Strange experience yesterday, feedback please...

[LovingLearning]

First, I didn't get into any difficulty or trouble. Phew. LOL. But this experience has me a bit baffled...

I'm a second semester student, doing a med/surg rotation on a trauma/neuro floor. I am utterly loving it...it can get really hairy, but hey, that's all right. Yesterday was one of those hairy days, though...and I ended up getting 'talked to' by my instructor.

I had two patients, both who discharged before I got on the floor. So I picked up two more, and then ended up giving one to another student. So then I got a third, who was comfort care/DNR/DNI. His family was there, and I did my assessment and charted. While I was charting, the fire alarm went off...and locked down the elevators.

No big deal, right? Except, it was during shift change, and half of the student nurses were downstairs taking a break, half the RNs were trying to get up to the floor, and the RNs on the floor were off-floor, waiting to give report to their replacements who were stuck downstairs. Our instructor was downstairs, too...and he doesn't have a cell phone.

So this one patient had both her regular nurse going off shift, and her student nurse was on break. This patient was reporting 10/10 of pain, and I was one of three SNs on the floor (we normally have 9). I chased down her RN(literally...quite literally), and told the RN. Who looked at me, said "well, I want to go home. I'll let the other RN deal with it." The other RN was NOT on the floor, but this RN was not going to even check the chart for PRNs for the patient. And since she wasn't my patient, I had no real idea what was going on. I grabbed the chart, looked at what was up (chest tube placement this afternoon, only motrin given 4 hours earlier, mets Ca brain/lung), and there was no order for anything stronger than motrin.

Long story short, I went to the RN again, asked what I could do, and she just told me again "I'm going home. Let the next RN deal with it." I'm sorry; the patient is in incredible pain, crying, muscle guarding, grimacing, praying out loud to die, freaking her kids...and my instructor and her SN were stuck downstairs, her RN wants to go home...so after checking my two patients, I went to the charge nurse.

I explained what was going on (she was also stuck because of the fire alarm), and told her I can't take phone orders. She said to page the Dr. on call, explain what was happening, that I was an SN, and that I couldn't do phone orders...and see what the Dr. said. Well, I did it, and the Dr. was on the floor (but another wing), and came right over to get the order written so we had something we could give. All this time, I'm back and forth to the pt's room, asking her to hang on, I was working on the meds, just hang tight, and reassuring her children that I was working on things as fast as I could. Ended up having an NA walk the order to the pharmacy because our fax machine was down...and about 20 minutes later, the meds were in the pyxis. The fire alarm had ended, elevators were working again, my instructor came back to the whirlwind, and I had him let me into the pyxis and we got the meds into the pt and 30 minutes later she was reporting 2/10. YAY. I gave report to the new RN, and filled in the SN as to what had happened, and went back to my pts (who were all just fine...).

After our shift ended, my instructor asked if he could talk to me. He wanted to know what the heck had happened that I was med-passing to a patient who wasn't mine, how come I'd called the Dr for an order, et cetera. I explained everything to him, and asked if I was in trouble.

He looked at me and said "you're doing what we are teaching you to do...patients are first, their comfort is priority, and I would've done the same thing." I was relieved...but then he said "but the problem is, you have to let the RN go home when it's time...they look unorganized if they work unauthorized overtime, and we are a 24-hour hospital, and the new RN should've done it." I reiterated the issues (fire alarm, people stuck up and down stairs, et cetera), and he said "no, you did the right thing...I would've done the same. But just be cautious about that in the future; you don't want the RNs to look bad for not getting things done in time."

Like I said, it was strange...I completely get his feedback, I understand the rationale. But I also had a patient in 10/10, whose nurse was not willing to do anything even though she was stuck upstairs during a fire alarm, and didn't even want to start the process of getting meds for the pt. because she wanted to go home. My instructor did say "if I had been up here, what would you have done?" and I told him "of course I'd've gone to you, but since you weren't, I went to the charge nurse." He then asked what I'd've done if the charge nurse had said to wait and relax, and I said I'd've just waited and relaxed...but the charge nurse told me what to say to the Dr., so I was able to adhere to the SN status and issues, as well as take care of the issue at hand.

Again, I got into no trouble...and my patient and her family were so appreciative. Even said something to our instructor about how caring I was. So again, no problems, but definitely strange.

What would you have done, and what is your opinion about what I did? I am wondering if I indeed overstepped a boundary, but my instructor assured me I hadn't and that he'd've done the same thing...but it was just...strange.

As a final note, my patients were all doing well during this time, so no worries that I had ignored their needs. And the other SN didn't have any problems with me helping while she was on break.

Just interested in your feedback. Thanks in advance...

