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
and I do not understand why your instructor was concerned about the off going nurse...shame on her. I do however agree that the nurse manager should have been the one to address the problem, not a student.
CountyRat
323 Posts
Great job, LovingLearning! You did the right thing in a bizarre situation. Get used to it. Once you start practicing as an RN, you are going to find yourself in many situations in which there is no way to provide proper care for the patient, and also follow routine procedure. Just part of the job. I hope, when those situations come up (and trust me, they will - often!) that you continue to use creativity and good judgment to meet the needs of your patient. As for your instructor's concern about, "making the nurses look bad," I do not agree. The one who made the nurses look bad was the RN who walked off the floor leaving her patient in unrelieved pain. Your good judgment and intelligent problem solving makes us look great! You are going to be one terrific nurse. I envy your future patients.
Lead on!