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Discussion

problem during clinical

Hi all,

I am in my second semester of nursing school, hoping to be an RN. I finished 7 weeks of clinical this semester, which all went well, and I just changed clinical instructors & units for my final 7 weeks of the semester. I also started passing meds this semester.

My first day of clinical with my new instructor didn't go very well. At 9am, I administered my patient's meds, including morphine and gabapentin. My pt stated that she had 7/10 pain, and I assumed the morphine would help. However, I had forgotten that hydromorphone was ordered prn for her pain. She refused hygiene/AM care (which we as students are supposed to do during clinical hours) due to her pain.

I know addressing pt's pain is a critical issue, but I think the reason why I had forgotten about her prn med is because I had never given prn meds before, and I didn't look up that med (we only had to look up meds given within the past 24 hours).

Now, my instructor wants to meet with me. I'm nervous! I don't want to fail clinical due to a mistake on the first day.

Please help with any advice or similar experiences you might have!

Thank you

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    • Featured Replies

    If you gave morphine then you did address her pain. Did you reassess her pain level and try to do am care after giving the morphine?

    I know its hard, but try not to worry too much before you talk to your instructor. If your instructor tells you you made a mistake at some point just apologize and tell the instructor you will find a way to make sure it does not happen again.

    Most instructors are reasonable human beings, and unless you made a critical mistake that could kill someone you should be ok. Keep us updated.

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    • Author

    I guess the morphine was a routine med & long acting, not for immediate relief. I didn't know that, but I should have. I asked my patient several times if she was ready to get cleaned up, but she kept saying no because she had a headache as well as pain elsewhere. I gave her acetaminophen for her headache, which didn't seem to help either.

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    Honestly I don't think you're going to fail clinicals over this. Just learn from it and make improvements next time! Anytime you give a pain med, you should always reassess within 30 min or so and evaluate whether or not further action is needed. Glance over the prn meds next time as well so you have a general idea about them in case you find yourself needing to give them. Good luck! :)

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    Not attacking you but didn't you go over meds in your first semester?

    We have to look up everything our pt is on and that we might give during our shift.

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    • Guides

    The morphine you gave should have helped with her pain (even oral ER morphine onsets within 30 minutes). You should have returned in 30 mins to evaluate her and see if she still needed a prn; even if she didn't have one on order, it's your job to advocate for one. I wouldn't expect a second semester student to know that and do it in on her own. It is a learning experience.

    The one thing you should have done is ask her about her pain, doing a brief symptom analysis. I say this because I had a student one time that came out and said a patient was having new onset 7/10 pain and asked if we could get him some pain medication. I said sure, went in the room to ask him about it and he was having 7/10 crushing chest pain. So....

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    as long as you assessed respirations and got a BP beforehand, and the morphine was due, I don't see this as a huge problem. Saying this, however, I don't know enough about your patient to know that for sure.

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    This isn't a big deal, lol.

    When you meet with your instructor, be prepared to tell him/her that you learned from this experience that from now on you will always

    a.) check medication orders INCLUDING PRN for pain/nausea/vomiting/diarrhea/constipation

    b.) Reassess the patient after the medication is given and make sure to document pain scale on the hour following administration

    If you make your learning clear from the opening bell, your instructor will be impressed with you instead of sitting there lecturing you about your future expectations (if that's the case).

    Good luck and have fun. it's all a learning process.

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