Best-

Lovin' Learning

[sh1901]

Lovin Learnin - I would probably have done the same thing that you did. I do understand what you mean though when you say that the situation was "strange". I think that you did a great job meeting the needs of the patient!

[RochesterRN-BSN, BSN, RN]

Sorry but the first question that comes to mind...........isn't the hospital legally required to have.......STAIRS?!?!?!? lol how do they possible have people stuck because the ELEVATORS are down??? This is what the stairs are for.

This is the crappy attitudes you will find with some nurses....welcome to nursing!!! lol That nurse needed to continue to be responsible for her patient until another nurse takes over that responsibility. Period. Unless the nurse leaving has reported off to the charge and she agreed to legally be responsible for the patient(s). Yes we all want to leave on time but patient care comes first. Part of the job. Yes if the patient was reporting that she was a little achey, wanted something for constipation, etc....something that could wait 30 minutes that is not a bit deal but yes 10/10 pain! Technically the RN should have gone in the patients room and done a quick assessment herself. Just to be sure that the patient was stable and there was not an emergency. I know I would have--weather I am the RN who is covering another RNs patients for what ever reason or the charge RN. Nurses CAN be lazy sometimes I have found. Unfortunately not every nurse you will come across may be as dedicated as you.....it's sad really. Thank god though that most are dedicated and very compassionate. There are some that need to hang it up though!! LOL

Team work is part of nursing....especially on a med/surg floor, at least in my experience. EVERYONES job is easier if all work as a team. The nurses, the techs, the charge. You really can't do it alone and shouldn't. Yes you need to learn to be independant but you will find that you are asking for assistance a lot even as an experienced nurse....weather its to boost a patient, change a patient, get a second opinion on a bed sore, get someone to try the IV that you can't seem to get, pass a couple of patients meds for you as you have a patient that has become unstable and is about to go to the ICU, another RN is eating and thier patient calls in in as you walk past and is begging for pain meds, you let the RN know and get them.......not a big deal. The patients will ALWAYS benefit and get far superior care AND the job will be easier if EVERYONE gets on board and acts as a TEAM!!

You seem to have this concept down early...as a student.....KUDOS!!!!

Don't let it go and don't let the bitter lazy nurses get you down. You did the right thing. It sounds like you will be an amazing nurse. You can take care of me anytime!!! lol

[RochesterRN-BSN, BSN, RN]

Oh and I forgot to mention.....as far as taking care of ALL the patients when need be. I had a fellow RN--a friend--go on lunch and she came back to find me doing CPR on her patient!! LOL--- I happened to be in the hall and a tech sticks his head out and asks if the patient he is with is mine. I say "No, but do you need something?" He tells me the patient "kind of fell"..... well the tech lowered him to the floor as he collapsed standing to wipe after using the commode......I go in and he is on the floor and on assessment I realize he is crashing!!! We call a code and the poor guy...still covered in poop got lifted to the bed and we tried to bring him back....for an hour!! The RN comes to the door way and sees me in there doing chest compressions with the code team and later I asked her-- "I hope you didn't feel like I took over with your patient....should I have had you come in and take over since it was your patient??"..... I was new and she a wonderful friend who had been a nurse like 20+ years. It was my first code. She laughed and said "Oh lord no. You did fine. Better you them me!! I have had more codes then any one RN needs to do! Gosh, no. You did what needed to be done and took care of my patient while I was gone. Thank you for that......oh and BTW you might want to call for some clean scrubs-- your covered in **** kido!!! LOL"...........I was relieved. Like I said I was a new nurse. So really you have to work as a team. And she was a wonderful mentor.

Just a funny story I had to share!! LOL

[FireStarterRN, BSN, RN]

Good for you in going the extra mile.

In the old days we were able to get narcotics as soon as it was ordered, but notice in the OP's account, that the whole thing had to go through a whole rigamarole to get one pain med. And, why those people couldn't walk the stairs is beyond me, but I see it all the time. I'm always trying to get my co-workers to walk the stairs with me and they act as if I'm trying to get them to climb Mt Everest.

[JeanettePNP, MSN, RN, NP]

I'm quite impressed with how you handled it. You had many excuses available to you not to get involved (I'm only a student; not my patient; her RN doesn't care so why should I) but you put the patient first and stuck out your own neck to get her needs met. I can understand why you were "talked to"--it wasn't that you did something wrong, he just wanted to be clued in on what was going on.

