I agree that the best you can do is provide education regarding the reasons why the patient needs transport home- the effects of anesthesia, impaired reaction time, etc. But after that, once the patient is out the door, they get to make their own decisions.
Just like on a post-partum floor, the nurses can make sure that the parents have a proper car seat and know how to strap the child in, but once they are discharged the nurses cannot force the parents to correctly use the car seat every day.
Patients will make their own decisions, often regardless of medical advice. You are responsible for educating your patients. THEY are responsible for their own safety/actions once they leave your facility.
I think your instructor is trying to get you to think more deeply about the scenarios. She doesn't want you to just see the word "airway" and automatically choose that option because it's the "A". Yes, airway is absolutely a priority, and assessing it will always be correct (in real life). But in the context of the question, is it your MOST correct response?
Let's see if I can think of an example...
Your 6 year old pediatric patient was admitted for observation after being stung on the neck by a bee while riding her bike 6 hours ago. The patient suffered a broken right radius after falling from the bike. A plaster cast was placed on the right lower arm. Upon assessment, the nurse notes swelling and redness of the neck in the area of the bee sting. The patient reports that her neck "hurts a little" but her arm "hurts a lot". She says it "feels like there are lots of needles poking her fingers and hand". She appears scared, is crying and having a hard time catching her breath. Vital signs are as follows: HR 113 BP 110/69 RR 36 SpO2 95% Ax Temp 98.3 What is the nurse's priority?
1. Administer prescribed pain medication
2. Assess for a patent airway
3. Instruct the patient in relaxation techniques to slow respiratory rate
4. Assess circulation of the extremities
In this example, all of the ABC's are addressed, as well as the 6th vital sign- pain. Every option is correct, but one is the MOST correct, and it's NOT the airway option OR the breathing option. Yes, airway is important. The neck has some swelling, the patient is having a hard time catching her breath. Yes, anaphylaxis is possible with bee stings, but remember it's been 6 hours since the sting. Anaphylaxis onset at this point is extremely unlikely.
Breathing- yes, the respiratory rate is high, and the breathing pattern is labored. Oxygen saturation is slightly decreased for an otherwise healthy child. But WHY are you seeing these symptoms? The patient is in pain and scared. All are expected findings in this situation.
Which brings us to our C- circulation. There's a few clues in this question. 1. The patient is reporting severe pain in the casted extremity. 2. The patient reports a pins and needles sensation in the hands and fingers (not just in the area of the break). These things are suggestive of compartment syndrome- a dangerous complication with serious consequences if left untreated. Assessing the circulation of this extremity compared to other extremities is definitely your priority.
I hope I helped explain why the ABC's aren't always the correct answer, and why it's important to evaluate your options in the context of the question. That being said, with the information provided about the facial trauma and swelling, I probably would have chosen airway as well.
Can you give specific examples of her behavior?
I often find that some instructors have high expectations of their students- and they let them know it. What the students view as condescending and mean behavior is actually the instructor trying to push the students to a higher level. Rarely do I find that instructors are rude just to be rude. Rather their style of instructing is not the soft, take-you-by-the hand style that the students like or are accustomed to. It's a higher level of expectation where the instructor expects the student to put in the effort, study the material in advance, and be prepared to answer the questions and discussion in class.
When I was in my second semester of nursing school, I had an instructor for Health Assessment. At first, I really disliked her. I felt that she acted like she thought we were stupid. If we answered a question wrong or didn't know an answer, her response was to shortly tell us we were wrong. She didn't coddle us and expected that we take the initiative to learn and understand the material. Her tests and assignments were hard, and a lot of people complained. Because her approach was so unfamiliar, students took it as being mean and critical.
But you know what I realized at the end of the that year? She taught that way because she knew that we were capable of performing at a higher level. She was trying to push as to start taking responsibility for our own learning and start thinking like independent, intelligent nurses. She knew that we were adults. We didn't need to be coddled and led through the course. We needed to learn how to be strong critical thinkers who didn't rely on someone else to help us find the answers.
This instructor became one of my most trusted advisors and mentor. As I matured, I learned just how much she really cared about the success of her students. There was nothing condescending or mean about her approach. It was designed to push us into a higher level of professionalism and learning that we otherwise would not have attained. Sophomore students still have trouble adjusting to her teaching, but her senior students adore her.
My advice to you is to focus on what you can learn from this instructor. Chances are she has tons of wisdom to offer you, if you can learn to adjust to her teaching style and not take her harsher style of instruction personally. Learn her expectations. Does she expect you to come to class prepared? Then do the reading ahead of time. Does she expect you to look up an answer before asking a question? The try to look it up yourself and when you ask, explain where you looked and what you found. Realize that all instructors have different teaching styles and very few people are just plain mean. I think you will come to find that this instructor is not actually condescending- you just aren't used to her methods.
We do baths with soap and water every night and PRN. Exceptions are our critical kids who are intubated/vented and then we do baths less frequently, as they can tolerate.
We have a really strict central line care policy. We've been infection free for more than two years.
You'll find that most hospitals offer a base pay for each position with pay increases based on certain things like experience, certifications, and extra qualifications that are pertinent to the job description. Since you entered this position with no prior experience as a PCT, it makes sense that you would start at the bottom of the pay scale. Since having EMT basic skills is not required for your job, it's unlikely you would get extra pay based on that. Since having a bachelors of English is not relevant to performing the duties of a PCT, it's unlikely you would get extra pay because of your degree.
Also remember that hospitals have no obligation to pay you anything other than minimum wage. The hospital's primary goal is to make a profit. They don't have to pay you extra based on any certifications or experience. A PCT job requires comparably little certifications in order to be performed, which means there are many people who would be willing to take your job if you were to leave. That is something to consider when asking for a salary increase. Many people would work for the salary you are making now, which doesn't give the hospital any reason to increase wages.
Median salaries from online websites are usually not good indications of what you should be making. Those figures include both major metropolis areas (higher pay) as well as small towns (usually lower pay). They also include people who have been employed for 25 years and thus have worked their way up the pay scale. A few aides who have worked in a unionized hospital for 30 years and are making 30 dollars per hour will skew the results of the online calculator. So don't base what you should be making on those results.
I don't think, based on the information you gave, that you are being unfairly underpaid. We would all like to make more money, but that's not the reality of our positions. If you would like to discuss a raise, I suggest meeting with your manager, explaining your skills, qualifications and amount of experience and asking honestly what are your opportunities for salary increase. She may be able to point you in the right direction, offer a salary increase to HR, or tell you straight out that they don't give raises before you've been employed for a year (or whatever the policy). It can't hurt to try, just don't go in to the meeting acting offended about your current pay or thinking you are entitled to more money.