what do i do in this scenario? i need help with so many things!

southern rn · Sep 9, 2008

There are so many things wrong with what you have posted I don't know where to begin. Ignore a patient because they are confused and pretend you are doing what you are supposed to? Let a patient fall and injure themselves because you are frustrated with trying to explain something to them? What do you say when they hit the floor? See, I told you so? Honestly, I hope I am just reading this wrong, but if you are having these kinds of issues, you need to sit down with your instructor and have a serious talk. Maybe you are just overwhelmed right now or maybe nursing just isn't for you. There are always going to be confused or demanding patients to deal with, it is part of the job.

I am not trying to be mean, just honest. Is there someone you can talk to about this, instructor or otherwise, and let them know how you are feeling?

icyounurse, BSN, RN · Sep 9, 2008

First off, nursing school is very confusing and challenging for everyone, especially those with no previous clinical experience. So it is normal to feel overwhelmed.

Secondly, you are a student and you sound like a pretty new one, so NEVER HESITATE TO GET THE RN FOR THE PATIENT IF YOU ARE UNSURE OF SOMETHING. Or your instructor. It doesnt matter what other students in your class do, not everyone goes at the same pace. Ultimately, its is the RN assigned to the patient, not you, that holds responsibility for the patient outcomes.

NEVER try to get a confused patient out of bed by yourself and risk them falling. Ever. Always go get somebody. I know it can be hard to find someone sometimes. If you feel unsafe leaving the room you could try and hit the call light and tell them you need help getting a patient up. Even if they say you should be able to do it yourself, do not try it if you are not comfortable with this.

It is hard to know your place as a student. Trust me, I have been there. But get used to telling pt's no and trying to find people to help you. You do not want to place a patient or yourself in any danger.

CABG patch kid, BSN, RN · Sep 9, 2008

First and foremost: you have only been in clinical for three months. You are not expected to know everything and nurses are supposed to ask questions throughout their whole careers, so that in and of itself is not an issue. You shouldn't trust yourself yet because you don't have the knowledge to do so yet. However, you should have some confidence in what you are capable of, and know that you are applying yourself to the fullest.

The second most important thing here is that you aren't a nurse yet. What ever patients you have in clinical have a licensed nurse caring for them, as well as you have your instructor to assist you with the patient. In other words, there is NO REASON why your patient should be ignored, neglected, left to fall or otherwise put in harms way when there is a licensed nurse who has assumed responsibility for the patient. It is your job as a student to alert the nurse whenever the patient is in danger and you are unable to assist however you are needed, whether that be helping with a lift or double checking a med you aren't sure about. If you could know just one thing about a nurse's duty, just know that its our job to keep them safe, whatever that may be.

As far as confused patients are concerned, yes, they can be difficult to deal with, but that is just part of the job honey. If you ever have a doubt about what you are doing (like if the patient refuses the med and you aren't sure what to do), when in doubt, ask your instructor. It's what they get paid for. Trust me, instructors prefer students who ask questions rather than pretending they know it all. In fact, pretending like you know it all could get someone hurt and/or get you kicked out of nursing school. Hopefully at the end of the semester, your instructor will give you a face to face evaluation (mine did with everyone, every semester) to let you know your strengths and weaknesses so that you can improve.

Please don't take anything I've said here as a personal attack. Nursing school is very difficult, don't take it lightly. Apply yourself to the fullest, its just two or three years out of your life, then you will be learning new things in new ways all over again when you get your first job as an RN.

Virgo_RN, BSN, RN · Sep 9, 2008

No, you should never neglect a patient, lie about the care you provide (or don't), put the patient in danger, or perform any task that you have not been properly trained to perform. If you don't know what to do, ask your clinical instructor or the nurse who is assigned to the patient.

snazzy-jazzy, BSN, RN · Sep 9, 2008

I understand it can be difficult being a student nurse in clinical prac because I'm almost at the end of my first year and 4th month of clinical practice. After 3 months though you should have some idea on what to do in these situations, learn from them by reflecting and then problem solve, cause it will help you become a better nurse in the future.

You can advocate for your patient, which means don't let them fall, and don't try and take them out of the bed if you are unsure that you can't handle it (which you havn't done anyway). Explain that you'll go and get a nurse to help you, and as someone else suggested press the call light. Practice what you will say when you are doing the reflecting about it at home, you need to be assertive and stick up for yourself and your patient.

