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.
Specializes in med-surg 5 years geriatrics 12 years.
I agree with the others; while the student was taking care of your patient she/he should have been monitered by the cover nurse as well as the instructor. My instrutors always made it quite plain that we were there to learn and not do the nurse's job for them.
i believe everybody involved here dropped the ball from the nursing staff (assigned nurse & aide), the student nurse & instructor, to dietary. i would go as far saying that the recreational therapy staff & possibly the pt staff as well as the general housekeeping staff should have notice something (provided these aforementioned personnel have daily contact with this particular patient). i've seen housekeeping staff report patients' behavior/condition change they observed to the nursing staff. a lot of alert eyes could've seen something.
then there's the matter of how the student nurses are allowed to do "total care" on their assigned patients. i remember as a spn, we were taught to bathe, dress, & bring our patients out to the common dinning room for socialization. we had to get them up, washed, & dressed. we weren't allowed to keep patients in their rooms. as a sn in my bsn program, we didn't have geriatrics per se; but we did care for elderly patients in a more acute environment. also, it was quite different as i took evening courses/clinicals; therefore, we didn't have to get patients washed & dressed to go anywhere. the day shift student nurses actually provided the daily baths.
now, it would definitely depend on the level of the student nurse regarding their ability to apply critical thinking. i also wonder about what types of meds this patient received as well...in addition to her vasodilating from her allergic reaction. did they receive a anti-hypertensive? did they receive a beta-blocker? what was her pulse? was her blood sugar taken & what were the results? did this patient receive insulin & if so, what type & how much? was this student able to get any other food in the patient? what color was the patient? was she pallor? how did the student get the meds & administer them to the patient? with or without her instructor or did they do it with the staff nurse? i wonder if the staff nurse thought the student was pouring meds with their instructor; if the instructor thought the student was pouring meds with the staff nurse; & the student thought they had to care for this patient completely or totally including giving the meds themselves without either the staff nurse or the instructor????? yikes!!!!!
certainly, the student bare some responsibility for their actions...or the lack of them! almost all nursing school go over med calculations as well as basic didactic/clinical lab vital signs & basic nursing tasks prior to students going to clinicals on their first day. this student should've known a bp *that* low was a no-no! they should've also notice the patient's diaphorectic & pallor at the very least as signs of something wrong. the student might've *missed* the increased urinary output, especially if that wasn't their focus. but they definitely should've known about the bp, sweeting, & blood glucose. it absolutely scares me to think that this student recognized these symptoms, yet did nothing! perhaps they somehow *knew* they messed-up & didn't want to be discovered???? didn't want the instructor to find-out that they might've caused the reaction with the patient & *choose* keep quiet. oh god...here's one ~ what if this student *did* report this to her instructor & they kept quiet because they don't want to be discovered that they'd dropped the ball with this student & patient. o.k....i'll stop cause that's too scary...even for me!
o.k....i may have gone a little over the top; but this really needs reporting to your nurse manager & your facility should do an investigation into why this patient fell through the cracks from the staff to the student & instructor. an after action should be taken so this sort of thing doesn't happen again.
i don't know about you cnainneb, but i would be glad that i didn't get into this school! it's students & instructors like this who'd give a fine institution a bad name. i can understand your feelings of indignation regarding this type of student, especially when *they* got in & *you* didn't! just drive-on, you'll get into an even better school soon enough!
I agree with everyone that it should have been up to the patient's care team to oversee the student, with the instructor doing an overall evaluation. Students in LTC facilities are totally lacking in experience. For most, LTC patients are their first clinicals. The anxiety levels are high, and they may have had a care team who just left her to shift for herself - shame on them. My daughter is in her first year of nursing school, and she has had some great nurses and aides helping her, and some who were terrible. In any case, she is there to learn. Correction and humiliation (perceived) are part of nursing school. Someone should say something, or at least monitor this student if they return to your facility.
Where I am doing clinicals now, the hospital staff from the CNA to the RN's don't have a problem telling my instructor when we do or don't do things (like didn't take vitals, didn't change bed, etc.) One nurse came to my instructor when a patient complained one of my classmates took a patient's BP 3 times and her arm hurt. My instructor pulled the student aside.
So yes, please DO tell. We need to know and to learn when something isn't done right.
i don't know about you cnainneb, but i would be glad that i didn't get into this school! it's students & instructors like this who'd give a fine institution a bad name. i can understand your feelings of indignation regarding this type of student, especially when *they* got in & *you* didn't! just drive-on, you'll get into an even better school soon enough!
exactly my thoughts! thank you for the encouragement.
I would discuss your concerns with the clinical instructor of the school. As an instructor, I would appreciate the up front communication. But also bear in mind that students are not substitutes for staff, as whatever students are not assigned to do or whatever students don't do for whatever reason, is the responsibility of the staff. That is where good communication between the student, instructor and staff should play in here. There are not alot of details in your post, but I would expect staff to check on their patients frequently, even if students are assigned.
If talking with the instructor doesn't work, I'd discuss with your unit manager, and tell her/him that you spoke with the insntructor and nothing has changed.
husker_rn, RN
417 Posts
I agree with the others; while the student was taking care of your patient she/he should have been monitered by the cover nurse as well as the instructor. My instrutors always made it quite plain that we were there to learn and not do the nurse's job for them.