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Protecting yourself

Posted

Has 3 years experience.

I was at the methadone clinic today as part of my community mental health experience. One of my tasks is to obtain urine samples from clients. I've already had a run-in with one client. This afternoon another client left the clinic for a cigarette after being informed he was to provide a sample. The nurse supervisor told me to pat him down when he came back, to look for an artificial bladder or supply of someone elses urine. The client is 6 foot, 250 lbs. My immediate thought was: he's not going to like this, how dangerous is he, what kind of position am I putting myself in. I'm a male student by the way, and nowhere near this mans size. My nursing instructor could see I was well out of my comfort zone, and said "This is nursing."

Question: Am I out of line to be concerned for myself in these situations? Is there something wrong with wanting to be a nurse and wanting to be safe at the same time? I really need some feedback about this, because my instructors comment made me question whether I am "cut out" for nursing.

No, there is nothing wrong with not liking one certain area of nursing. I have a nice career and don't have to deal with patting down my patients.

No, you're not out of line for being concerned. We should all be concerned. Most positions are safe, but things do go wrong at times.

As far as this patient, there should have been security there to take care of the patting down. I don't know of any nursing school that offers courses in search and seizure.

gwenith, BSN, RN

Specializes in ICU.

You could always try the "You have two choices mate. Either you let me pat you down or I watch you dangle it into the bottle and pass urine." Do it with a bit of a light tone in your voice and it is more likely they will comply and it lets you out of what you consider dangerous.

Your instructor was wrong to assign you to this duty. When the man left the area and went outside, a security alert should have went into effect and upon his return he should have been "patted down " by security. It is routine in most city ER's and even in some rural ones to ask if a person is carrying needles, razors or knives. If for any reason the nurse/doctor feels unsafe then security is alerted. Police too at times. This is not nursing, once he was designated as safe or clean, then you as the nurse should have accompanied him for his specimen. If there was any question remaining that you would not be safe then security should have accompanied you. Some instructors like to act like they can handle any situation and know all of the rules. Your did not and she placed you in unnecessary danger.

I agree with the above posters; you were not wrong in feeling concerned for your safety. I work in a huge county jail with all manner of pre-trial inmates and I would not feel secure about 'patting down' any of them. We are not taught what to 'pat' for. Some of the inmates fight with the biggest, baddest, deputies you ever saw so I know they would not think twice about kicking the crap out of a nurse. Don't let the instructor discourage you; hang in there.

I just wanted to add something--I drew a parallell line between jail inmates and methadone patients because, well frankly, we get a significant number of inmates who are methadone patients. I just went back and read my post and thought someone might say, 'what is she talking about, he's not in jail!' Methadone clinics frequently deal with folks who are familiar with our justice system.

live4today, RN

Specializes in Community Health Nurse.

Originally posted by barefootlady

Your instructor was wrong to assign you to this duty. When the man left the area and went outside, a security alert should have went into effect and upon his return he should have been "patted down " by security. It is routine in most city ER's and even in some rural ones to ask if a person is carrying needles, razors or knives. If for any reason the nurse/doctor feels unsafe then security is alerted. Police too at times. This is not nursing, once he was designated as safe or clean, then you as the nurse should have accompanied him for his specimen. If there was any question remaining that you would not be safe then security should have accompanied you. Some instructors like to act like they can handle any situation and know all of the rules. Your did not and she placed you in unnecessary danger.

AMEN sister! :)

ktwlpn, LPN, RN

Specializes in Med Surg, Homecare, Hospice.

Originally posted by epg_pei

I was at the methadone clinic today as part of my community mental health experience. One of my tasks is to obtain urine samples from clients. I've already had a run-in with one client. This afternoon another client left the clinic for a cigarette after being informed he was to provide a sample. The nurse supervisor told me to pat him down when he came back, to look for an artificial bladder or supply of someone elses urine. The client is 6 foot, 250 lbs. My immediate thought was: he's not going to like this, how dangerous is he, what kind of position am I putting myself in. I'm a male student by the way, and nowhere near this mans size. My nursing instructor could see I was well out of my comfort zone, and said "This is nursing."

Question: Am I out of line to be concerned for myself in these situations? Is there something wrong with wanting to be a nurse and wanting to be safe at the same time? I really need some feedback about this, because my instructors comment made me question whether I am "cut out" for nursing.

