Should I say something to this student?

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I am a CNA in a nursing home, where LPN and RN students often do clinical. I hate to be the CNA that tells more educated people how to do thier jobs, but this one really got on my nerves. They have one patient to do total care and meds for every day (seems like a breeze to me, but I'm sure there are more responsibilities than meets the eye). Anyhow, I come in for the evening shift, after a BSN student from a very reputable school had been providing care all day for one of my residents. I find that her BP was 60/40 on a patient that normally has a high BP. She did not re-check the BP or tell anyone.

The resident was so soaked that her pants, kelly pad, and wheelchair pad were all completely soaked. The room was just rank with urine. I was very confident she hadn't been changed as long as this student had been here. Normally this woman isn't a big "pee-er".

I then find out that the student had brought a tuna salad sandwhich with lots of mayo on it, for the resident from our lunch buffet. She is allergic to eggs, and the student didn't know that mayo contains eggs. Understandable enough, but you would think the student would think to ask why she didn't eat the sandwich and if she could grab anything else from the buffet line for her. Especially since the resident is diabetic!! Normally dietary tells us what can and can not be taken for a resident's tray, so I don't know how she managed to sneak by dietary with that sandwich. She must have not given the resident's name, I don't know.

I didn't say anything, because the students left right as I was comming in, and I didn't think it was my place to say something anyway. I have noticed that other students from this school aren't with it as much as the other students from other schools in this area. I don't want to step on anyone's toes, but I feel like instructor or someone needs to step up to the plate next time they come in for clinical. I was denied admission to this school of nursing, so perhaps I am being overly critical.

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Specializes in Med-Surg.

The problem is the staff that is paid to take care of the patient abandoned the patient to the care of the student.

Where was the licensed professional for this patient? Where was the CNA?

If that patient were to crash and burn, whom would management or the BON go after? The student? I don't think so.

Shame on the student for sure, but forget the student, your own staff from the previous shift is the one who are responsible.

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Specializes in Telemetry, CCU.

First off, thank you for having consideration to students feelings; they are often overlooked by the staff where clinicals are held (at least in my experience). But a BP of 60/40 should have been reported!!! I don't care who's toes I would be stepping on for the safety of the patient, that is a critical value. I would have rechecked the BP and reported the findings to the proper person (BP was 60/40 at 1100, wasn't reported, rechecked at 1900 and BP was 85/60 or whatever the case was).

If you see some wrong-doings in the future, I would report them to nurse in charge of that particular patient rather than going directly to the student. In most cases I would go directly to the source, but in this case I think an approach to the student from the nurse or instructor would be better so that the nurse could explain the rationale behind why what the student did was wrong (not that you don't know the reasons why something is wrong, but "rationales" are a nurse thing).

It is important that you report errors to prevent them from happening again. The student is still learning and since you came in as they were leaving you didn't get the whole picture. Good luck in the future and I hope you get into a good nursing school :)

*edit* just read Tweety's post, I agree the previous shift must have been lacking. "Total care" from one RN student isn't as easy as you said it looked. Patient care takes several people working together, not just one. There should have been other people (your coworkers) helping this student and assessing the patient as well. Maybe someone else did take the BP and caught the low value, but you'll never know unless you clarify.

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I did recheck and report the BP, it just angered me that the student didn't.

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Specializes in Public Health.

I think you have every right to say something. You can say something to the student, if he or she is approachable, but if that doesn't work, go to the nurse in charge of the patient. Patient safety is a priority here, not whether or not you're stepping on anyone's toes.

Obviously something was very wrong with that patient that required immediate intervention, and the student failed to recognize that. Go to the charge nurse if you need to do so.

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Specializes in Neuro/Trauma SICU.

You have a right to be concerned about your patients and to advocate for them. Anyone that is urine soaked for a long period of time is unacceptable. A few questions come to mind when thinking about the blood pressure like how often do you guys do BP's, and was she symptamatic?

One thing that I learned in school, and something that was on my NCLEX was that if you have a problem you go to your manager. For example, you find a member of the house keeping staff sleeping on the job multiple times after you have spoken to them about it. Who do you go to? Answer- your manager, not the house keeping manager.

If you feel confident in talking with the student, go for it. But if not, go to your manager. Sufficient care was not provided and someone has to do something about it.

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Specializes in LTC.

The nurse responsible for this patient (not the student) should have been checking on her throughout her shift to make sure that the student was doing everything correctly. That nurse is ultimately responsible for this patient even when a student has her for the day. She/he should have known exactly what was going on with this patient. Also, the instructor should have been monitoring his/her student and been with that student during the med pass etc. I hope that when you discovered your patient in that saturated condition with such a low bp that you immediately informed the oncoming nurse who should have gone directly to the unit mgr. or DON so that they could inform the instructor of that school before they return to your facility. When I was in nursing school, the instructor had a conference with the mgr. of the unit we were working on before and after each clinical we had and the mgr. also had her cell number so that she could call her if anything amiss was discovered after we left. Feedback from the facility is very important to the instructor because he/she only has two eyes and can't always be on top of everyone of the students. More importantly, your patients need proper care given to them and if a student isn't capable of giving proper care, the instructor needs to know as well as the nurse responsible for the patient. If you feel that a student isn't taking care of your patient properly or is causing or potentially causing harm, the nurse can request that the student be removed either from caring for that patient or from the clinical. (Sorry that was so long winded)

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Specializes in Cardiac Telemetry, ED.

The student is there to *learn*. The nurse assigned to this patient and the student's instructor should have been supervising the student.

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Specializes in CNA, Surgical, Pediatrics, SDS, ER.

Dawn30's post is absolutly correct. That pt is ultimatly the scheduled RN's responsibility. When I was in school our instructors double checked our meds, VS, and pt cares. She also made sure that we reported this information to the nurse who was in charge of our patient. I could not imagine leaving a patient in this sort of condition, I would hope that the student would know that BP was not WNL and would have at least reported it to someone. W/out a doubt I would have reported it to the charge nurse so they could address it w/ the instructor. 60/40 is not the type of BP you want to just let go esp if it's not the pt's norm. Maybe she did recheck it but forgot to report it or write it down, but I would still have the issue addressed.

CNAinNEB good luck to you and I hope you plan to pursue nursing. Sounds like you'd be a great one!

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Was anything charted re: this resident's care that day? By the way, I think good CNAs are worth their weight in gold. Thank you for your hard work every day! :bow:

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Specializes in Neuro ICU and Med Surg.

I have to ask where was the nurse overseeing this pt? I have never left a pt just to be taken care of by a student. I always reassess the patient after the student to see if anything was missed including reevaluating VS if something seemed off.

I think I would have gone to the oncoming nurse and let her know of your findings and she should be the one to report to management.

Also where is their instructor? Our instructors even reviewed our VS while giving meds. If the BP was too low to give those meds, then the med was held, and BP rechecked.

I cannot believe the lack of supervision over this student.

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The student is there to *learn*. The nurse assigned to this patient and the student's instructor should have been supervising the student.

I asked my friend who is a RN and that's what she said. Someone should have been supervising the student and noticed the problem long before you did. You should go to your manager and let her address it with the instructor and preceptor. The instructor can then in turn deal with the student.

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