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

Quidam · Mar 21, 2009

... 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.

As of yet...I don't have a license. And I continued to ask to be allowed to help the patient and finally just went on my own to rectify the situation. The client's husband knew I was trying to get him help even if I was not allowed to help myself. I was quietly advocating for this patient.

Equinox_93 · Mar 22, 2009

As of yet...I don't have a license. And I continued to ask to be allowed to help the patient and finally just went on my own to rectify the situation. The client's husband knew I was trying to get him help even if I was not allowed to help myself. I was quietly advocating for this patient.

I'm not criticising *you* here- *she* was the one who was the primary responsible party- you were clearly and unquestionably trying to do the right thing. You were unfortunately between a rock and a hard place there because she's the authoritative party in that situation. I'm just saying- sometimes you just have to do what needs doing- whether that means trumping that authority or not. You say "we cannot trump the nurse" and I'm saying- well- sometimes doing that may be necessary. If it means stepping in and making yourself heard or refusing an action because you find it unsafe or abusive/neglectful etc. sometimes trumping that authority is exactly what is called for... I mean- what would you have done if you hadn't eventually found that opportunity? Just went on with your day? (I doubt it...) How did you feel having to wait that long? Would you have done anything differently if you had it to do over? What might you do differently next time? (Rhetorical questions). The reality is- sometimes we have to put our foot down for what's right even if it means ******* off those up the heirarchy. I just wonder- in situations like that- what if the patient's family complains and decides to name everyone involved? That nurse and you, the student? I'm not sure what the ramifications of something like that would be- if the student could be used as a scapegoat and/or dismissed from the program along with the nurse who made the bad decision.... They can do some nutty things sometimes... Also- in the event of a lawsuit from something arising from that situation (say the excrement were acidic and caused skin deterioration and the family chose to sue...) That is a possibly dangerous position she put you into.

Quidam · Mar 22, 2009

You say "we cannot trump the nurse" and I'm saying- well- sometimes doing that may be necessary. If it means stepping in and making yourself heard or refusing an action because you find it unsafe or abusive/neglectful etc. sometimes trumping that authority is exactly what is called for...

I understand what you are saying. Makes perfect sense and I agree. I meant trumping as in blatantly going against what the nurse is saying to do, barring a critical incident. As students we need to understand that we are guests in the hospital and we need to behave as such. Too many times I have seen and heard about students, feeling empowered with all this new knowledge and we fail to relate our education to the real world setting. Not saying the OP did this...just in general. Thank you for clarifying.

elthia · Mar 22, 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!

Sometimes I have given a pt medication, and then and hour later they have called for the medicine...somtimes pt's forget. Sometimes I have had pt's tell my how the evening shift nurse gave them something, and I look at them and say, I was your evening shift nurse, I work 12 hour shifts.

Did the pt understand what colace is??? Does colace come in a pill or liquid form in your hospital, did the nurse call it DOCUSATE instead?? Was the pt thinking colace something like milk of mag or an enema??

The pt hadn't had a bm in 3 days, so maybe the nurse had decided to go with an enema, or maybe she had obtained orders for something else. Maybe the pt was given something on another shift, did you check the nightshift MAR.

Post partum cramps, did the pt need to void? Did you massage the lower belly? Or were the cramps related to a laxative that the pt may have recieved earlier??? ( I only ask that because I once had someone come up to absolutely sure a pt was having an acute adomen, the pt was cramping from mag citrate he was given for constipation).

the pt may have not been disoriented, or drugged up, but she had gone through a severe emotional trauma...pt's don't retain a lot of what we tell them, and emotion and loss into the mix, and it's even less.

I think you would have done much much better by going to your clinical instructor on the best way to handle this, than drawing an emotionally fragile patient into a what amounts to a temper tantrum against the nurse. It was unprofessional, and not how you advocate for a patient. Later on in the real world, is this how you are going to handle situations where you feel a pt was not receiving appropriate care, or if a pt complains to you about the care from another nurse. I hope not. There are appropriate channels and methods, and you failed to use them. For the future, keep in mind, Clinical Instructor, Charge Nurse, Nurse Manager, Nurse Director, Patient Advocate/Patient Representative, Ethics Committee.