[Daytonite, BSN, RN]

Your instructor was attempting to convey to you the importance of chain of command and job responsibility. As a student you are a visitor in the hospital and not on staff. When you are a staff member you need to respect everyone's job responsibilities and respect chain of command or you are viewed as a buttinski even though you consider a patient's needs first. I understand you were concerned about the patient. Yes, that is admirable. But, in the hierarchy of the working world you just do not outshine the nurse who was ultimately responsible for the care of this patient. It's rude. It makes you look like you were trying to make the staff nurse look like a doofus and you look like a star. You may not see it that way, but the staff will see it like that. The staff has the right to do their job as they see fit despite how you feel they should do it. You are not their boss. That is part of the wisdom your instructor was trying to tell you without deflating your enthusiasm about doing the right thing.

[LovingLearning]

First, let's clarify the stairs issue. We can go DOWN them, but cannot go UP them (except to the roof...). They do not exit into the hospital or on floors, but rather outside the hospital, and thus bypasses security. So if you go into the stairwell, you cannot get out on other floors, and can only exit by the downstairs door. Don't even ask me why it's this way; I think it's one of the dumbest designs around, but then again, I'm not an architect. Go figure.

Daytonite, I see and hear your point. I was not trying to outshine, but can see how it might've been seen that way. And that's why this whole thing was strange...my instructor was making sure I followed the chain of command (if not him, than the charge nurse), was not doing something outside the scope (e.g taking phone orders), and agreed that he'd've done the same thing. OTOH, there is the issue of the RN, it not being 'my patient', and the fire alarm/stair thing...so it was just a weird time on the floor altogether. I also understand wanting to go home...the RN had had a rough shift apparently, and was tired. I know that feeling, too.

I don't really feel like I did anything wrong, but since it was odd, I wanted feedback, and I appreciate all of yours. I am not always the best at seeing boundaries, but as my instructor said, "I can't fault you for doing what we're teaching you - patient comfort comes first. You were doing that, and did it within protocol." But I can always learn, and will always try to do better...and I take things into consideration and try to apply them the next time something comes up.

Thanks, everyone!

Best-

Lovin' Learning

[morte, LPN, LVN]

i believe that accessing the floor thru the stairwell was contraindicated by the fire drill/alarm.....need to have all doors shut....

[sissiesmama, ASN, RN]

To the OP, I would have done exactly the same thing. I know the hospitals are a 24 hour service, and we do have shifts around the clock, but you were looking out for the patient's best interests, their comfort. I would be guessing, but somehow I just don't see the next shift "getting right to it" as soon as they came on, and the patient can be in pain "for free", as one of my old instructors put it.

I think you did fine.

Anne, RNC

[Daytonite, BSN, RN]

daytonite, i see and hear your point. i was not trying to outshine, but can see how it might've been seen that way. and that's why this whole thing was strange...my instructor was making sure i followed the chain of command (if not him, than the charge nurse), was not doing something outside the scope (e.g taking phone orders), and agreed that he'd've done the same thing. otoh, there is the issue of the rn, it not being 'my patient', and the fire alarm/stair thing...so it was just a weird time on the floor altogether. i also understand wanting to go home...the rn had had a rough shift apparently, and was tired. i know that feeling, too.

i don't really feel like i did anything wrong, but since it was odd, i wanted feedback, and i appreciate all of yours. i am not always the best at seeing boundaries, but as my instructor said, "i can't fault you for doing what we're teaching you - patient comfort comes first. you were doing that, and did it within protocol." but i can always learn, and will always try to do better...and i take things into consideration and try to apply them the next time something comes up.

i suspect your instructor is being nice and he was expecting to get a talking to about this from someone because some toes were stepped on. i would not be surprised to hear that he went back to do some follow up. if i were the manager i would have pulled him aside to talk with him. want to know why? (1) because you overstepped your boundaries as a student. (2) because someone on my staff failed a patient and i want to know the details. (3) because someone on my staff was outrageous to you. (4) you failed to report it to me. a manager needs to know when their staff is doing substandard care because they can't be everywhere at once and know everything going on.

at the time you may not have thought you were trying to outshine the staff, but that is exactly how it will be perceived. your actions not only reflect on your instructor, who is your immediate supervisor, but on your school as well. what you thought was simply helping a patient was actually involving yourself in the job of the staff nurses. students are visitors/guests who are there at the invitation and kindness of the facility. if someone on the staff has dropped the ball, you make your instructor and someone on the staff aware, then step aside and let the staff handle their own dirty laundry. your responsibility is ended. when you get to be a manager, then you can look at your staff nurse who said, "well, i want to go home. i'll let the other rn deal with it" and say, "no, you go and take care of getting mrs. x her pain medication right now."

[fiveofpeep]

you're so great for being an awesome patient advocate like that

If I were in his shoes I would be so grateful for your kindness and proactiveness

I think it's great you got an opportunity to collaborate with the doc too : )

PS as a student I dont know that I would have known that that was wrong to do. I can see how you were just trying to be helpful and kind

When youre a real nurse you can advocate all you want without things getting hairy