they teach us to be advocatees for patients but,,,

mRpeNa · Mar 20, 2009

Sorry! I added an extra "e" on advocates!

truern · Mar 20, 2009

SORRY THIS IS SO LONG...BUT I HAD TO VENT!
Yesterday in clinicals i was caring for a patient who was going in for a scheduled c-sestion and upon arrival they couldn't find a fetal heart beat. well come to find out the baby was still borne. this was on a monday that it happened AND 3 DAYS LATER she was my patient of her. As i was doing my assessment on her she had not had a BM in 3 days, she had active bowel sounds, and she was not given any colase (AT ALL) which is a standard med that they give to post op moms. so i finish my assessment, oh i forgot to mentioned that on this particular day we were not given meds, so anyways i finished up and i let the nurse know about the patients concerns and asked her about the colase and other meds. well the primary nurse responds to me that she hasn't looked at her chart yet and as soon as she does she will see what has been ordered. ok, that was at 7:30 so i give it some time. this patient was ready to go home not to mention all the pyscho/social needs that was going on but she couldn't go home until she had a BM. So i waited for about an hr and asked the patient if the nurse had given her the medication and she responded no, so, i go and ask the nurse about it again. and the response i got this time was "oh yeah i already talked to her about it". ok, so i left it at that and around 10 i am doing my quick rounds and she still wasn't given anything and i ask her if the nurse came in and talked to her about it and she said no...so at this point i am frustrated because First the nurse lied, and its not like my patient is disoriented or drugged up or not abel to understand anything and to tell me she did talk to her and not even mentioned anything to her about it! So i finish up and mentioned to the nurse again about her cramping in her abdomen and she was asking for it and wanted something to help her and the response i got was rolling her eyes...in her chart it said give colase if no BM after 2 days give fleet enema...so, we are to get off the floor at 11 and i go check on her and told her the best thingto do is call her q 15 minutes until she gets her meds... and i did mention to her that i was letting the nurse knowabout her concerns...HOW ARE WE SUPPOSE TO BE PATIENT ADVOCATES IF WE ARE STUDENTS NURSES WHO THE NURSES ACT LIKE WE ARE OVER REACTING AND BOTHERNG!

It's good that you were concerned about your patient and that you advocated for her, but imo you were out of line to suggest that she call every 15 minutes for Colace. Do you even understand the action of Colace? It's a stool softener and won't have an immediate effect. You told the nurse, you reminded the nurse, end of story.

I'm wondering why you didn't offer to do the enema since you were so concerned?

mRpeNa · Mar 20, 2009

yes i do know the effects of colace and the nurse only had 2 pts that day...i did offer but i was told that we were not given any meds that day! IT HAD BEEN 3 DAYS AND SHE WASN'T GIVEN ANYTHING TO HELP HER!

sorry if i touched a nerve...

Jolie, BSN · Mar 20, 2009

I understand your concern and am not excusing the nurse for failing to adequately address the patient's needs.

But I can't help wondering what was going on with the nurse's other patients. While Colace and a BM were understandably on the patient's mind, and yours, since she was your only patient, the nurse may well have had far more pressing issues to address with other patients. You were not present when the nurse spoke to the patient and don't know what was discussed. I don't think it is reasonable for you to jump to the conclusion that the nurse lied about their conversation. Patients can misunderstand or forget things as well, especially patients who are preoccupied with grief and emotional stress.

Everything needs to be put into perspective, which is understandably difficult for a relatively new nursing student and a grieving patient.

NurseLoveJoy88, ASN, RN · Mar 20, 2009

The nurse was wrong for lying. I think the problem is your program. Why can't you give meds with your instructor ? When I has OB clinicals we gave colace, pain meds, and injections for the babies. I also agree with the above poster, the nurse may have had other priorities dealing with other patients. I do give you a thumbs up for being a patient advocate though ! Way to go !

ChristineN, BSN, RN · Mar 20, 2009

I would not have told the pt to ring out every 15min for Colace. For all you know the nurse might be waiting on it to come up from pharmacy and it might not be on the floor. Instead, as a student, you could educate the pt in other things she could do to encourage a bowel movement. Interventions such as drinking lots of fluids, being up and walking around, or eating salads and high fiber meals. Pt education is something that you as the student could have done, and would not have had to depend on the staff nurse to do it.

truern · Mar 20, 2009

You will notice the only poster to agree with you is another student.

Guess some warm prune juice was out of the question??

ChristineN, BSN, RN · Mar 20, 2009

One thing I'm wondering is that if the Original Poster was so concerned about the pt, did she at any time consult with her instructor to see what plan of action her instructor would reccommend? I have a feeling the plan she took and the plan that would have been reccommended by the nursing instructor were vastly different.

NurseLoveJoy88, ASN, RN · Mar 20, 2009

You will notice the only poster to agree with you is another student.
Guess some warm prune juice was out of the question??

Thats not true... I as a student agree to disagree with the student. I'm just shocked that her clinical group were not allowed to pass meds. If I was her, I would of did some patient teaching and thats it. I would not of went to the nurse so many times, because I understand nurses have other patients other than my one. I believe the OP had good intentions, and remember we are students and still learning. Its not a matter of whether she was right or wrong she's still learning.

ChristineN, BSN, RN · Mar 20, 2009

Thats not true... I as a student agree to disagree with the student. I'm just shocked that her clinical group were not allowed to pass meds. If I was her, I would of did some patient teaching and thats it. I would not of went to the nurse so many times, because I understand nurses have other patients other than my one. I believe the OP had good intentions, and remember we are students and still learning. Its not a matter of whether she was right or wrong she's still learning.

At some hospitals/schools passing meds in OB is a libility issue. I was not allowed to pass meds in OB, but could assess, straight cath, and chart in post partum. The meds used in OB, for the most part, are meds students have passed in med-surg, so I'm sure most schools feel that students are all ready familiar with these meds.

missjennmb · Mar 20, 2009

To the OP I am very curious what your CI said? If I had a desire to do something for my patient that was outside of my directives for the day, I would go straight to my CI. An enema is something that most CIs are dying to have their students do (any any other procedure), not to mention reinforcing the patient advocacy process. I'm sure my CIs if asked would have talked to the nurse and offered our assistance to give them the time to get everything done.

If I was the patient and had just delivered my child stillborn, I would have absolutely felt that my need to leave the place where it all happened, was a high enough priority to get my needs taken care of atleast within a couple hours of requesting. In fact, I'd have acted quite a lot worse than this poor woman did, but then I'm a horrible patient.