i am 20 years old. i have been in clinical for 3 months now..i am like this squeaky little highschooler that keeps asking questions whenever i am on the floor...
i always feel the need to consult someone else, or i just copy what other people are doing. i feel like i dont have a trust in myself yet, and i have to keep bothering others. am i being annoying? am i too clingy? how do i stop this!? my basic fear is that i dont want to hurt myself or anyone else with my ignorance, but the people in my class seem to just get up and move to the charts, already knowing what they're doing, or they're sitting around doing nothing... sigh.
should i just pretend and not help my patient when they are confused? i sometimes have done this, neglected my patient because they are confused and they dont like me being in their room and push me away like i'm a bother. i wont be in there unless i absolutely have to be.. is this LEGAL/ETHICAL?? or i leave them in the nursing station..
transferring 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?!"
i sometimes feel like being absolutely sarcastic with my patients it almost makes me laugh.. is what i'm doing considered..right? wrong? what?
do i give my patient what she wants...let her fall on her face because she wants to walk when she shouldn't be? or let her pee in the bed, ignore her because that is what is safest for her? ugh, i have so many conflicting snap decisions to make in nursing........... help.
is it wrong to not jump at the every whim of my patients screaming when i've already told them what i can and cannot do?!
patients also get mad at me when they speak a different language and expect me to know what they mean.. this lady was screaming for a toilet thing for the bathroom... i was like, what? i had handed her something and she threw it away, and then she was fussy the whole time....even with taking her meds.. can i say, patient refused meds?
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!
Specializes in Pediatric Psychiatry, Home Health VNA.
These are the types of questions you are going to have to face over and over, not just in clinical but on your HESI exams and the NCLEX. I'm about to give you the secret to nursing so please drill this into your head.
Safety first, ALWAYS. You can't even worry about vital signs or anything else until your patient is safe. What does safety mean? Safety is checking your patient to see if they are alert and oriented to person, place, and time. They are? Check. Next, are they a fall risk? Anyone elderly, history of falls, confusion, or surgical/on pain medicine is considered a fall risk. They should have a bed alarm on and/or a tab alarm unless they have been given permission to walk alone. If you don't know what these alarms are ask your instructor or a floor nurse. Make sure the number of side rails are up that are ordered (usually 2-3)...lastly, make sure they have everything next to them that they could fall out of bed to get...i.e. the call bell, their telephone, their table, and a drink (if they are allowed to drink). Before you leave ask them if they have everything they need. You wouldn't believe how many trips you can save by doing this. When you write your nursing note, documented their mental status and that they remained safe throughout the shift.
In school, if you get a question in school about what the first thing to do with an admission is, the answer is ALWAYS orient them to the room and clear any obstacles out of the way that they could trip over. I got this answer wrong MANY times before it clicked. Safety is KEY. If you can't get them up safely don't do it. Too bad if they don't want a bed pan. Yes, it's true, I said it. In nursing school theory you would always have two people ready at the bedside to assist with a transfer...in real life, you offer them a bedpan and if they refuse you tell them you will be back with help as soon as you can...it's better to let them pee the bed than to unsafely transfer a patient. You can change their sheets a lot easier than you can explain how they ended up on the floor with a broken hip.
If a patient speaks a foreign language you should be able to access the language line for them, and/or have a family member (if available) make a list of common questions/needs of the patient in their language and then in English. Common issues are pain, hunger and thirst, needing to use the bathroom, wanting to see the nurse, repositioning, and temperature preferences.
Sometimes you just have to play along with a patient who has dementia or is agitated and confused because trying to reorient them can just make the situation worse. If it's a chronic disease process you're not going to be able to reverse it so there is no harm in playing along as long as it won't hurt the patient. However, if your patient was alert and oriented yesterday and today they're out to lunch then perhaps they have an infection and it's a situation that needs investigating.
These things will come to you. I know a lot of fellow nursing students who did the "fake it til you make it" in the first year of nursing school, specifically med-surg...it's overwhelming and there's a lot of theory to apply to a clinical setting. You will learn to prioritize in time. Just know that safety is always key...still at the end of a terrible frustrating day I go home and think "okay, all my patients are alive and safe, and they got everything they needed to make it through the day" and that has to be enough for that day. Make sure that you're paired up with a supportive nurse. This is YOUR learning experience, it's what you make of it. You have the right to be with someone who enjoys teaching and can make you feel comfortable. Speak up to your professor. At some point you learn to be assertive...it's usually the point where you realize you are the only voice and support person for a patient. They are depending on you to do right by them because they don't have anyone else. That's when you shed the shell and step out into the light. Don't worry, OP. At the end of the day your patient was safe, and she only made it halfway out of the bed. She didn't fall, and that's a start. Everything else will come with time and you'll look back and laugh at yourself that these were the most plaguing questions and you'll wish they were still as cut-and-dry. They get a lot more complex as you go along.
