Just a student nurse
I encountered a situation during my clinical yesterday, and I defintely underestimated how upsetting it was. I figured that after blowing off steam with my family and stuffing my face with ham pizza, I would feel better about it. Unfortunately, I was awakened from my normal clinical-induced coma at 5:00am on my day off, feeling very, very angry. Not only do I strongly dislike waking up angry, I hate it even more when it’s 5am and I should be sleeping until noon. I also have been in the process of establishing a rule for myself: I can let things that happen at work affect me until I go to bed at night, and then it’s over and time to move on. Preferably, I want to be able to mostly let things go by the time I get off the bus on my way home. It is a way I have been trying to establish some boundaries, but last night it just didn’t work. I was and probably still am, really upset. I joked with my Mom that I was going to write a 12-page blog post, but now I realize that I might. DOH.
So where to begin? I don’t even know. FYI, basic details have been changed for HIPAA reasons, but I’m giving you the basic idea.
I had a young patient (20-something) who was going to surgery for a pelvic fracture that he sustained in a car crash that also killed another family member. By the middle of the morning, there was no word on his surgery, his pain was starting to get out of control since we couldn’t give him anything by mouth, and his mother was getting pissed. She pulled me aside and immediately broke down sobbing. After that, I called the OR, and they gave me almost no information except that it was going to be a few hours. That, in and of itself, was irritating. Throw me a freakin’ bone, OR peeps. Anyway, the situation continued to escalate, the mother continued to pull me aside and let me know that she was getting angrier and angrier, and basically nothing continued to be done about this kid’s pain.
Side note: We are supposed to be working almost entirely independantly in this rotation while still keeping our “precepting” nurse aware of all situations (The word “precepting” is evidently a joke at this hospital but that’s another discussion, and I’m used to being abandoned so I’m over it.) Of course, not having access to the computer system (i.e. all orders and meds) makes that whole “independence” thing slightly difficult. So gist is that every time my patient needs pain medication, I’m completely helpless except to tell the nurse, over and over and over and over again.
A few minutes later, the mother pulled me aside again. She said that she was concerned that the hospital was pushing back the surgery because they don’t have insurance. At this point I realized that her level of frustration (combined with lots of grief from a whole run of bad luck) was beyond something that I could handle as a student nurse. I told her I was going to do a number of things to help the situation along, one of them being that I would put her in touch with a patient advocate who could help her better than I could.
In the meantime, no one (other than myself) has explained a damn thing to the family about the surgery or anything else, the nurse is no where to be seen, and the poor kid has waited over 40 minutes for an IVP of morphine. I know, because I charted exactly when I asked the nurse to get his meds. (Lucky for me, I charted my ass off yesterday.) If you waited 40 minutes for a hamburger at a restaurant, you probably would have left by now. Instead, he’s stuck in bed with no where to go and no surgery to fix him, complaining of climbing pain.
At one point my clinical instructor told me that the reason the family “picked on me” and “didn’t like me” was because I was just a student. I had to take a moment to pick up my jaw from the floor. Apparently at this hospital, a family who “doesn’t like you” will cry in your arms and beg you for help.
Following up on what I told the family I would do, I went straight to my nurse and explained the situation. I told her (and this is an important piece) that I was going to call a patient advocate and would she mind doing the social work consult for me? She did it immediately (although it took her 45 minutes to deliver pain meds.) I walked away and called the patient advocate.
This patient advocate arrived less than half an hour later, and the first thing he did was thank me for calling him. I felt good that the situation was going to be resolved, and walked off.
Twenty minutes later, I get called to the nurse’s station. Standing there is the patient advocate, the charge nurse, the director of the OR, and my clinical instructor. For the next five minutes (although it seems like a freakin’ eternity) I was publicly chewed out by the director of the OR for calling the patient advocate, who now stood next to this woman shaking his head at me. (A far cry from the reaction I got when he first came to the floor and thanked me for calling him.) The director told she didn’t have “time to be coming up to the floor and dealing with this stuff.” (Excuse me? You don’t have time for unhappy patients who are having surgery and haven’t been communicated with?) I was told over and over, in front of basically every nurse on the unit who happened to be walking by, that I screwed up. Apparently I should have told the charge nurse about the situation first, instead of going straight to the patient advocate.
