Refusing a Clinical assignment

metal_m0nk, BSN, RN · Jul 3, 2012

RE: Pill crushing

As a student, if it's a choice between doing what my instructor expects me to do (which is practice safely according to the letter) and impressing a practicing nurse who has the freedom to do bend the rules, I'm going with my instructor every time. My clinical instructor decides my fate. All that "once you're a nurse" talk is great, but useless if the student fails clinical for doing something "stupid".

Christina_RNBSN · Jul 5, 2012

I believe that what the student did was alright, in this scenario. As a student she didn't presume that she knew better than the RN, she was just practicing how she was taught. I was taught never to crush an ER tab as a student, even though I know now that sometimes it has to be done. As a student I would have either consulted with the pharmacy or told the nurse to administer it herself. Better to be safe than sorry as a student. Every nurse defines their own way of practicing based on the experience that they have under their belt, and maybe that would be the first experience with that situation for the student. When I was a student I definitely learned med admin loopholes with those enormous 40mg K+ pills! lol!

As for the instructor...it is their job to look after their student. I don't think the instructor was trying to insult the nurse, but rather saying what her student did was O.K. based on what she learned. Granted, some instructors go way overboard and come across as raging lunatics; but that's just a personality thing. Student mistakes are a liability for the school, the hospital, and the nurse who the student is practicing under. Staying on the side of caution is fine in this situation. It's a learning experience like anything else.

ashleyisawesome, BSN, RN · Jul 6, 2012

OB docs perform circumcisions since they complete surgical training as part of their residency. Pediatricians do not have surgical training as part of their residency and don't perform circumcisions or any other surgical procedure for that matter.

not the case at my hospital. pediatricians do all the circs on site in the well baby nursery, as well as visit the newborn/mother in their hospital room the day after birth.

allnurses Guide · Jul 6, 2012

not the case at my hospital. pediatricians do all the circs on site in the well baby nursery, as well as visit the newborn/mother in their hospital room the day after birth.

Off the OP topic, but interesting. In my experience I have only ever seen OBs along with their NPs and PAs do circs (because their malpractice is more extensive) but it seems like it really should be the peds job.

brillohead, ADN, RN · Jul 7, 2012

Regarding circumcision, I'm also against genital mutilation. I discussed this with my clinical instructor, and she told me that she wouldn't *force* me to observe one, but she strongly recommended that I do so. Her argument was that if I one day had a patient ask me about my feelings regarding the procedure, I'd be able to give a 100% informed opinion.

The nursery area had a separate procedures room with a window for observing, and I stood and watched most of the procedure through the window with a few classmates. I turned my head whenever I had to make a face, in the off-chance that the parents happened to look at me. Funny how I can keep a straight face when dealing with Code Browns and nasty flaky feet, but I couldn't keep a poker face while watching that tiny baby's skin being cut off. The second it was done, I was out of there faster than The Flash.

A classmate with three sons said that if she'd seen one done before, she'd never have had her sons circumcised (she didn't observe her sons' procedures). Kinda makes me wonder just how much "informed consent" is actually given -- I have a feeling it mostly consists of:

"Did you want him circumcised?"

"Yes."

"Here, sign this paper."

allnurses Guide · Jul 7, 2012

Some practitioners are great with circs and the baby doesn't even cry, others are not so good.