Questioning the nurse during clinical

[motay68]

While I was at my last clinical the patient I was assigned had dementia and pulled her foley out prior to day shifts arrival. The nurse taking care of the patient had let me watch her put another one in and was fantastic about explaining the procedure to me. As the morning wore on the patient complained more and more often of needing to go to the bathroom and feeling a lot of pressure. I palpated her abdomen and it was slightly distended and firm. The foley bag only had a tiny amount of urine in it after being in for hours. I was worried about the placement (At that point I had not had a catheter lab and was unsure of the proper amount that was supposed to drain and if you could misplace a catheter.) I alerted her nurse who came in to assess the patient. She told me that the foley was okay and it was probably the balloon that was causing the pressure.

All though I have grown friendly with this nurse and feel like she is a great RN I was uncomfortable and went to my instructor who also came in to assess the patient. Instead of telling me that I was right or wrong she asked me what I thought my best course of action would be. I decided to get the bladder scanner and see how much urine was actually in the bladder before I went back to get the RN in charge of the patient.

As it turns out, I was wrong. There wasn't a huge amount of urine in the bladder, the amount of urine in the bag was normal and I felt like a complete idiot. To make matters worse, while we were doing the scan the RN came in and stayed for the entire time. I was so embarrassed and apologized to her once we were out of the room and said I was out of line for questioning her.

To my complete and total amazement she told me not to ever apologize for advocating for my patient. That I didn't actually do anything wrong and if I was concerned about a patient and felt like something was the matter to always go with my gut and not to ignore a potential problem because I didn't know as much as the person that was in charge. Then she winked and said don't ever question me again though and it was over.

My instructor congratulated on beginning to think like a nurse and even though I still feel like a moron for the whole thing it did end up boosting my confidence in myself.

I know situations like this don't always end up on a positive note and I understand that not everyone would react as the RN did when she was questioned by an SN but it taught me a powerful lesson on what it means to be a patient advocate and learning to trust my judgement (even though I was wrong) when it comes to caring for another person.

[applesxoranges, BSN, RN]

She may have been curious too. I would have been.

[SE_BSN_RN, BSN]

#1....Always, always, ALWAYS go with your gut! If you feel something is wrong, it could be! In this case, nothing was. You didn't do anything wrong, and you were able to think what to do next. When I worked as a LPN in LTC, I had a pt who was acting weird. My CNA's kept telling me something was wrong. The pt had been to the ER earlier in the day and they found nothing wrong, and sent him back. On assessment, I, too, thought something was wrong so I called the doc on call to see if I could sent pt back to the ER and he said "No, he's already been to the ER and the found nothing, so I won't give you the VO to send him." So, I got my charge nurse, explained to her I was sending him anyway, and I did. We get a call a few hours later from the ER doc who wanted to know why our on call doc wouldn't let us send him, and I told him. Then the ER doc tells me "Good, I am glad you sent him. His troponin level is off the charts!" Then we get a call a few hours later from our on call doc who was mad that I sent him without his ok....I don't know what he said to my charge nurse, but she was mad. He obviously didn't like me going against him. He didn't apologize for his behavior, but he hasn't been very nice to me since then. Oh well.....things could have ended differently, and the blame would be squarely on me, not him!

#2....always question. Everything. You learn more that way. Sometimes the hard way!

Good job!

[bebbercorn]

I have been questionned before for the most simple things. Although I might have been irritated I never let anyone apologize for a safety concern. We are all human and deadly mistakes are made everyday in healthcare. Kudos to your preceptor, too, for reacting the way she did. You're going to be a great nurse!

[michiganstudent]

A couple of weeks ago in clinical, I actually made a discovery during an assessment that saved my patient's life. Don't feel stupid. I felt like a moron too for questioning the nurse, but my patient got well and went home instead of to the morgue.

[Meriwhen, ASN, BSN, MSN, RN]

I never mind being questioned by a student during clinical. It's an educational opportunity for both of us.

[JustBeachyNurse, LPN]

I think your query was appreciated because you did it professionally and appropriately. You asked the nurse, then brought your concerns to your clinical instructor and were able to articulate your assessment and thoughts.

I'm sure your questioning would have not been appreciated if you loudly asked in front of the patient/family and appeared to contradict the nurse. Or went to the charge nurse instead of your instructor.

You both learned from the experience AND you demonstrated professionalism to both the nurse & your instructor in addition to showing that your primary concern is for patient safety.

[LadyFree28, BSN, LPN, RN]

I agree; you practiced a questioning attitude appropriately and professionally.

[Chisca, RN]

Don't get caught up in the "social truth" of any situation. Just because you have grown friendly with a nurse you feel is a great nurse doesn't mean she couldn't be wrong. Especially hard to do once you move up the power structure and you have a medical doctor ask you what medical school you went to. As others have said ALWAYS trust your gut and be a detective, advocate for your patient, and question authority. It sounds like you are well on your way to being a good nurse.

[BSNbeauty, BSN, RN]

OP you did a great job being a patient advocate. I would have done the same as you. THAT is what nursing is. You did the right thing by getting a bladder a scan. You should not feel like an idiot. As for the nurse saying "don't ever question her again", is totally out of line. Never get tired of doing the right thing. Always question when it doubt.

[NurseDirtyBird]

Any decent nurse knows they don't know everything. They also know they're humans with very busy workdays and miss things sometimes. While nobody likes having their judgement questioned, in the end it's the patient that matters, not the nurse's feelings.

When I was a brand new nurse (emphasis on brand new), I had a patient who developed a rash. I wasn't overly concerned about it - she had no diagnoses that could cause a rash and no known allergies. Could have been a heat rash, as it was summer and I live in an area where air conditioning is not widely used. I felt it would be silly to call the MD in the middle of the night for a simple rash. Then the CNA who was helping me with her said, "Didn't she start an antibiotic today?" Duh! Rashes can be a symptom of an allergic reaction to a new medication! I felt really dumb for not even thinking of it, but I was very grateful for two things: 1) I gave a report to my CNAs at the beginning of my shift about patients on alert and anything else significant, because the CNAs are the nurse's eyes and ears and; 2) That CNA cared enough to advocate for her patient, even if it meant questioning her supervisor. I wasn't upset about it at all, and I'm glad she stepped up for the patient. The patient could have been in some serious trouble if she hadn't said anything, but because of that super awesome CNA, the patient got the care she needed.

Keep it up!

[JBudd, MSN]

As for the nurse saying "don't ever question her again", is totally out of line.

It was said with a wink and a smile, which is not a threat, it was friendly kidding around. If the nurse had been angry, she'd not have encouraged the OP as she did.