At one point, even my clinical instructor screwed me when she made a statement about “in defense of myself, I wasn’t aware of the situation.” Well guess what? My nurse was and my nurse could have stopped all this, and my nurse was no where to be found. I felt completely humiliated and furious. I was thrown to the wolves for advocating for a patient, and not even my clinical instructor would stand up for me.
But I held my tongue. Why? Because I’m the student nurse and this is a learning experience. I took full responsibility. I apologized for inconveniencing everyone. I thanked them for teaching me. I even shook their freaking hands after they hung me out to dry. And I walked around with a smile on my face for the rest of the day, even though the charge nurse continued to scowl at me, and every other nurse who had witnessed the attach avoided eye contact.
Two hours later, my patient went to surgery.
I encountered even more hostility in the OR area. The charge nurse screamed “where the hell have you been?” when I went to get my OR scrubs. I was pretty sure everyone on the surgery team knew what had happened. They all stopped talking when I walked in the room. It was incredibly humiliating. And I hadn’t even done anything wrong.
Aside from the poor nursing I witnessed (in the PACU, his nurse refused to scratch his leg because “we don’t do that here” and then walked away mumbling “jesus christ…” under her breath) I was really astonished at the lack of communication and the complete lack of teamwork demonstrated that day. A measly student nurse poked a hole in one of their policies, all for the good of the patient, and no one came to the defense.
Words cannot even explain the incredible anger I feel towards this hospital, employees, and the whole situation.
The saving grace in this story is my patient and his family; they are truly what is enabling me to see the good in the situation. When he woke up from surgery, he said “Caroline, can you hold my hand?” Tell me, does someone who thinks you’re “just a student nurse,” as my clinical instructor put it, say that? The family confided in me. Cried to me. And in the end, I know that I did exactly what was right for them, even though no one else in the damn place would stand up.
Yesterday I was not a student nurse. I was a nurse. I was an advocate. And that is my job. I can place IVs and foleys and do blood draws and pass meds. I empty bed pans, bring clean linens, do assessments. But yesterday I got to do more than that, and I realized that as humiliating as it was, I left that hospital knowing I did everything right and that I’d do it again in a heartbeat. When that family leaves the hospital in a few days, it will be me they think of when they recount the situation. It will be me who changed things for them, who let them cry, who honored their needs, who didn’t judge. It will be “just a student nurse.”
And that is what it’s all about.
This entry was posted on Wednesday, April 9th, 2008 at 7:27 am and is filed under . You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
April 9th, 2008 at 12:20 pm
Hey there! Great post!
May I add it to the next edition of Change of Shift?
April 9th, 2008 at 1:06 pm
Caroline,
You are right where you need to be: nursing. It is a very brave thing to advocate for someone who has no one and is simply incapable of speaking up at the time.
I would want you to be my nurse. Truly you showed compassion…don’t lose that as you go along.
Karen M. in NC
April 9th, 2008 at 5:39 pm
I just wanted to encourage you to keep doing what you are doing. I know it’s hard when you are in school and don’t have power to do anything. You will have days after you graduate that are like this and maybe even worse (read my blog from yesterday for an example). But, you are exactly right, you were there for the family and the patient and you did what you needed to do for THEM! You are a great nurse! You could take care of me any day! Keep up the good work!
April 9th, 2008 at 5:42 pm
It would have been easy to tell your nurse and then simply wait for her to do something because you’re “just a student nurse.” Instead, you stood up for a patient and family when no one else was willing. And in my opinion, you were the only nurse that family and patient saw.
Nursing school can teach you many things, but it can’t teach you passion. It didn’t teach you to truly care for the patient’s well-being - so deeply that your words and fervor alone moved me to tears. You are the kind of nurse I would want caring for me, and you are certainly the kind of nurse I would want to work alongside.
