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

[mRpeNa]

just to let you know i did do patient education. i did get her up to walk and educated her on drinking plenty of liquids but as i stated before this was 3 DAYS LATER which was already there to give but for some reason was not given and she had not had any medicines given to her as i forgot to mention colace wast not the only medication she was waiting on. Her pain level was an 8 and she had pain medicin PRN that the nurse was ignoring also...

i understand what you are all saying... REMEMBER I AM STILL LEARNING...:wink2:

[yelnikmcwawa]

Her pain level was an 8 and she had pain medicin PRN that the nurse was ignoring also...

Why was her pain level an 8??? Did she have a section or deliver naturally? At 3 days PP and ready to discharge, her pain should not have been at an 8 with a natural delivery. And if that was the case, she proabably had more pressing concerns than the bowell movement. Had the physician been monitoring her? Had she met with psych? I'm not saying that she was lying to you, but was she attention or med seeking? She clearly had suffered great emotional trauma because of the stillborn, so I'm curious to see if that had been addressed, and whether or not that played into any of this.

[mRpeNa]

she did have a c-section and i asked the nurse on the floor if they had a special number that i could give her so she could talk to someone and the nurse told me to call another floor and i did that and i was told that she would talk to her primary nurse and get her a chaplain for her to speak with...

[hunydew2262]

I was wondering the same thing about the instructor.

I had a nurse that sat in the day room for 8 hours, literally. When my cancer patient needed his PCA pump refilled, I didn't bother with the nurse, but went straight to my instructor and told her what was going on. She told the nurse we would take care of his medication and that was the end of it. Even though there were days when we wouldn't pass oral meds, if we had a patient in distress, our instructor would have been the one to go to the floor nurse to find a solution.

Frankly, if I had told a patient to call the nurse every 15 minutes, I would have been severely reprimanded at best and most likely failed the clinical, which would have meant waiting a year for the next rotation. Being an advocate doesn't mean getting into a ******* contest with the staff.

I was sweating bullets watching one patient crash. The FNP didn't think he needed to go to the tele unit. I thought he needed to go, my instructor thought he needed to go, his floor nurse thought he needed to go, but we don't write the orders. He was sent to ICU later in the day and I found out he passed away a few days later. Was I angry? You betcha! But I was the only person there with him throughout the day as his daughter had to leave and go to work. I advocated for my patient by giving him the very best care I knew how to give.

Having given my two bits worth of opinion, we live and learn. I've had horrid nurses in clinicals and I've had wonderful nurses that couldn't wait to teach my pants off. If you really want an answer to your question, go to your instructors or deans at your CON and ask what you could have/should have done differently. They will have plenty of ideas that might help you know what to do for your patient next time.

[NurseLoveJoy88, ASN, RN]

Why was her pain level an 8??? Did she have a section or deliver naturally? At 3 days PP and ready to discharge, her pain should not have been at an 8 with a natural delivery. And if that was the case, she proabably had more pressing concerns than the bowell movement. Had the physician been monitoring her? Had she met with psych? I'm not saying that she was lying to you, but was she attention or med seeking? She clearly had suffered great emotional trauma because of the stillborn, so I'm curious to see if that had been addressed, and whether or not that played into any of this.

Pain is completly subjective and pain is occuring when ever the patient says its ocurring. Yes as nurses we should assess. However, we can't assume she is seeking attention. And if she didn't get pain on the onset of her pain that would also cause her to have increased pain, especially if she's ambulating.

[yelnikmcwawa]

Pain is completly subjective and pain is occuring when ever the patient says its ocurring. Yes as nurses we should assess. However, we can't assume she is seeking attention.

I wasn't saying that her pain report was false...I was stating that if she had a natural delivery and pain at an 8 three days PP, then she needed to be seen by a physician to assess why. And psychotropic pain is very real! But it needs to be addressed psychotropically as well as medically. The more pain meds on board, the more difficulty one will have pooping! But also, the more pain you have, the higher the likelyhood that you'll hold off your BM out of fear. I'm saying that all these things should have been considered as part of the picture, and was merely asking if they were.

