Thursday, November 11, 2010

Hot Water

Ok, so my whole nursing career has pretty much taken a turn for the worst. Here's what's happened so far...

First of all, I did majorly bomb that endocrine test. A 63% dropping my test average to 74.3%. That sucks, because I am technically failing; I need a decent grade on exam # 4 and the final exam to get through. However, that's doable and I'm not too worried. But wait, there's more and it gets even worse....

I was at clinical with the new clinical instructor (yes, same one that failed me on skills check). I'll give you a little background on how she's been teaching. First of all, she manages her time poorly. All of our meds and treatments end up being late, even though our clinical site policy leaves us an hour before up to an hour after for administration. In my opinion, there's no reason to be late. Second thing, she wants us to know everything before administering a drug. For example, she's asked me what someone's LFT is before administering 650mg of Tylenol. It drives me crazy. I understand where she is coming from, I really do, but there's just not enough time to do this: she has eight student and thus eight patients.

Well, the problem was this: my patient was due a blood transfusion. I was all excited, because as an LPN, I cannot perform this skill. I was getting real-world practice on an RN level skill. Well between all her questions and running from room to room, it took me 30 minutes to administer two pain pills and some eye drops. The blood had arrived from the blood bank, so there was a 30 minute time-limit to hang it. Since I can't even get a Tylenol administered in 30 minutes with this lady, obviously the staff nurse had to administer the blood so it didn't expire. If I wasn't in the room, I would have had no idea the blood was hung. I was then supposed to administer some low-dose lovenox as prophylaxis for DVTs. That was going to be late too so the staff nurse did it. The staff nurse did nearly everything because she, understandably, didn't have time to wait. Irritated that I had done virtually nothing all shift, I left the floor with the students to complete my paperwork.

However, I get called after clinical by the instructor. Apparently, I was supposed to do the q15 minute vital signs on this transfusion. No one asked me to; I guess it was just assumed I was. My instructor was nowhere to be found. I had no part in hanging the transfusion, no it's only natural that the person who hung it in this situation would take the v/s or at least delegate them to assistants.

Nope... totally my fault for not doing it. And I technically didn't report off to my nurse. I'm actually in trouble for not reporting that there was nothing to report. With all the stuff the staff nurse had to do, she should have reported off to me; I actually didn't do anything except an assessment, two pills, and some friggin' eye drops. The only reason I didn't formally report off was that the staff nurse was better informed of the patient's condition than I was because the tasks I was supposed to do had to get done by her so they weren't late.

What can I do? I dunno... I wrote a journal entry stating that I could improve my communication skills. Maybe I'll get off the hook with that. I just hope whatever gets done it doesn't boot me out of the program. Anyhow, I have to meet with her later so I'll post up what the resolution is.

Interested to know... what do you guys think? If you are a nurse, and you hung a transfusion, and you patient had a student, would you assume the student was going to take the q15m vitals without ever asking them? I can see where better communication on my side could have prevented this, definitely, however I don't feel the blame falls squarely on me because of two simple reasons:
  1. My instructor should have been present so I could have hung the blood. Crisis averted.
  2. The staff nurse should have asked me to check vitals. Crisis averted
This week has pretty much sucked... Until next time with more stressful and depressing news!


DV said...

Wow, very interesting. We are not allowed to hang blood. We can only "assess" a person with a blood infusion running with the RN in the room with us. I can't imagine that it was solely your responsibility.

CeeCee said...

Did the staff nurse expect you to do the v/s? or was it just your instructor? The nurses I've seen tend to be pretty good about going about their business as if the students weren't there. Not to say they're rude or unaccommodating, but at the end of the day, the pt is their responsibility, so I'd imagine she'd want to check the v/s anyway.

Since I'm pretty much stalking your experiences and nodding my head as I read them, I thought you might like this gem: I'm in med-surg now. Chest tubes and trachs and intubation and cardio monitors... well my clinical instructor is an L & D nurse. She decided that our scope of care should focus on bed baths, turning and positioning and every other task the CNAs are supposed to be doing. She doesn't think it's important for us to see codes or central line implantation or intubation because "in real life you won't see that."

nurse XY said...

You need to bring this to the attention of your lead instructor. There is a pattern developing here, but the lead won't recognize it as a pattern unless you bring it up early and often.

Likely since she's so new, your clinical instructor is learning how to balance her authority and encouragement.

Chris [The Man-Nurse Diaries] said...

I'm coming onto this late, so you're probably figuring some of this out, but clinical instructors just have to, shall we say, bust your balls constantly about SOMETHING. Partly because they're just crazy, probably, but she has eight students doing things on her RN license, which makes people a bit goofy and paranoid.

I was a student not long ago, and now that I'm an ICU nurse with only eight months under my belt, it's so funny to read stories like this. A few points:

1. Nobody's going to die because they got Lovenox late. Holy cow. You could've given it.

2. Clinical instructors are so bad at getting meds in on time. You have to just be proud if you can get your meds in an hour late. And you have to accept that some med/surg nurses are anal retentive and will "steal" your meds and give them just to get it done. Try to get your clinical instructor on your side about this (i.e. you and your instructor vs. the staff nurse who is crazy about getting the meds in on time) rather than the instructor and the staff nurse vs. you.

2. The nurse who hung the blood is totally responsible for getting those vitals. For watching that patient, really, because that's the point, right? Not writing dumb numbers down. They should have expressly delegated that to you or the CNA, or told your instructor, or just did it. They had the communication problem, obviously.

3. In nursing school you are ALWAYS WRONG. Just deal with it. It really doesn't matter unless you make an actual error or you break a rule that fails you. Otherwise, just take it in stride and don't argue.

4. I feel you on the details. Just know to get the LFTs on all your patients for that instructor. In the real world you're just going to give Tylenol. *rolls eyes*

I had one that wanted to always know the difference between aspirin and Plavix, and what their platelets and hemoglobin were "in case they were bleeding". In the real world you just give the damn drug, unless the hemoglobin dropped 3 grams or something (in which case the lab would've alerted you!).

Chris [The Man-Nurse Diaries] said...
This comment has been removed by the author.
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