Diana, a.k.a. “Just a new nurse”
April 10th, 2008 at 2:25 am
You were completely failed by the nurse you were working with, and your clinical instructor. Going up the chain of command, while not obvious to you as a student, should have been more than obvious to the “professionals” that you were working with, and by allowing you to make that mistake and then unprofessionally chastising you in the hallway for it is pretty darn loathsome in my opinion.
You did an excellent thing in advocating for your patient. Keep up the good work and don’t let the bastards get you down. And PLEASE go work in the ICU, immediately after school. Whoever told you that this is a bad idea is ill-informed. Don’t sell yourself short. Just make sure you join a program with an extensive orientation and you will be more than fine.
April 10th, 2008 at 3:51 am
Caroline I commend you for standing your ground and doing what you needed to do for your patient. As you said, you were not “just a student nurse.” You were a nurse advocating for your patient. Working in a hospital with many nurses I’m learning very quickly which ones I can collaborate with for the better of patients and which ones are simply going through the motions of their job, doing just enough to get by. Those are the ones who won’t let me leave a patient in a chair after therapy for a little while because they would have to go get a lift to put them back. I’m sorry you got such a dressing down, likely they were all embarrassed that “just a student” did what was right for the patient. Hang in there!
April 10th, 2008 at 6:26 pm
Good for you! I am glad you stood up for your patient, and were his advocate. Which is what they teach us is a vital role. And your clinical instructor is an ass.
April 12th, 2008 at 6:44 pm
Your OR nurses sound like our OR nurses! They make a mess of things and then pawn off the true work to the unit nurses. I am not saying all OR nurses but just like everything else there are some bad apples. If a situation like that escalated at least you went through the motions as a patient advocate and you did what was correct when it came to ‘practice’ regardless of what the bureaucrats said/did because you inconvenienced them.
April 16th, 2008 at 6:48 am
Dear Caroline,
You kicked some serious @ss! as a student nurse. You did what you could for the patient under the circumtance. Anyone of those people that chewed you out publicly could have made a difference in the situation had they explained what was the best alternative.
Unfortunately, they acted unprofessionally and turned an opportunity for learning into a humiliating and back stabbing session.
Let go of the anger, you did your best for the patient and that is an A+.
((Hugs))
April 16th, 2008 at 6:15 pm
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April 16th, 2008 at 7:56 pm
As someone who has been the patient, not the medical professional–THANK YOU for what you did.
April 17th, 2008 at 4:00 pm
Hooooleeee shit. I mean, DAYUM.
Whoever it was up there (on looking, I see it was Beth) who said you were failed by your preceptor and charge is absolutely right. There was no reason at all to hang you out to dry; the same thing (telling you you’d somehow bucked chain-of-command) could’ve been accomplished by a quick, casual, private aside.
More importantly, if those folks with licenses had been doing their jobs, the whole damn situation could’ve been avoided.
I don’t blame you for waking up angry. You have a right to be pissed about the poor care your patient got. You also have a right to be proud of being the one decent caregiver your patient had.
I want students like you to work with. Please come orient at my hospital.
April 18th, 2008 at 11:35 pm
Congratulations.
Welcome to nursing.Where your colleagues will screw you, you manager will throw you to the wolves and everybody in between will gossip about you.
Being a woman and an ICU Nurse for ten years I can tell you that the nursing community is exactly the same as high school.
Lot’s of gossip, lot’s of backstabbing and to top it off with a cherry anytime there is a possibility of trouble the perpetrators will either hide or lie their asses off.
You did the right thing.You did exactly what you need to do to survive the patients. What you did wrong was you stuck your tail between your legs and excepted blame that wasn’t yours.
That is also a nursing trait..the need to martyr oneself . During this time you have to resist this urge and you have to learn to be mature and responsible and to forcibly lay the blame where it belongs.