Specializes in Community Health, Med-Surg, Home Health.
I would ask the assigned RNs or the clinical instructor about interpeter services. This is important, because the patient may be trying to tell you something crucial, such as "I have chest pains", or something that needs immediate attention (better to get used to obtaining an interpeter, now, because in the real world, this can certainly happen). I do understand that it is overwhelming for a new student. Nursing is not what is shown on television, it can be a stressful, dirty job. Think deeply and decide if this is really the path for you. We've all been there, for sure.
words of wisdom? advice?????
HappyPediRN
328 Posts
These are the types of questions you are going to have to face over and over, not just in clinical but on your HESI exams and the NCLEX. I'm about to give you the secret to nursing so please drill this into your head.
Safety first, ALWAYS. You can't even worry about vital signs or anything else until your patient is safe. What does safety mean? Safety is checking your patient to see if they are alert and oriented to person, place, and time. They are? Check. Next, are they a fall risk? Anyone elderly, history of falls, confusion, or surgical/on pain medicine is considered a fall risk. They should have a bed alarm on and/or a tab alarm unless they have been given permission to walk alone. If you don't know what these alarms are ask your instructor or a floor nurse. Make sure the number of side rails are up that are ordered (usually 2-3)...lastly, make sure they have everything next to them that they could fall out of bed to get...i.e. the call bell, their telephone, their table, and a drink (if they are allowed to drink). Before you leave ask them if they have everything they need. You wouldn't believe how many trips you can save by doing this. When you write your nursing note, documented their mental status and that they remained safe throughout the shift.
In school, if you get a question in school about what the first thing to do with an admission is, the answer is ALWAYS orient them to the room and clear any obstacles out of the way that they could trip over. I got this answer wrong MANY times before it clicked. Safety is KEY. If you can't get them up safely don't do it. Too bad if they don't want a bed pan. Yes, it's true, I said it. In nursing school theory you would always have two people ready at the bedside to assist with a transfer...in real life, you offer them a bedpan and if they refuse you tell them you will be back with help as soon as you can...it's better to let them pee the bed than to unsafely transfer a patient. You can change their sheets a lot easier than you can explain how they ended up on the floor with a broken hip.
If a patient speaks a foreign language you should be able to access the language line for them, and/or have a family member (if available) make a list of common questions/needs of the patient in their language and then in English. Common issues are pain, hunger and thirst, needing to use the bathroom, wanting to see the nurse, repositioning, and temperature preferences.
Sometimes you just have to play along with a patient who has dementia or is agitated and confused because trying to reorient them can just make the situation worse. If it's a chronic disease process you're not going to be able to reverse it so there is no harm in playing along as long as it won't hurt the patient. However, if your patient was alert and oriented yesterday and today they're out to lunch then perhaps they have an infection and it's a situation that needs investigating.
These things will come to you. I know a lot of fellow nursing students who did the "fake it til you make it" in the first year of nursing school, specifically med-surg...it's overwhelming and there's a lot of theory to apply to a clinical setting. You will learn to prioritize in time. Just know that safety is always key...still at the end of a terrible frustrating day I go home and think "okay, all my patients are alive and safe, and they got everything they needed to make it through the day" and that has to be enough for that day. Make sure that you're paired up with a supportive nurse. This is YOUR learning experience, it's what you make of it. You have the right to be with someone who enjoys teaching and can make you feel comfortable. Speak up to your professor. At some point you learn to be assertive...it's usually the point where you realize you are the only voice and support person for a patient. They are depending on you to do right by them because they don't have anyone else. That's when you shed the shell and step out into the light. Don't worry, OP. At the end of the day your patient was safe, and she only made it halfway out of the bed. She didn't fall, and that's a start. Everything else will come with time and you'll look back and laugh at yourself that these were the most plaguing questions and you'll wish they were still as cut-and-dry. They get a lot more complex as you go along.