Patient advocate vs. Being Nosey

[Kim O'Therapy, BSN, RN]

I have a current situation going on in my clinical rotation that I don't know how to handle. Here it is:

I took care of Ms. Patient last week. She has a terminal illness and is weak.

During my last day of care for her, she asked if I could care for her again next week. I explained that I would love to, but could not have the same pt two weeks in a row.

Flash forward to this week. I am at the hospital researching and interviewing my new patient. Another student, we'll call her XYZ, approaches me at the computer and the following conversation takes place:

XYZ: Hey, KOT, remember the pt you had last week?

Me: Yes

XYZ: Well, I want to take of her this week, but she keeps falling asleep, so I can't interview her.

Me: Yeah, she's on alot of pain meds and I give her a brief history.

XYZ: Well, I figured we could save her the interview process if you would just let me borrow your care plan for her.

Me: You don't need my care plan, if the pt is sleeping right now, you can start your charting research and interview her later when she's awake. Personally, I don't start anything until I have the patient's permission to care for them, or you might be doing alot of work for nothing. It's up to you, but I'd pick another patient.

XYZ: Like I said, why don't you just bring your notes in and I can take a look at them.

Me: Well, first of all, their my notes from last week, so they probably won't be accurate for this week. Besides, you don't have his permission yet. Sometimes, during end of life care, a pt may not want alot of extra people around, they want privacy with their family, so you better ask him. She may not want a student nurse this week...it IS their choice.

XYZ: Hell, I don't care, I'll just sit in there all day if that's what she wants.

Me: Well, if that's what you're gonna do, you can sit there and work on your own careplan - you don't need mine. Again, I strongly urge you to get actual permission. If she is not giving you a definite "yes" or "no", that usually means they don't want a student and are avoiding hurting your feelings. Did you get a response when you asked her?

XYZ: [silence and rolls eyes - then a fellow student/friend of hers walks up and says we need to go now. XYZ grabs her purse and head off down the hall. When she gets to the other end of the hall, she sing songs "Don't forget your notes!" and steps into the elevator.

I go back to my research, finish, and grab my stuff to head out of the unit. Just as I'm walking past Ms. Pt's room, her call light goes on and she yells for me. I stuck my head in the door and she says weakly, "Can you help me eat?"

Me: You know what? I'm not allowed to care for anyone if my instructor isn't here, but I'll go ahead and cut up your food for you, then I'll let your nurse know you need help eating. Is your sister here today to help you?

Pt: Shakes head no.

As I'm cutting up pt food, her sister walks in and sees me and smiles. "Are you our nurse this week?!?"

Me: No, sorry, I can only care for a patient once, but XYZ will take good care of you this week.

Pt & sister: (They both look at me like I'm crazy.)

Me: You know, the student that was in here earlier? Did you talke to her? Pt: (Shakes head no)

Sister: (speaks limited English) No new, no.

Me: Oh, did you tell her that?

Pt: No response.

Me: What's wrong Ms. Pt? Don't you want a student nurse this week - you get wonderful one on one care.

Pt: (head lying on pillow) Vigorously shakes head no and tells me to please tell her that.

Me: OK, please don't get upset. You don't have to have one if you don't want one. Take care of yourself and enjoy your meal. Bye.

I drive home and immediately e-mail XYZ (don't feel like a phone confrontation) and update her on the situation.

OK, clinicals are tonight and I've received no feedback from XYZ.

If she continues to press the issue of caring for Ms. Pt, should I say something? For instance, if she ignores my message and our prior conversation, should I speak to our instructor? To her? Help!

Sorry this is so long - thanks.

[futurecnm]

I would actually just let it be and let your instructor take care of it. If you instructor is like mine, she/he will be in and out of the pt room and find out soon enough that the pt did not want a student and then that student will have to explain the situation. It really doesn't involve you at this point from what I can see. I wouldn't give her any of your notes from last time either. Just ignore the requests.

[TazziRN, RN]

Yes, tell the instructor if XYZ pushes her way in. People have the right to refuse permission to have a student, and XYZ is ignoring the pt's wishes. She needs to pick up some lessons in compassion while she's in school.

[Kim O'Therapy, BSN, RN]

Unfortunatly, I think she's pushing the issue because she wants an "easy" patient. My notes + immobile pt + very few meds + no incontinence + sister always there = easier work load.

[llg, PhD, RN]

Unfortunatly I think she's pushing the issue because she wants an "easy" patient. My notes + immobile pt + very few meds + no incontinence + sister always there = easier work load.[/quote']

I agree with your assessment of the situation. I would definitely NOT give the student my notes. Also, I would talk with the instructor -- but would not emphasize the "lazy student" angle. I would say something like ...

"I believe there may be a misunderstanding between pt___ and ____. They told me that they did not want another student nurse this week. Perhaps there has been a misunderstanding because of the language barrier. I don't want to put myself in the middle of this situation, but I thought you should know there might be a problem."

[santhony44, MSN, RN, NP]

I agree with your assessment of the situation. I would definitely NOT give the student my notes. Also, I would talk with the instructor -- but would not emphasize the "lazy student" angle. I would say something like ...

"I believe there may be a misunderstanding between pt___ and ____. They told me that they did not want another student nurse this week. Perhaps there has been a misunderstanding because of the language barrier. I don't want to put myself in the middle of this situation, but I thought you should know there might be a problem."

:yeahthat:

I think this is an excellent way to handle it.

You aren't being nosey or butting in; the other student asked you about the patient.

[donsterRN, ASN, BSN]

Unfortunatly I think she's pushing the issue because she wants an "easy" patient. My notes + immobile pt + very few meds + no incontinence + sister always there = easier work load.[/quote']

Or...

your notes = your notes = your notes.

XYZ might just have to do her own work...

[kukukajoo, LPN]

Is there a way that you could ask for an exception to help care for this pt? It really sounds like you are wanted and needed and may be comforting to the family and pt which is very important in end of life care.

It sounds like you have developed the rapport that we all strive for and sometimes rules can be bent a little- as we know the pt comes first!

[nuangel1, BSN, RN]

you know kukukajoo i was thinking the same thing .they seem like they want her maybe if she talks with instructor and instructor talks with them she may be able to care for pt again.but either way i wouldn't give over my notes.xyz needs to do her own work.

[kukukajoo, LPN]

Yeah keep your notes. She needs to do her own work for any pt she has. All the info she needs is right in the chart.

[Indy, LPN, LVN]

My careplans were 30 page monsters that took me hours of blood, sweat and tears, not to mention the research and hours of putting it all together. Anyone who would have been silly enough to ask for my notes ... let's just say you were very nice and probably more tactful that I'd have been.

[Kim O'Therapy, BSN, RN]

My careplans were 30 page monsters that took me hours of blood, sweat and tears, not to mention the research and hours of putting it all together. Anyone who would have been silly enough to ask for my notes ... let's just say you were very nice and probably more tactful that I'd have been.

I agree with you. I do have an update. Last night, XYZ came in, slammed down her books, and headed back out to the nurses station to pick a new chart! I guess she took my e-mail to heart or assumed I would talk to the instructor. When I ran into pt sister last night, she thanked me for taking care of the situation. Thanks for all of our input. It was very helpful.