RN or Textbook - who's rule to follow on the hospital floor?

[royr]

I would like to post a general question. As a student - should I always follow the text book - or should I follow the orders of the floor nurse (RN) during preparation for a clinical experience? The "book" says "no contact with the patient befor clinical". The charge nurse says "get in there and find out what you need to care for your patient tommorow morning", - the patient chart is not available, and you are told by the charge nurse that it will not be available to you in the time you are allowed. What should I do? All opinions are welcome.

Background informatin I had been told on previous clinical experiences that I should ALWAYS follow Doctors or Nurses orders when in question as to what to do in a hospital setting. I did what I was told. The out come was I have been written up for seing my patient before clinical and threatened in the form of a clinical progress note with a failure for this course. I have answered the complaint with a letter of fact, and started the greivance process according to the school student handbook. What else should I be doing to pass this class and continue learning to be a nurse? Without a satisfactory outcome - I cannot continue with the program. Please help!

[-=Brandon=-]

I would have followed the instructions of the charge nurse too. It almost sounds like entrapment. Good luck.

[Tweety, BSN, RN]

Follow the instructions of your instructor. Be assertive. Inform the charge nurse of your instructions and unless she/he holds a gun to your head don't go into the room.

About the chart, ask "when will it be available, I can wait". If you're told you can't have the chart, then notify your instructor and follow your instructors instructions.

Who is it that told you that you should always follow doctors or nurses orders? Was it your instructor or the charge or floor nurse?

If anything contradicts what you have been told to do in clinicals by your instructor, calmly don't do it and seek instruction for your instructor. It's not worth failing to blindly go against school policy. The floor nurses should respect this. If they don't respect you and harras you, too bad. It's your grade and your butt and don't let them ruin your plans for your life.

[luvmy2angels]

I totally agree with Tweety, whenever I questioned anything I went to my instructor. Keep your instructor informed as to what the charge nurse is telling you as well as making sure the charge nurse knows you are to be following the instructions of your instructor and not her. Good Luck to ya!!

[smk1, LPN]

your instructor is the one whose license you are working under so she or he should be THE LAW. Be polite but let the charge nurse know that you have to go by what your instructor says and that you will check with him or her.

[Daytonite, BSN, RN]

If the "book" says "no contact with the patient before clinical" then that's what you should do.

The charge nurse who says "get in there and find out what you need to care for your patient tommorow morning" is right, but she is not your immediate supervisor nor responsible for your performance. When you get your license and have your own nursing job then you can do just what she says, but for now. . .the "book" rules.

I don't know how hard I need to shout to get through to all the students out there. Even though you are students, you need to think of all your time as nursing students as being the same as employees at a job--even though you are supposed to be learning. You need to keep in mind that you are always being evaluated and observed by your instructors and clinical instructors. Information about your performances is being compiled in files. One of the main reasons for this is because so many prospective employers want to know how students conducted themselves while they were learning to be nurses. There is no other way for your first employers to know what kind of nurse you are except by what your school has to say about you. And, nursing instructors, particularly clinical instructors, like employees every where, come and go. What they might put on paper will be in your files for perpetuity and long after they have left the employ of the nursing school. For that reason alone, you should always want to be following rules, not making waves, demonstrating your ability to learn from your mistakes, plus demonstrating all your positive personality traits that are going to make you hireable for your first nursing jobs. Filing grievances is serious business and should not be undertaken lightly because they become part of your file. If you are trying to impress a prospective employer in the future, do you want them to know you are a person who is willing to go toe to toe with the people in charge? Is that an image you can afford, or a risk you are willing to take? There are some battles that you just have to decline to fight and just walk away from. This, Ray, IMHO is one of them. In the great vastness of life this is a "small potatoes" issue. Can't you just do what you are asked and get on with the business of getting through your nursing program so you can get on with getting your license?

[Bala Shark]

I am in the last semester of nursing school..During clinicals, we do not work with the instructor that much and we work with the nurses..Everything, that we do is based on the judgement of the nurse we work with and not the instructor..If you dont follow the nurse in my setting, then you will get no where.

[psalm_55]

as others have said, i think you really need to clarify this with your Clinical Instructor.

i know of no book that tells a student NOT to have contact (verbal?) with the patient prior to care. In fact, the National League of Nursing (NLN) requires that nursing students be well-prepared before actually starting their care of their patient assignment.

every nursing program that i know of REQUIRES that the med-surg student acquire certain information on the patient and to meet and greet the patient the day / evening before. so, perhaps this was the charge nurse's frame of reference.

Legally (the short version), the Clinical Instructor is responsible for the student -- the student is responsible for their own actions -- the RN is responsible for the PATIENT -- so the RN trumps everyone when it comes to directing and decision making. if there are inconsistencies / differences of opinion, the Clinical Instructor needs to meet with RN / Charge Nurse / whoever and iron out the details.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

Whenever you feel you are in a pickle no matter what you do, see your instructor. Thats why they are there. If staff gives you instructions to do something that you do not agree with or are not allowed to do, always see your instructor for clarification. They will understand if you can not have access to the chart in the given time period, or allow you to stay late, or come early the next day to go over the chart. If all fails, and for some reason the chart will never be available, they will assign you a new pt. There have to be some charts available!