Mar 7, 2006

The Good and the Ugly

I have had good days and bad days in Nursing school and as well in my work as an nursing asst. My good days were really those days when I left there feeling like I really made an impact and helped someone.

One good day was when I did my pediatric rotation. I got an 18 month old born with a
Cytomegalovirus infection, Hepatitis C, and he was definitely cognitively delayed. But that's not why he was there. He was there because his guardian broke his leg, a spiral fracture. Those of you in the Med field and social work field know there aren't too many accidental causes for a spiral fracture in an 18 month old. He was such a joy though. He made you smile when you walked into a room. He was constantly smiling. He loved playing PeekaBoo. Sadly, Since his birth he'd gone from family member to family member. This last "Guardian" would be his last. He was discharged to foster parents, whom I met and they seemed very attentive and loving people. He was finally going to be loved and I got to love him for 2 shifts. That's why it was a good day.

OH but the bad days can be BAD. Not unlike the bad day I had in second semester. I made the mistake of telling this patient I was holding his blood pressure med. I shouldn't say mistake, It's only right to inform patients on their meds, but in hindsight, I should have maybe phrased it differently or something.
The drug was Cardizem, an Anti-hypertensive, and I was holding it because the Patient's BP was something like 90/50 and his heart rate was borderline at around 58. This is what I'm supposed to do, if I had given the drug, his BP could've dropped even lower, and would've been very dangerous. So I walk in with his other meds and explain the situation and I explained why and everything. He suddenly started cussing at me! This was a middle aged, middle income seemingly pleasant man until I told him I was going to do something that could keep him from dying. The other nurses could hear him out in the hall. (Now I'm OK with the mentally unstable cussing at me, I see that often at work. It really gets me when the mentally stable get verbally violent)
I paged my instructor as the patient was demanding I bring him his medicine. She went in with me to explain again and although, not cussing this time, he was still rude. I was brought to tears by the situation, frustration, and the demeaning way he treated me.
His demeanor had changed with me as soon as he found out I was a student. This is not something we hide from patients and it is usually added to our introduction (Not to mention the big ole patch on my arm that says STUDENT). He was nicer to the staff, he just thought I had no idea what I was talking about.

We students have no problem with patients denying our services. Not everyone wants to be a guinea pig for us. We understand. So, I make this plea to you, my readers. If you ever find yourself hospitalized and a student walks into your room, please tell them right away if you have a problem with them caring for you and please don't keep quiet and then treat them with disrespect.

Personally, as a patient, I would love to have a student. We students only have a couple of patients (2 or 3) at most versus our staff nurses who have 5, 6, or 7 patients. Sometimes, We have to do extensive research on your diagnosis, lab results, and medications. We also have to do EVERYTHING by the book and depending on our level, with our instructor (With their Master's degrees) watching. It can be like having your own private nurse for a shift.


At 12:15, Blogger Tara's World said...

I dont have insurance and I have cancer. Because of this I go to the County Hospital where everyone there is pretty much a student. I find sometimes the students have more compassion then someone who has more experiance . Thank You for taking up this profession.

At 16:11, Blogger The new Third Degree Nurse said...

That's too bad. My patients at our hospital expect students and every one I've had has been very sweet and helpful about letting us hover over them and fuss. We even get a lot of nursing scholarships given to us by terminally ill patients that former students have taken care of because they got so much extra attention from students.

And what's that 5, 6, 7 patients per nurse thing? It's 4 up here. 5 max and then they call in the agency nurses. You're scaring me.

At 11:01, Blogger Jo said...

Yes, some of the nurses on the med surg floors here can get up to 7 or 8 patients even. The floor I'll be working on has an daytime average of 5 or 6. And our charge nurse will take 3 or 4.
One of the drawbacks of working at the county/charity hospital.

At 14:00, Blogger MomThatsNuts said...

Hey honey! Let me tell you a little story. This one time I was married to a Sailor (thats a DIFFERENT story) but I digress. So while married to said Sailor, I was pregnant. In my 4th month of pregnancy the babys heart beat stopped and I was admitted to Balboa Naval Hospital. I dont know if it still is, but at the time it was a teaching hospital. While facing the fact that I was losing my baby, and having to fly my mother in to take care of the then about 14 month old Troll~ette, I was poked and prodded by EVERY SINGLE NAVAL CADET IN THE FLEET. They explained to me that it was a teaching hospital and would I mind. So I am all no I guess not...OMG they brought them in by the dozens! Keep in mind I was a 20 year old simply GORGEOUS young lady and it was VERY hindsight, I shoulda picked a DIFFERNT Sailor,,but again thats a story for another day....


At 21:49, Blogger Dreaming again said...

When I wind up in the hospital, unfortunately, not an infrequent thing, I wind up with a nursing student almost every time.

