The balance between Defensive and Doormat?

[Guest233447]

So I'm a student on clinical. Surgical unit. So far, seems like the place I want to be.

I recognize that there is an implicit hierarchy wherever you go, and I respect that. Gotta earn your stripes.

Students are lower than anyone else on that hierarchy, I respect that too.

So here's the thing: I accompanied my patient on a follow through to the OR today - was off the unit from 0900 to 1300. In the patient's room from 1315 - 1530ish doing assessments, checking/emptying drains etc. Did not have the chart at any point during this time - the charting papers I needed I had at bedside with me the entire time. (Post Op Assessment sheet). Finished up with patient, headed back to the station into the staff room and was sitting with my instructor and some fellow students doing some more charting (still without the patient's chart, just my own paperwork). The PT guy came in asking for the chart, I pointed out the window to where the chart was on the Unit Clerk's desk filing system. He used it briefly and put it back on there. The Charge Nurse comes in and says, 'Who has patient ____ in Room ____?" I turn and say, "I do."

She unleashes a severe scolding saying, "I have been looking for this patient's chart ALL day and every time I need it I cannot find it. I have spoken to you guys before saying how important it is to put the chart on the rack or on the desk if there are outstanding orders. When are you going to figure this out. Etc, etc." Doesn't sound too bad here, but tone of voice was harsh. It was a chewing out, first rate.

I was kind of blank for a second. Then I said, 'I haven't had the chart at all today, it's been up on the Unit Clerk's desk the entire afternoon when I've seen it." She kind of looked at me, then turned around and walked out. She was upset I think. The nurse at the desk who saw her looked at me and kind of had a sympathetic "Don't worry about it" look on her face.

One of my classmates, when we were discussing it said that she would have just said, "Sorry." and not tried to defend herself. I said that I didn't want to take the blame for something I had nothing to do with... but didn't want to come across as defensive either. My instructor agreed saying that if you come out all defensive it just makes you look guilty.

I was taken aback by how she attacked me over the chart (my fellow students were the ones who described it as an attack, so I'm not trying to be melodramatic).

How do I walk the line between advocating for myself so I don't look incompetent in these situations, vs coming across as an arrogant student who doesn't respect the floor staff?

This Charge has, at other times, been very helpful but I know her standards for care are high (as they should be) and she takes no guff... but doesn't seem to have much of a soft/caring side.

I just wish everyone would stop and remember how they felt as a student nurse. It's overwhelming at times.

[loriangel14, RN]

Hey that could have been a staff nurse getting chewed out too.It was not necessarily because you are a student.I find that you have let stuff like that roll off your back.There was nothing wrong with replying as you did. I find you just have to let stuff like that go and don't take it personally.Sometimes others are just having a bad day too.

[OttawaRPN]

You're right, we've all been there. And you will continue to take flak even as a full fledged nurse from other nurses and various levels of other staff. You will also get a considerable amount of flak from patients, their family members and sometimes people whom you have no idea who they are. Sometimes you will be responsible for the flak, other times you will having nothing to do with it.

I say get used to it now. I'm not trying to be harsh, just realistic. The way you replied was excellent, assuming you used a professional but non-threatening tone. Depending on whom you're dealing with, you may have to be more stern - but equally professional and non-threatening - but as a student you're better off being humble, remember you are a visitor in a place where invisible territorial lines are drawn early and often, so you don't want to encroach on this culture risking making your clinical experience a nightmare. But above all, like the previous poster said, you must let these things roll off your back or else you'll drive yourself batty well before you've reached the seasoned level. I really wish nursing schools would better prepare students for the realities of nursing instead of painting those pretty little pictures that are so fictitious and ludicrous, it really isn't doing anyone any favours.

Good luck in your journey, hang in there.

[Fiona59]

Depending on how old the Charge is, she probably was treated far worse when she was a student. The old hospital based training was at times brutal.

In reality, the chart would have been off the unit with the patient while he was in the OR. In my hospital, the porters leave the chart with the recieving nurse who settles in the patient, then the nurse leaves it at the nursing station (we usually make a production of announcing the chart is now there, because we've got some Charges that would have made great Army Drill Instructors).

Let it roll, once you are employed, then you pick which hill to die on. Your classmates need to learn that in the real world Charges will rarely apologize to a group but are more likely to talk to you privately, or one that comes to mind buys you a Latte to make up.