was i wrong?

Reigen · May 7, 2010

When dealing with students who only have one or two patients, I have found it is best to say thank you for informing me, I shall follow up. This way the student feels as if their observations have been validated, and you can by using your professional judgement make the decision(s) you feel are best for your patient. If that means informing the physician or another nursing intervention, then it is still your responsibility and duty.

Wrong, no, it was perhaps the way the response was delivered to the student was what started and caused the student to use some critical thinking skills.

silentRN · May 7, 2010

Chart it in the I&O's and the doc will see it later. Nothing worth calling the doc over.

tele jelly · May 7, 2010

Reigen....simply telling the student "thank you i will follow up" teaches them absolutely nothing. they need to SEE what the follow up is, and what the thought process was that led to your action. that is the whole point of clincials....to learn how to think critically.

and no i dont think that output was any red flag...but always better safe than sorry with an angry surgeon =)

cb_rn · May 7, 2010

I know lots of schools have great nursing instructors but sometimes you have ones that haven't done bedside nursing in a while but try to act like they still remember everything. I dunno how much experience you have, because I know its easy to doubt yourself in the beginning of your career, but if you feel like something you get reported probably isn't a big deal, you can always run it by your charge nurse or a more experienced nurse on the floor and see if they agree with you, prior to notifying a busy physician of an expected finding.

cb_rn · May 7, 2010

Reigen....simply telling the student "thank you i will follow up" teaches them absolutely nothing. they need to SEE what the follow up is, and what the thought process was that led to your action. that is the whole point of clincials....to learn how to think critically.
and no i dont think that output was any red flag...but always better safe than sorry with an angry surgeon =)

If she thought that the finding was normal she should teach the student the reason for her thinking "Its often normal to lose that amount fresh out of surgery but lets assess the patient -- lets see - last vitals were at her baseline with no tachycardia, normal BP, she's in a little bit of pain but is A&O, urine output is >30ml hour. Lets make a plan to monitor her and we'll notify the physician if the drainage increases or we start to notice a change in her vitals or other deterioration in her condition."

I understand CYA but if you truly think something is WNL, being bullied into calling by a nursing instructor is not a good way to build up credibility with "an angry surgeon" if you aren't worried about it. Second, if the NI also made the SN tell the Charge and she didn't seem concerned, that should have reinforced OP's assessment. 3rd, before she made a decision to call she also could have spoke to the nursing instructor as well, to see what her thinking was.

Kooky Korky, BSN, RN · May 7, 2010

You say you had student(s). Plural. You get the gold medal. One is tough enough to deal with.

If VS were normal, if the drainage was WNL in color, etc., you could have asked the instructor what she thought was the problem and gone from there.

Yes, students need to learn critical thinking, but I think their instructors can teach them that. Why does the floor nurse have to do all of that, on top of everything else she has to do? Where was the instructor all day? She should have been trailing the students very closely, not expecting the floor nurse to do the instructor's job. And who said there was an angry surgeon?

How much drainage was expected?

tele jelly · May 7, 2010

no one said there was an angry surgeon. we were speaking theoretically.

cherrybreeze, ADN, RN · May 7, 2010

That sounds a *bit* high to me if it was a simply hyst, BUT...there are a lot of factors as well, of course....appearance of drainage, other history (if it's done for cancer, they will often drain a LOT of fluid that is ascites), stable vs unstable VS, etc. Granted, I agree that it's up to the instructor to explain this to the student, but if they don't, why don't you? I love taking the small opportunities to teach. Explain why it isn't a concern for you, and give them the reasons. That way, also, they know you are REALLY aware of it, and why you do or don't plan to call the doc.

CaLLaCoDe, BSN, RN · May 7, 2010

I would have brought it up to the MD, if the fluid from the JP had been overly Frank Blood, patient's vitals were off, low blood pressure/ high heart rate etc. Having no other signs outside of 300+ ml output, I would not have called the Doc and recorded it in the I and Os . I think it was a teaching moment that unfortunately you were the victim of. Why didn't the instructor come to you and explain the concern. Input output are not to be taken lightly of course, but why didn't the student ask why you weren't overly concerned? Perhaps the instructor was ignorant of a post op patient with JPs? Sometimes students hesitate to question for fear of being told, "So you think I don't know what I'm doing?"

Bblessing2u · May 7, 2010

I am an end of first year student. I have loved our clinicals, but not all the nurses. Our instructor has 6 students and can't be everywhere at once! That being said.... We are given patients that in "my" mind we are really responsible for. We are to report to the nurse who REALLY has the responsibility of that patient first-- to make sure we are doing all the care and assessments that are required. ( I really do take this serious!! I would HATE to miss something !) If I come to my nurse and say someone's JP is x amt, ( and it is not in the care plan on what is acceptable drainage) I would GREATLY appreciate her/him taking a few moments to acknowledge my concern by explaining the whys and whats of the situation.

What I have NOT appreciated is being made to feel like "I" am the idiot for asking what to "YOU" seems silly and inappropriate. I am a student! What do I really know about post-op JPs? Not much to be honest! Some drains barely register 50 ml after 8 hours. If I saw this lady with a JP nearly full, I would probably come to the nurse asking if that was normal.....( and nevermind looking in my book...I can't find any book that agrees with others!)

I think it would be great if people remembered what it was like to be a student, and cut each one of us some slack... just once that day.

And just for the record...When I have a nurse that really acts like she cares that I learn something.. I work my tail off for her. When I am done with my day, her rooms are spotless, urinals emptied, commodes cleaned, beds made,linen closets filled, CS orders filled, charts done,VS done, Bags ready to hang, med sheets done, bagels in the break room and happy aides for the rest of her shift.

Looking forward to being a RN and mentor!

Bblessing

RN1982 · May 7, 2010

380cc over an entire shift to me isn't bad especially for a fresh post op patient. How about 500cc in two hours out of a JP drain that is in a patient who is two days post op Liver transplant and it's all blood. That would freak me out even more.

But I agree, the student needs to see the process. Call the doctor and document.