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.
No matter what the reason, both the instructor and student need to know what needed to be done. And your facility needs to know that this instructor didn't seem to be on top of the student's work.
There's also the issue that the assigned nurse didn't catch the problems. That may be due to a lack of clarity regarding how the nurses should work with student nurses.
Thus, informing the key parties of the problem isn't the same thing as "tattling" on the student nurse or the clinical instructor or the assigned nurse. Just stick to the facts "The resident's bed was soaked. This is unusual. What happened today?" and "The BP was very low this morning but it looks like the nurse wasn't informed. What happened?" This is different than turning to the student nurse saying "How could leave this resident sitting in soaking bed all day?! Why didn't you tell the nurse about the BP?! Don't you know anything?!"
And for those who say that any nursing student who missed those things is horrible, consider this. Maybe it was one of their first days of clinical and the student had no idea what to do and no direction. I know we weren't given much direction during my first clinicals. Imagine that if you'd never stepped foot in a hospital or nursing home before? They might assume that the assigned RN would be right on top of everything (ideal world) and would have immediately noticed the low BP as soon as it was documented. If nothing were done, then that must mean the nurse knows something the student doesn't. And goodness knows, the nurses are usually busy, so they might think it inappropriate to interrupt them, again assuming that the nurse will have checked the documented BP.
And maybe the student changed the bed & toileted the patient first thing in the morning and never checked again figuring the patient would tell her if there were a problem. That strong urine smell? A totaly newbie might not know if it's okay to pull up the patient's covers to check if they are wet.
On the other hand, maybe the student is a total flake with not one iota of common sense and will probably fail out sooner rather than later.
The patient is ALWAYS the staff RN's responsibility...don't assume total care of a patient without talking to the RN, because students often cannot call docs, take new orders, etc....that's ludicrous.....It makes you wonder if that student is going to be found out someday...for all our sakes' I hope so...
The ball got dropped several times on this poor patient; the student, the instructor, the CNA on staff assigned to her and ultimately the staff nurse.
In my opinion the proper route of reporting this neglect would be the way you would report any issue within your facility. Management needs to be made aware of what happened and it is their responsibility to deal with all involved.
You sound like a great patient advocate! Good for you for speaking up.
I have one other concern - did this pt receive the correct meds that day? I am worried - increased urine output, low BP - did she get a Lasix does intended for someone else??
Good for you for caring enough to have conerns about her care.
I have one other concern - did this pt receive the correct meds that day? I am worried - increased urine output, low BP - did she get a Lasix does intended for someone else??
Good for you for caring enough to have conerns about her care.
Gosh, I hate to admit it, but I don't even know the answer to that question! I assumed she just hadn't been changed, but maybe she did have increased urine output!! The oncomming nurse didn't say anything about a med error, and I didn't think to ask about a lasix. I just hate this situation, b/c this is one of my residents that I have grown attached to.
Specializes in Community Health, Med-Surg, Home Health.
I would also speak to your charge nurse. You are not sure what the student did, meaning, did she tell her clinical instructor (not about how dirty she left the patient-that was obvious)? I have seen some clinical instructors ignore some blatent things....believe it or not. I assume she did NOT tell the instructor, to be honest. I feel that she did not because if she was responsible for the total care of that patient, she would have been cleaned, linens changed and current vitals would have been taken.
I think it is best to deal with your personal chain of command, because you are safer there. Telling the student may cause animosity, and (no flame war, please), it is not your place to deal with the student and instructor directly. Tell your head nurse, and from there, do what you can do for the patient, meaning to clean them up, re-take the vital signs and report all changes and observations. The nurse responsible for the patient and the head nurse should follow up on that condition.
I have also seen students being treated like garbage by seasoned nurses in their clinical sites. It happened to me a few times. We have been blown off, mocked, mistreated and abused several times.
Kuddos for you for seeing that it takes common sense to report a varience, and do basic, fundamental care for your patients!
Specializes in Community Health, Med-Surg, Home Health.
Gosh, I hate to admit it, but I don't even know the answer to that question! I assumed she just hadn't been changed, but maybe she did have increased urine output!! The oncomming nurse didn't say anything about a med error, and I didn't think to ask about a lasix. I just hate this situation, b/c this is one of my residents that I have grown attached to.
There is nothing for you to feel guilty about, because your scope of practice does not require that you know or even ask whether she took her medications or not, or WHY there was an increase in urine output. Those are assessment questions that the nurses should investigate. You knew that something was wrong; meaning that this patient urinated much more than usual, the vital signs were off and that there was a major change in the condition that the nurses and doctors have to assess why this is happening. How would you know unless you had access to the medical administration record, or doctor's orders (most CNAs over the years I have been one don't have access to that information-although that may be changing)? By being observant and reporting this, and other things, goes a long way in discovering the problem of what happened. You have alot to be proud of! Don't feel guilty! And continue with your wonderful observations...those are what can save a patient's life!
This is definitely NOT the student's fault, but the RNs full responsibility.