The problem with accepting the blame for someone else’s fuck up is that idiot still has a job and still has the opportunity to continue creating hell and havoc. It is the culture of nursing to not hold our co-workers accountable, some sort of retarded idea about not tattling. If was your job to tell these people that you weren’t having this conversation in a public place and you weren’t having it without the nurse responsible present.
If you continue to believe you are just a student nurse blah, blah then you should have plainly stated to all of them that you are just a student nurse that holds no responsibility and you should have left the conversation. If you believe you are a competent nurse ready for practice and you certainly sound like you are it is your job to demand accountability and an appropriate setting with all parties present.
Anybody in Nursing will happily bully anyone who wont fight back. Remember this is high school all over again. Time to stand up for yourself.
On your next clinical day you must tell your preceptor and your educator that you want a meeting with all parties involved. It’s time you did some damage control over your reputation. They think they can bully you now anytime they want. Better nip this shit in the butt or you will be a continuous target.
By standing up for yourself you will also regain your pride. You know you allowed these people to change how you feel about yourself, that is where the anger is coming from . Time to reaffirm your own good opinion of yourself.
When in the meeting explain yourself quickly and succinctly. Be polite but be firm. Finally remind them that it is always your job to advocate and that unless there is an actual written protocol in place that forbids anyone from calling an advocate other than the charge nurse you can see nothing wrong with the nurse who was responsible for the patient calling one in. Because remember it wasn’t you that performed the action, the nurse did. You only suggested it’s necessity. Finish the meeting by going back to the patient and the families experience and how successful the nurses actions were.
Do not expect support from anyone present. Remember the meeting is for you so you can have a chance to reconcile the events and feel positive about them and positive about yourself.
anything these people say is meaningless because they have already shown their true colours. Disregard their comments and cut their participation short by acknowledging their statements without reply.
Do not engage in a discussion with them so they can try to justify being assholes.
This meeting should last no longer than five minutes. State your case, mention how offended you were, lay blame where it belongs and pointedly state that you expect this wont be happening again and leave. Bullies back down when confronted.
Your clinical instructor is a twit that needs talking to later informally. Remind her that she is being paid by YOU to protect your interests only.
Instructors are your employees. You pay them a lot of money to teach you the skills you need to do your job.
Would you allow your plumber or mechanic to behave this way?
April 19th, 2008 at 6:02 pm
You are EXACTLY where you need to be; you advocated for your patient and did what you thought was in their best interests. You provided care for your patient, and you should be proud of yourself.
To be blunt, your supervisor should be ashamed of herself - she sounds like she belongs to that group of nurses who my classmates and I kept running into during ER clinicals - the ones who think their feces aren’t malodorous and they have FAR too much education to be talking to menial beings such as EMT or nursing students or patients. I’ve been unfortunate enough to have been at the mercy of nurses like that as a patient, as recently as last week when I ended up with bacteremia and osteomyelitis and got admitted. The worst one, though, was the nurse I had after having a level of my spine fused after a car accident. I was less than 12 hours post-surgery, had a 9+’ incision on my belly and was puking prolifically. She removed me from my PCA pump, refused to call my doc - or ANY doc - to ask for replacement pain meds, then proceeded to come in my room every half an hour and chastise me because my temp rose to 100.01 degrees. She said I had ‘a pneumonia’ that I caused because I ‘refused to get out of bed and walk’. I was on the phone with my husband the last time she came in and went on a tirade about pneumonias and refused to help me with any pain medications and he was furious when he overheard what was going on - and within the hour I had a patient advocate at my bedside, a copious amount of IV pain meds and anti-emetics and, most importantly, a replacement nurse who actually cared. I don’t know what happened to Nurse ‘You got a pneumonia and it’s your own fault’, and I don’t really care - the moral of my tale is that you are now a far better nurse than she ever will be. Don’t forget that, and don’t ever stop caring and standing up for your patients. They’ll thank you for it. I know I did.
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October 27th, 2008 at 6:49 am
Well written article.
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