I wonder what the WRITTEN POLICY is-and I am sure they have one...I am betting that nurse's patting down clients ain't on it..

sjoe

Specializes in Corrections, Psych, Med-Surg. Has 15 years experience.

"The nurse supervisor told me to pat him down when he came back"

I definitely confirm what barefoot said, above. This was nothing other than poor judgment on the part of your instructor who was trying to be a "big shot."

In my 4+ years of experience working in jails and prisons, and several more years working in inpatient psych, it was NEVER part of nursing job descriptions to "pat down" anyone for any reason. This was always a custody/security matter and was done ONLY by people specifically trained and authorized to do so.

What does the Policies and Procedures Manual of this facility have to say? What does the facility employees' union have to say? What does your dean of students have to say (in writing) about this?

You put yourself in danger from not only assault, but from being stuck with secreted needles, razor blades, weapons, etc. Not to mention the fact that, unless you gained prior (and witnessed or signed) permission from this client, YOU are guilty of assault and battery. This is NOT a legitimate part of nursing, whether one is in school or not, IMHO.

I agree with the above posts. In fact, I would discuss this with the Dean (or powers that be) of your nursing program.

epg_pei

Has 3 years experience.

I was pretty sure I was on the right ground.

I don't think I will be going to the Dean or "higher powers" though, those are the people running the clinic. The clinic is a community based effort involving our school of nursing, and I think it's a great idea. But it's very small, and lacks the resources to have security on staff. There are no written policies regarding this issue, that I am aware of. Anyways, thanks again for the opinions!

sjoe

Specializes in Corrections, Psych, Med-Surg. Has 15 years experience.

"There are no written policies regarding this issue, that I am aware of. "

There NEED TO BE, in order to protect your school of nursing, the clinic, its employees, the students, AND the clients. This might be a good project for you (or you and a group of students) to do for a class. At least suggest it strongly to a suitable instructor and the dean and whoever is in charge of the clinic.

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

Your instructor needs her head examined! Get a grip - that's what police do, not nurses! BTW I work charge in an inner city level one trauma center and security and police both have a place in my day.

Why in the world would she let that guy go out for a smoke if a urine sample was to be taken? He couldn't wait a few minutes? If you ask me...that should have been addressed to the patient.."Mr. SOand So, the policy is that we need to get a urine sample from you before you step out that door..otherwise I cannot not give you your treatment today because I would get in huge trouble for not following procedure" Of course this is said in a non-threatening , matter-of-factly, non-condescending type of way.

epg_pei

Has 3 years experience.

I guess it was my responsibility to tell the client that, and I didn't. I was startled when he said he was leaving for a cigarette, and honestly I was afraid to tell him he couldn't. As I said earlier, he gets to give his sample alone (yeah, I don't get that one either). He didn't come back afterwards (whew!) but I am still having trouble wih this one. I am thinking I don't have the guts to be working with this population. I am also wondering why the clinic made exception for this one client. Was there an incident with this patient? Good question to ask next clinical day.

I looked through the standards of practice for nursing in this province and found this: "The goal of nursing practice is the best possible health outcome for the client, with no unnecessary exposure to risk or harm." I guess the point is that to be a nurse in this jurisdiction, you have to accept this kind of risk.

I know I have to assert the authority I have to do this job. I also have to accept the risk that assertion will put on me. It doesn't look like there are other options.

PS: One thing I noticed, and you guys can tell me if this is normal. There are several points in the standard which define improper conduct of a nurse towards a patient. I didn't find any which define the opposite.

Farkinott, RN

Specializes in Renal, Haemo and Peritoneal. Has 22 years experience.

All I can say is that you are a nurse NOT a warden! NEVER place yourself in a positon of danger. The nurse that was with you on that day was way out of line. If someone was going to give a tainted/suspect sample of urine, let them. Your safety is paramount! Security searching (pat down's are a responsibility of security staff). You can always plead :"I have not been trained in this procedure" In this day and age of litigious society by just performing the procedure (without proper education) left you without a defence (other than naievity).

I hope nothing like this eve happens to you again. Good luck with the rest of yor study.

Farkinott, RN

Specializes in Renal, Haemo and Peritoneal. Has 22 years experience.

Another thing! Don't beat orself up about this! You did know worng, you were shafted by your suervising nurse. If you are going to work n the sam area agian then familiarise yourself with the policies etc so that you are one step ahead of the rest but would it not be true that as a student at the time you are or should not be liable for the patien'ts outcome, particularly in a situation such as this? Good wishes

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