It sounds like quite possibly, the nurse attending to her was not being as attentive as she could have been. When you graduate, you'll use this as a learning experience and treat patients with a higher level of care than she did!

[GAstudentNurse]

Ultimately, we are all still on the same team, aren't we???

[tencat]

I think it's good that you are advocating for patients. However, getting the patient to call every 15 minutes for colace is NOT helping the situation to be any better. There were better ways to handle it. Getting your instructor involved would have been the best way to begin after you had asked the nurse to help you out. And if there was a PRN enema, you could have oferred to administer it.

[mRpeNa]

I think it's good that you are advocating for patients. However, getting the patient to call every 15 minutes for colace is NOT helping the situation to be any better. There were better ways to handle it. Getting your instructor involved would have been the best way to begin after you had asked the nurse to help you out. And if there was a PRN enema, you could have oferred to administer it.

as i stated before i did but i was told that we were not giving meds that day and colace was not the only med she was waitng for...in another post i replied that her pain level was an 8. i have taking everyone's words and realize that i could have done something different and next time i will.

[Quidam]

i have taking everyone's words and realize that i could have done something different and next time i will.

From another student, sometimes there are more subtle ways to advocate for a patient. My very first patient in clinical was an example. My case was very simple and required no meds. She was on heavy duty laxatives and had a broken hip. She had a B.M. and it was HUGE! I was shadowing the nurse and while we were in there it happened. The nurse gave her meds and turned to leave. The husband called us back at the door, but the nurse just kept walking. I turned and he asked if we could get her changed quickly. Sure I said. Thinking that surely there would be no problem with this. I was wrong. I caught up with my nurse and asked her if we could make time to change that patient. No. Ok...remember this was my first clinical day. I was clueless. Then I asked her if we could call a tech to come and I could help the tech. No. The techs are very busy today. I was confused at this point. I guess I was looking at her funny, because she added, "Just leave her". I was astounded. Then I asked her if I could get a fellow student and we could change her. No...and again, "Just leave her". But she added we will get to her later. And she instructed me to follow her into the next room. Ok. As we continued from room to room, I noticed the husband at the door. Once he called me over and asked me if I could get the supplies and make time that he was more than willing to help clean her up. This was about 45 minutes later. I asked the nurse again, and got a rolling eyes look and again, "Just leave her". It was clear now that she was irritated with me. I was upset and the husband was so sad. That is what got me. He was sad...not mad, just so sad. I slipped away from her and went to the front desk and told the secretary that the lady in room whatever needed to be cleaned and changed. I told her if she could get someone to help me that I would be glad to help. She immediately called a tech and we got this lady taken care of. It had now been an hour and a half or so. My clinical instructor was not on the floor...she was split between 2 floors so I could not ask her at the time. But I did bring it up in post conference and asked how to handle something like that in the future. She told me there was no excuse to leave a patient lying in their own excrement and that I did the right thing. She also told me to call her if something like that ever happened again and she would come help me clean the patient herself. I thought the nurse might be upset that I slipped off...but she saw me later coming out of that room and she just said, "Oh there you are! Did you get her cleaned up?" Yes...and that was that. It was quite a day for my first clinical day. I still don't know why she refused to allow me to take care of her when I asked initially. It was just a really weird way to begin clinicals.

I think that as students we are pumped full of all the right things to say and do for patients...and real world is so very different than schooling. The majority of nurses are wanting to to the best they can for their patients and a student who seems to behave as though they know better than the nurse can be quite annoying. As a student we have to understand that even though we have an assigned patient, that patient is first and foremost assigned to a nurse. We cannot trump the nurse. We may see things that we are taught should not be, but real world often goes against our formal training. As students we focus, and rightly so, on the methods of nursing. Real world can't always allow for the same methodology we are taught. Thankfully, our instructors are teaching us that as we go along. This is textbook, this is real world. This is ideal, this is getting the job done. I think this has helped keep many of us students grounded and helps us realize that the ideal (text book) way of doing things is not always possible in practice. Something to strive for...just not always possible.