You can overcome this, honestly it will make you a better nurse and a more confident person in the long run.

Who is responsible for your actions while your on the ward? Won't they assist you in helping a patient.

snazzy-jazzy, BSN, RN · Sep 9, 2008

Heres my advice, but I'm still a student like yourself.

ansferring patient i know i cannot lift...., but no one else wants to help me carry her, but the patient is complaining and needs to go to the bathroom... do i just leave her there? i gave her a bed pan and she didnt want it.. so i tried transferring her, and she was hanging on the side of the bed, and almost fell to the floor.. she also had surgery done on her hip, and she was stubborn about wanting to go to the restroom even though she couldn't walk... she didnt speak a word of english, so i couldnt explain to her.......... "you will get hurt if you try to walk... do you want to go back to surgery?!"

With this situation, as a student, I would not lift her, 1. she's had surgery on her hip (2. I would look at her chart and see if she has been documented as being a risk for falls and what is usually done for her, it should tell you somewhere whether she is assisted walking/walking frame ... or no lifting. (3. I would tell her to wait while I see the nurse about what she would like to do. When I see the nurse I would think about what could be done, such as maybe putting an incontinence pad on her, if she is refusing to use a bed pan and is not allowed out of bed. I would take the patients chart with me, hunt down her nurse and explain the situation then add, would you like me to put an incontinence pad on her for now? She'd either say yes or no, I'll help you take her to the toilet.

I think how we approach these situations is part of our training, if you see it that way rather than thinking you're a failure then you will be able to overcome it, and move onto the next problem because they neverend. Also your not expected to just automatically know everything, we are students and are only learning. If someone won't take their meds I would go see the nurse and say 'such and such is refusing her medication, how would you deal with that?' I've been lucky and can talk them into taking their meds, probably because I have children LOL. I did have a patient refuse a shower once, she was nearly in tears and begging me so I told her I wouldn't do it then and how about I put a fresh nighty on her, talc, spray, and brush her hair to make her feel better... She loved me for it and even took her meds for me. I later found out that she had been refusing medications previously by saying they were trying to poison her.

I was on a chronic disease unit for the first 2 months and it was a lot of older people that were a risk for falls and some were also confused pts, many had those incontinence pad or pants on, or were assisted with 2 people. And it scared the hell out of me that they would fall, some I assisted on my own but only if I was sure it was ok. I think you can overcome this, just think of whats best for your patient and don't worry about what the other students are doing or not doing.

locolorenzo22, BSN, RN · Sep 9, 2008

First, breathe.....we've all been there, even if we staff RNs seem as calm and put together as all get out...asking questions is fine, but you need to be able to retain some info.

The trust issues is just that...you've been in there 3 months, it takes time to get confident....I had that issue for the first 6...then I grew by leaps and bounds...

NEVER pretend and don't help your patient....that will get you a BAD reputation and you will quickly be found out and it will become a issue for you. If a patient doesn't like you being in the room, you explain "I'm your nurse, and I need to take care of you...I know it's uncomfortable, but does it help to know I'm nervous too?" You just need to grow that backbone, girl! DO not leave them in the station, etc.....I can tell you must be in LTC....it's rought there, I almost got kicked out my first week, I took my diabetic patient away from breakfast, cause they told me to go assess my patient in their room right away....so go figure.

NEVER transfer someone you KNOW you can't lift...you can injure yourself, the patient..etc. Even if someone wants to get up, you make sure they continue to sit...put on the light, or give a holler "HEY, can I GET A HAND IN HERE?" There should be some sort of translator service so we can communicate with patients...my hospital uses cryo phones...you dial a number, and you can speak over 300 languages with a interpreter...on a two way phone...

You do what you can, and explain why or why not things can or can not be done...and that's the deal...

You could say patient refused meds...but did you really try? Maybe she was just upset with you....

What girl did you ask for help...another student? or staff? student-wise, I'd be asking the instructor in post-conference if we could talk about being a team for ALL the patients....all my classmates and I were a team...we helped everyone out so all patients were ok. staff should help you....or else...

You DO have authority as a student...you are a junior RN, so to speak...