I have been to clinicals before where as a student nurse, I sucked and didn't notice things I always should have.....BUT it's ok because I am there to learn and you really learn from your mistakes. Oh my gosh I look back on my first year of clinicals and I must have been so stupid....lol.
It's also very hard to be a student in a place where you really don't know anyone, sometimes don't know who to tell, it's hard when RNs and CNAs (etc) sometimes treat you like crap, don't let you do anything, etc.
So no I would not say anything to the student because the RN is who is responsible and if she/he didn't notice a low BP I really wonder about that RN Who knows maybe the stupid DID tell someone but they forgot or something, you really don't know the whole situation.
Specializes in Alzheimer's, Geriatrics, Chem. Dep..
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...
I think you have some very valid concerns! I'd let the instructor know, privately, just what happened. She/he should have been supervising the student better, I think.
Who is ultimately responsible for the pt I wonder? It's on whose license, in other words? I would think the instructor. Maybe I'm wrong?
Gosh, I hate to admit it, but I don't even know the answer to that question! I assumed she just hadn't been changed, but maybe she did have increased urine output!! The oncomming nurse didn't say anything about a med error, and I didn't think to ask about a lasix. I just hate this situation, b/c this is one of my residents that I have grown attached to.
Please don't feel bad - I wasn't implying that it was your repsonsibility to know this - my hospital is 100% RN/RPNs so I am not used to working with CNAs.
My thought process was that you need to report your findings because they could be part of the bigger picture - if a med error was made, and harm came because of it the student needs to know. Part of being a student (and a nurse) is learning from your mistakes -
if you don't know that your mistake has consequences it is hard to learn from it. I know I'm not making my thoughts clear, but I think you all get the idea.
I admire you for caring and being worried about the care this resident was getting. I would want you to care for my loved one.
I usually do not approach students with things like that. I learned better when I advised a student to hold a scheduled dose of insulin for a 50 glucose until the doc rounded (in 30 minutes), and the instructor told the student (with me present the in the room) to ignore me that I had only 3 months experience. BTW...the pt's blood sugar crashed within an hour.
But, I do report things like this to the instructor. After all the instructor is there to educator the students. If that is not effective, I have talked to our DON. Also, I agree with the person that said this was more the fault of the staff. Even if a student is assigned to my patient, I still monitor that patient. And I don't care whose toes I step on, if I see a problem, I intervene.
In my last semester of nursing school(advanced med/surg) we did clinicals at a large hospital in my area. Once the staff(RNs and CNAs) found out that a particular patient had a student, well, they would just disappear into the woodwork. I actually found a problem with one of my patients and went to find the RN..no dice, I got my instructor instead. This elderly man had gotten a foley in the ER the night before and whoever put it in forgot to put his foreskin back in place...one of the first things he said to me was "my member hurts". I take a look and OMG, he actually was bleeding down there and it was all angry looking. Apparently, they weren't aware of the fact that you shouldn't leave the foreskin retracted after you cath someone. :nono:This guy had dementia so he couldn't really speak up effectively but you'd think one of the staff would have taken a peek in the shift prior.
It's good you spoke up for that patient. I have more of a problem with the RN though than the student. Students are learning, the RN should have known better.
Who knows maybe the stupid DID tell someone but they forgot or something, you really don't know the whole situation.
jjjoy, LPN
2,801 Posts
No matter what the reason, both the instructor and student need to know what needed to be done. And your facility needs to know that this instructor didn't seem to be on top of the student's work.
There's also the issue that the assigned nurse didn't catch the problems. That may be due to a lack of clarity regarding how the nurses should work with student nurses.
Thus, informing the key parties of the problem isn't the same thing as "tattling" on the student nurse or the clinical instructor or the assigned nurse. Just stick to the facts "The resident's bed was soaked. This is unusual. What happened today?" and "The BP was very low this morning but it looks like the nurse wasn't informed. What happened?" This is different than turning to the student nurse saying "How could leave this resident sitting in soaking bed all day?! Why didn't you tell the nurse about the BP?! Don't you know anything?!"
And for those who say that any nursing student who missed those things is horrible, consider this. Maybe it was one of their first days of clinical and the student had no idea what to do and no direction. I know we weren't given much direction during my first clinicals. Imagine that if you'd never stepped foot in a hospital or nursing home before? They might assume that the assigned RN would be right on top of everything (ideal world) and would have immediately noticed the low BP as soon as it was documented. If nothing were done, then that must mean the nurse knows something the student doesn't. And goodness knows, the nurses are usually busy, so they might think it inappropriate to interrupt them, again assuming that the nurse will have checked the documented BP.
And maybe the student changed the bed & toileted the patient first thing in the morning and never checked again figuring the patient would tell her if there were a problem. That strong urine smell? A totaly newbie might not know if it's okay to pull up the patient's covers to check if they are wet.
On the other hand, maybe the student is a total flake with not one iota of common sense and will probably fail out sooner rather than later.