[Equinox_93]

If I were the patient who was schedulled to go home and was being held up because the nurse couldn't get me a med to help me go I'd be livid. (Hadn't gone for 3 days??? At that point with the abdominal pain I'd be wondering about the possibility of an impaction.) If I were the patient and were staying anyway- OK whatever- prune juice, coffee,- great. But if it's discharge day and I'm told I have to stay another day because someone has to sign off on my discharge but left already because I hadn't pooed yet? I'd be calling admin and bi------ a blue streak. (I've been held up on discharge as a patient for that very reason so I understand. Especially when grieving- who wants to be stuck in the hospital? You want to be home with your loved ones and in the comfort of familiar surroundings. Most people anyway.)

[Equinox_93]

... In a situation like that though ones own license is on the line and that would in many cases be viewed as neglect- which is reportable... The husband, the patient or anyone else aware of the situation would know that you knew the patient were laying in their own excrement and that you didn't do anything about it. I wouldn't put my license on the line for neglect charges- I *would* put my job on the line to "trump the nurse" if I thought what she was doing were neglectful/abusive etc.

From another student, sometimes there are more subtle ways to advocate for a patient. My very first patient in clinical was an example. My case was very simple and required no meds. She was on heavy duty laxatives and had a broken hip. She had a B.M. and it was HUGE! I was shadowing the nurse and while we were in there it happened. The nurse gave her meds and turned to leave. The husband called us back at the door, but the nurse just kept walking. I turned and he asked if we could get her changed quickly. Sure I said. Thinking that surely there would be no problem with this. I was wrong. I caught up with my nurse and asked her if we could make time to change that patient. No. Ok...remember this was my first clinical day. I was clueless. Then I asked her if we could call a tech to come and I could help the tech. No. The techs are very busy today. I was confused at this point. I guess I was looking at her funny, because she added, "Just leave her". I was astounded. Then I asked her if I could get a fellow student and we could change her. No...and again, "Just leave her". But she added we will get to her later. And she instructed me to follow her into the next room. Ok. As we continued from room to room, I noticed the husband at the door. Once he called me over and asked me if I could get the supplies and make time that he was more than willing to help clean her up. This was about 45 minutes later. I asked the nurse again, and got a rolling eyes look and again, "Just leave her". It was clear now that she was irritated with me. I was upset and the husband was so sad. That is what got me. He was sad...not mad, just so sad. I slipped away from her and went to the front desk and told the secretary that the lady in room whatever needed to be cleaned and changed. I told her if she could get someone to help me that I would be glad to help. She immediately called a tech and we got this lady taken care of. It had now been an hour and a half or so. My clinical instructor was not on the floor...she was split between 2 floors so I could not ask her at the time. But I did bring it up in post conference and asked how to handle something like that in the future. She told me there was no excuse to leave a patient lying in their own excrement and that I did the right thing. She also told me to call her if something like that ever happened again and she would come help me clean the patient herself. I thought the nurse might be upset that I slipped off...but she saw me later coming out of that room and she just said, "Oh there you are! Did you get her cleaned up?" Yes...and that was that. It was quite a day for my first clinical day. I still don't know why she refused to allow me to take care of her when I asked initially. It was just a really weird way to begin clinicals.

I think that as students we are pumped full of all the right things to say and do for patients...and real world is so very different than schooling. The majority of nurses are wanting to to the best they can for their patients and a student who seems to behave as though they know better than the nurse can be quite annoying. As a student we have to understand that even though we have an assigned patient, that patient is first and foremost assigned to a nurse. We cannot trump the nurse. We may see things that we are taught should not be, but real world often goes against our formal training. As students we focus, and rightly so, on the methods of nursing. Real world can't always allow for the same methodology we are taught. Thankfully, our instructors are teaching us that as we go along. This is textbook, this is real world. This is ideal, this is getting the job done. I think this has helped keep many of us students grounded and helps us realize that the ideal (text book) way of doing things is not always possible in practice. Something to strive for...just not always possible.