Here's what I would suggest...and everyone is different. I would say you need to get some work in as a CNA, and I think as you learn and deal you would be able to apply work lessons to clinicals....worth a thought?

Be confident, even if you aren't...fake it till you make it. Maybe go in and talk to your professor 1 on 1, and tell them everything you told us....if you have that kind of relationship with her. Our instructors are supportive, and they always knew that we could ask them anything....and even talk things out with them....the good ones are there to HELP YOU!

Breathe, think, and rethink....maybe, at 20, you are not ready for the stress and schooling that NS can entail....It hurts, but think about it. Maybe, with a little more life expierence you'd be better. Not to put you down, but just a thought.

GL hun....keep posting and let us know what develops....

everyone tells me to calm down... i am so jumpy. my nervousness is SO obvious and everyone treats me like a child that needs to be coddled. i asked this girl for help today and she ignored me.

my professor tells me i need to speak up, but i feel weird asserting myself when i have no real authority as a student nurse!

please help! :no: words of wisdom? advice?????

whiteoleander5 · Sep 9, 2008

Hello! I had my first clinical the other day, and in two weeks will be going to a nursing home to begin doing exactly what you are doing... I am a very nervous person also... I am twenty years old also, and everyone else in my clinical is twice my age and seems so comfortable, with the professor, with the environment, with everything and I am not like that.

Although I will probably have to listen to my own advice within the next few weeks, because I am most anxious about clinical and could easily be in your shoes:... You are not expected to know everything. You were dealing with a stubborn woman, and there were many factors involved to it-- you didnt want her to fall, she wanted to get up, she was angry. You knew your limits.. You're only human (and only a nursing student thus far :rolleyes: ), you dont have to know everything. Please dont be so hard on yourself..

... I think your anxiety is causing you to forget that you know what you're doing. If you had read this same post from someone else, you would probably say "Oh, well i know what i would do"... but of course, when you get there and you're nervous, all logic flies out the door..(Really, I know all about that.) I think as long as you follow the appropriate measures to keep the patient safe then you wont have a problem.

Pretend that you know what you're doing, because you probably know more than you think.... :clown:

If you want to chat you can always message me.. You remind me of myself:rolleyes:

Penelope_Pitstop, BSN, RN · Sep 9, 2008

i'm wondering if this is just lack of experience and nervousness...or something else. why did you choose nursing, and what did you expect out of your experience in nursing school? if your attitude, though, is indicitive of you not being on the correct career path, then i'm sorry to hear that, but i'm glad you realized this now instead of later. if it is nerves and whatnot, you need to inform your instructor about what's going on because to be a successful nursing student you're going to need help.

i remember my first clinical. egad, it was a nightmare for me! i was terrified of looking like an idiot and of hurting my patient. however, i was frustrated at myself and my patients' disease processes and circumstances.

i am concerned for you and your patients because it seems as if you are frustrated at your patients themselves.

like others have said, you are not a bad person and you may one day be a great nurse. but right now what is going on is not good, and it needs to be remedied. keep us updated!

*~jess~*

withasmilelpn · Sep 9, 2008

Know your patients weight bearing status. Think like a lawyer. If your patient is not allowed to walk, you can not help them do it. Sometimes you have to be firm. One option though would be to get her a bedside commode. If translators aren't available, sometimes family members who speak english can be helpful. You can call them at home and get some key words translated. Sometimes speech or social services will have word boards available. But you won't know til you ask, ask, asK! Your primary responsibility is to learn and to do so safely. You can not be expected to know everything. Watch the nursing staff and see how they handle patients. (Though keep in mind some you will not want to emulate.) Confused patients often just need to be reapproached sometimes. They may completely change in the next 15 minutes. Luckily with only a few patients you have time to figure it out. Sometimes patients will just be unhappy with you, no matter what. You will develope a thicker skin, I promise. Never neglect a patient and always document refusals and what you did to address them. NEVER Ever lift someone you are not sure you can. It can lead to injuries for both you and your patient.

Pepper The Cat, BSN, RN · Sep 9, 2008

You remind me very much of myself 25 years ago. I was afraid of doing something wrong, was afraid of looking stupid, etc. I tried to cover up just as you did. Then one instrustor said to me "I am here to help you, Pepper the Cat, take advantage of me". Once I got over the fear of asking quesitons, I realized that everyone else was scared too!