN, RN · Oct 18, 2007

As for baths - offering to wash face & hands might be a good compromise.
I personally disagree with this. I do not see why the student should have to compromise the wishes of the patient in order to appease her instructor, who should frankly know better.
CC918, the patient is obviously alert and knows what she does and doesn't want and this should be respected. Her wish to be left alone today after having agood bath yesterday is both reasonable and understnadable. I don't see why you should be more assertive, when you were only respecting the wishes of your patient and acting as her advocate.Which is after all part of our role? If you need to be more assertive in any way, it would be to tell your instructor that you are respecting your patients wishes and think it would be unresonable to push her to do something she doesnt want to do (I do appreicate that thats easy for me to say, I have been a student and I know thats its extremely difficult to cross an instructor!).
You were right not to give personal care, just remember to ALLWAYS document document document if a patient refuses anything, including patient care, meds, food, drink, etc... Then when they come back and say..'nurse so and so , never even bothered to make sure I had a drink or make me comfortable, than you can go to your documentation and prove them wrong! Documentation is there to cover your butt!! Sorry, I digress.....

wooh, BSN, RN · Oct 18, 2007

If a patient has dementia, I frame the question like you're supposed to do for toddlers, give them a choice, but still get the answer you want. Not, "Do you want a bath?" but "Would you rather have your bath now, or after breakfast?" And there's always a good ploy, "Now come on, if you don't let me get you bathed, I'm going to get in really big trouble!"

But in the end, if they're A&O, they have a right to refuse.

Zookeeper3 · Oct 19, 2007

Here's a broad perspective, Try to find the good lesson that I'll try to assume is there (devil's advocate here).

The instructor wanted you to know to never just do any nursing task "because you were told to", I KNOW you KNOW this... but still let the experienced nurse sway you from what you knew (we've all done this don't worry!)

Be more assertive- yes, it takes alot of experience to learn how to sweat talk patients into getting care done. For some, accepting care and participating is a huge part of their nursing diagnosis. We all know the patient can refuse, it's more of ... did you demonstrate behaviors that showed you having good communication to try several different methods to provide basic care? Vrs a nurse who thinks 'you say no? okay" does that make sense?

You're doing fine! Clinicals is the best time to gain these learning experiences and incorporate them into practice with a smile... lord knows you'll be learning the rest of your career! :lol2: Best regards, you're FINE!@!!!!!

eamon66 · Oct 19, 2007

You really didn't do much wrong. So you forgot to ask what her pain score was. The important thing is to learn by our mistakes. You'll remember next time. As for her refusal to wash.....that is every patient's right and must be fully respected. We, as nurses, appear to be obsessed with daily washing of patients and at the same time are taught to follow the patient's normal routine. As someone else commented, the elderly rarely tend to have full daily washes. Check what her normal routine is. Suggest that she lets you know if she changes her mind or would she rather that family members helped her when they visited. Good luck and all the best