The Dog Ate My Care Plan…

Just a mom/wife/nursing student extraordinaire trying to make it in the big bad city…

Posts Tagged ‘vitals’

Nurse Nasty Not Niceness

Posted by isntshelovlei on November 3, 2009

mean-people-suckLast clinical weekend I had a nurse from hell. Not only was she nasty to me, but her attitude even trickled down to my (I guess I should say “our”) patient.  The day started out how clinical days usually do, getting up at the butt-crack of dawn, hot-wheeling (as my children would say) to the hospital with just enough time to grab a cup of Starbucks before running in for report. I find the nurse I’m assigned to—”B”— introduce myself, tell her I’m assigned to such-an-such a patient…all that good stuff. She looks at me like I have three heads. I shrug it off—it’s too early, we’re all a little grumpy and most of us are waiting for the caffeine to kick in. She grudgingly pulls out her little notes to give me report. She tells me a few relevant things about the patient, but mostly just complains that she was “too young to need such total care.” She then asks (herself I’m guessing, because how the hell would I know), “Is this ‘the one’ with MRSA?” And proceeds to go back and forth in monologue about whether or not the patient had MRSA–something you’d kinda wanna to know before going in the patient’s room. We finally did establish that the patient did not in fact have MRSA.

So I go to check on the patient, introduce myself, etc. She’d had a dilaudid PCA from which she was being weaned (or actually by the time I got to her it had already been dc’d). Poor thing was clearly in pain and was wondering why her IV “didn’t seem to be working” so apparently no one had talked with her about it. I got my own set of vitals and asked her to rate her pain for me—which she of course rated as a 10 on a scale from 0 to 10. I reported this back to “B” who replies unsympathetically —“Oh well, she ain’t getting nothing else.” OH-KAY… The patient recently had a lumbar laminectomy, was discharged, then fell and broke her wrist. So she’s laying here with post surgery back pain, which was most likely made worse by her fall, a splint holding her broken left wrist together, and an IV in her right arm which was clearly infiltrated—unpleasant to say the least. So right about now, I’m stumped. Am I supposed to go in and tell my patient that her “real” nurse doesn’t give a crap that she’s in pain?

I return to the patient’s room to find breakfast trays are being delivered—good—a welcomed distraction. I helped her get set up—between the splint and the IV she really had limited use of her hands. She relaxed a little as we talked, but as the last traces of dilaudid wore off you could tell the pain was beginning to bother her again. Usually after breakfast we do hygiene and personal care, but she refused as she was in too much pain and did not want to be touched. I let her be for the meantime and decided to get started with my meds. Nurse Ratched finally allowed me to see my patient’s MAR (medication administration record), so I was able to look up the meds I didn’t know. She did not want to give me the key, nor let me into the drawer so that I could pull my meds. “You don’t need ME, you NEED YOUR INSTRUCTOR!” she snapped. Now at this point I’m seriously wondering what is this chicks’ malfunction? I went to find my instructor, who mind you is running around like a chicken with her head off helping all six of us pull meds (this was the first weekend that ALL of us did meds, previously just one or two of us would). After I returned with my instructor, “B” didn’t want to give her the key to the damn med drawer either!! She walked her devil-red scrubbed arse down to the room with us in tow, unlocked the drawer, and left without a word. Why couldn’t she have just done that 20 minutes ago? So I pull my meds, my instructor double-checks them, and then down the patient’s hatch they go.

At the beginning of the day the nurses were informed that the students would only be doing PO (oral) meds and injections—no IVs. Lo and behold we’re meeting with our clinical instructor in the cafeteria and Nurse Nasty hunts us down, MAR in hand—mind you the unit is two floors up, over the river and through the woods. “Why didn’t you give the such-and-such?” (I don’t remember what it was). I responded that was an IV medication. “Well how was I supposed to know you weren’t giving it?” Now she was really beginning to annoy me. If she took the time to actually l@@k at the MAR which she snatched back from me seconds after I gave the PO meds, she would have seen that I had not signed off on the IV medication—hence I did not give it! My instructor also added “I informed all of you this morning that the students would only be giving PO meds and injections today.” Nurse Nasty turns and leaves, horns just a-glistening. When we returned to the unit she now wanted to know why I also neglected to sign off on the patient’s Desenex powder, “You haven’t even bathed her yet…well what exactly ARE you doing today?” Nurse Nasty aparently forgot that “50” (she referred to all of her patients by room number and not by name) refused hygiene because SHE refused to acknowledge her pain status! Why would I apply desenex powder to a soiled ass behind?!? I figured we (more like I) could give it another try a little later after the oxycontin I had given her had a chance to kick in and her pain was a little more under wraps. Needless to say I could not wait for this day to end.