I never mind. I have such an unusual disease that I figure the more nurses who get 'trained' on me, the better care people with Myasthenia Gravis will get in the future.

But you're right, you do get better care because they are so focused on you.

At 09:55, Anonymous Anonymous said...

I know when I'll start accepting student care.

-When I feel confident I'll get the same diagnosis that comes from experience. I'm in the hospital, remember? I'm SICK. And unless it's some obvious thing (I broke my leg) I want to make sure someone figures out what's wrong with me, quickly.

-When I feel confident I'll get to talk to the attending personally. Otherwise it can be like playing "telephone": I tell student something, student summarizes it to attending, attending makes a decision. Something is usually lost in the summary.

-When saying "yes" to a student--ONE student--doesn't get me the "swarm" treatment on grand rounds, nor the "he's not here" treatment during in-room discussions.

-When I get a discount. Yes, I mean it. If I can pay for the attending, or for a student, why on earth would I take a student?

At 11:12, Blogger Jo said...

To Anon,
I think you are confusing a Student MD with a Student Nurse.
I am a student Nurse. We have nothing to do with attendings and diagnoses. (Well there's nursing diagnoses but that's in relation to your comfort)
I know many interns who are very attentive to their patients. They include an entire team of residents with an attending, the intern never flies solo.
The job and the goals of an RN student versus an Intern is very different.

At 21:27, Anonymous Anonymous said...

I've never minded student nurses, although at the delivery of my last child I did have to educate a newly graduated OB nurse that I could no longer wait to push just because my doctor wasn't in the room. Poor girl, they left her with a precipitous deliverer in middle of the night labor whose mother-in-law took over an hour to make the 10 minute drive between our homes even after being told my water had broken. (In other words, I was spitting mad before I ever got to L&D.) More unfortunately for her, my MD walked in just as I was telling her it didn't matter if he was there or not, this baby was coming NOW so she'd better catch him.
Bless her heart, she got the same lecture from the MD that she got from me, and neither of us was very nice about it. Me because, well, I was in labor and not inclined to be nice to anyone and him because he'd been wakened from a dead sleep to be greeted by an inexperienced nurse handling the delivery of a baby in fetal distress (the umbilical cord was around his neck and each contraction was choking him)alone. He apologized to both of us for making a scene later, but to the poor new nurse the damage was done.
I told the nurse in the middle of the next night (yes, she actualy came back to work) not to worry about what had happened because it wasn't her fault and that I was sorry I had yelled at her, but to learn to listen to the mom in labor, especially if she'd been through it before. She knew the generalities of OB nursing and I knew the specifics of how my body handles L&D. Between the two of us, my son would have been fine without a doctor in the room, if she could have fought off her inclination to "go by the book" just long enough to listen to me.

At 21:37, Blogger Jo said...

To other anon, Yes, there's an important lesson learned there. We are taught that sometimes the patient knows their body best. Maybe she missed that lecture. Although I think I would have grabbed a doctor, ANY doctor and suggested an emergency c-section if the baby was in distress via umbilical cord. Sounds like it was a close call.
Thanks for the comment!

At 06:10, Blogger mary said...

Patients come with their own life stories and agendas. Every reaction to something you do or don't do is not necessarily a direct reaction to your action. It's a reaction with many causes. The reaction of the guy whose med you held was probably exacerbated by past experience of one kind or another, either with a staff person who did not listen to him, or maybe a lecture from his medical team to NEVER EVER skip his medication...but I doubt it was solely due to your using your judgement to hold a med.

That said, since he had such a vocal response, it deserved checking with your teacher or the charge nurse (which you did).

The world of nursing is full of complex people reacting in complex ways to what appear (from the nurses' point of view) to be simple actions. A pause to reflect on your action that caused this reaction is a good thing, but many times (most times) you will conclude you were acting appropriately. If not, learn from it. If so, move on. When you stand so close to people's intimate physical and psychic functions-which is the place in which nurses stand most of the time, literally or figuratively-you will sometimes get emotional responses. Expect it, but don't take it to heart. The best you can do is the best you can do.

Advice from 30 years in the trenches.


At 21:03, Anonymous Anonymous said...

Jodi, my son wasn't in serious danger because he wrapped the cord around his own neck trying to get himself the rest of the way down the birth canal without my pushing. I could feel him turning himself over and my doc later told me that when he got in the room he could see my son's nose. Honestly, if she'd let me go with the urge to push when it first started instead of arguing with me, it would never have gotten to the fetal distress point.
I am having Baby #4 in June and my MD, husband, and I have decided that the 14th will be a good day to induce labor so that she's there for the whole thing this time. Apparently, what happened with #3 looks much scarier in print than it felt while it was happening.


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