I realize that most of the time the nurses aren’t given a choice as to whether or not they will have a student nurse—I get that. The clear discontent of some of them is quite evident. And while they may be good at their jobs, some clearly do not have the right attitude to teach. But do they have to take out their frustration on us and even worse, the patients?!? Can’t they remember back to when they themselves were students? Sometimes I really do wonder why certain people have chosen this profession.

Thankfully, the next day I was not assigned to any of Nurse Nasty’s patients (which by the way, sucked for one of my classmates). I had a great nurse and two patients both of whom asked if they could take me home with them :). It was also the first time that I had more than one patient so I was busy—vitals, breakfast, baths, meds, fall risks, bed monitors going off, safety checklists, care plans…the whole shebang. My older patient (I believe she was 85-yrs-old) had literally about 15 9 a.m. PO meds. It took her three tall cups of water and about 30 minutes to get them all down. On top of the PO meds I had to give her a subcutaneous lovenox injection, “up close and personal,” as she called it. But I must admit that I do love when I give injections and they ask “are you done already?!?” It was an exhausting yet exhilarating day, and before I knew it, it was over.

We have clinicals again this weekend so we’ll see if Nurse Nasty remembers to take her happy pill. I guess sometimes the devil doesn’t wear Prada, but scrubs…

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Finally—Patients With A Pulse!

Posted by isntshelovlei on October 16, 2009

thumbnailSo we are finally out of the lab and in the hospital—woohoo for making it through all the exams, math tests, and lab practicum that made it possible. For a minute there I was becoming a little unraveled and thought I wasn’t going to make it. Our first day we had hospital orientation—which of course was boring as all hell. Videos upon videos we watched—fire safety, restraints, Accu-Cheks—ancient VHS tapes (do they still make those?) that they’ve probably been using for decades. And since watching TV has become such a rarity in my life these days, having to sit there and actually watch those videos for hours was just pure torture. Afterward we took a tour of our unit and the staff rolled their eyes at us with this “OH GAWD–we’re being invaded by nursing students” look on their faces. But whatever—never mind them. On my way home I stopped at Barnes and Noble to pick up a care plan book—Ackley’s Nursing Diagnosis Handbook—I LOVE that thing and highly recommend it. That along with my Medical-Surgical Nursing textbook (which at 2016 pages is more like a nursing bible) helps me crank out care plans with no problem.

Day 2 of clinical we were actually assigned a patient. The nurses were still less than enthusiastic at our presence, but none of them were downright nasty—though there were a couple that were a little more snappish than I would usually tolerate. But since this wasn’t my turf I had to fall back. I was assigned a sweet, older woman who basically had surgery but was discharged from the hospital too soon (imagine that—damn insurance pressure). So she had a fall, which landed her right back where she didn’t want to be. Acute pain, impaired mobility, and risk for peripheral neurovascular dysfunction were my nursing diagnoses for her. Probably should throw risk for impaired skin integrity in there as well. But basically all I did all day was vitals, hygiene/toileting, and meals. I didn’t get to give meds even though my patient was on plenty of them. I must admit I was bored out of my mind. The downtime at least gave me a chance to get a head start on my care plan. But even that was difficult given how cumbersome the nursing station had become with all the extra bodies—the only place left to sit was probably the bathroom!

And last but not least, we took our Fundamentals midterm last night (NCLEX-style questions of course)—I didn’t think it was so bad. You can usually narrow each question down to just two possible answers anyway. Both might even be right answers, but you have to determine which one is more right. Ah, the joys of nursing school…

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