I am a nursing student working as a tech at a community hospital. At the beginning of each shift I made rounds and do vitals on each patient. I enjoy spending time with the patients, but how can I just go in briefly? I try to be kind and brief at the same, but it seems like every time I go in, the patients need to be pulled up in bed, or have to go to the bathroom, or need help ordering their lunch, etc.. or all three! I try to say I'll come back and see you after I take all the vital signs but sometimes the patients just get so irritated and by the time I come back to see them they weren't able to hold it and now they have urinated/defecated in the bed, which now requires a partial bath and a linen change. What is a nice way of saying "I don't have time for that right now!"
Help!
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November 25th, 2007 at 9:39 pm
I am also a nursing student, graduating in August 2008, and am a nursing tech. At our hospitals the techs are not allowed to take vital signs, which gives me more time (yeah, right, as if there is ever enough time!). I too like to round on patients at the start of shift. However, I think that in the long run you will save yourself time by taking care of some of their needs when you go in the room – bathroom needs are definitely a priority! By your own admission, by the time you get back they may require a linen change or partial bath, which will only take up extra time.
Things like being pulled up in bed or ordering their meal can wait, but make sure that you are honest with patients. If you know you won’t be back for 20 minutes, tell them so. I think what irritates patients the most is when they have the expectation that you’ll return in 5 minutes, when you know it is actually much longer.
As far as a polite way of disengaging from a patient’s room, I’d continue along with the honesty line. Tell them that you need to take vitals on all your patients at the start of shift to establish a baseline, and that it’s important that you do so within the next 30 minutes (or however long it will take you). Let them know that once you have finished that, you would love to help them order their meal (or whatever else they need). Hope this helps!
November 26th, 2007 at 9:01 am
I’m not sure from your comment if you’re issues are when you’re ‘teching’ or when you’re a student.
Either way…
Nursing is about the whole person and not just the clinical/technical side. For me, I would expect my staff to deal with things that are important to the clinical role AND the patient first, such as comfort. Other matters can be negotiated with the patient for a later time.
I work in psych and have always had a difficulty in working in the ‘task orientated’ manner. For me, the dignity and comfort of a patient not sitting in their own waste is probably more important than all baselines being done at a certain time. Any matter that compromises patient comfort to the extent of soiling themselves would have to be of critical importance.
I would suggest you prioritise the ‘baselines’ that definitely or more importantly need doing first and those who are less critical can wait til after. That way you can afford the time to deal with the other matters that come up and any delay in getting to the last ones is of lesser critical importance.
If you’re finding the clinical load is too much and the patients are requiring more than your time will allow, then I suggest the ‘task’ process needs to be reviewed by the team so that patient personal care needs are met in a timely fashion as well as clinical needs. As a student or tech, that would require a pretty receptive ward nurse management who weren’t just likely to tell you to work faster – only you can judge that.
As for – What is a nice way of saying “I don’t have time for that right now!” –
Ask the patient what their needs might be and prioritise these with the patient
eg
“If we get you to the toilet now then later I can come back and help you with a wash, is that ok?”
or for lesser immediate needs;
“I can help you with your menu but I have to get to a few other patients first to finish this before I can get back” [and I support Damaris comments re being honest with time]
Of course, I may be underestimating the importance of ‘baselines’ and am happy to be corrected by my learned colleagues . 🙂
December 4th, 2007 at 4:22 pm
Thanks for the responses. At my hospital, I am a multi-functional tech, which means that I am responsible for all IV insertions, all phlebotomy, all catheterizations, simple dressing changes, vital signs, glucose checks, assisting with physical therapy and respiratory therapy, baths, feedings, etc… for my 7 or 8 patients.
Clearly I don’t want to wait around to get someone to the bathroom, but if another patient is going to the OR and I need to get an IV in them before they go and I know that I need to stand there for 10 minutes while Mrs. so-and-so uses the bathroom b/c she’s not steady enough to be left alone, I might try to run in and get the IV really fast so the other person can go. I guess my job is probably more complicated than a regular CNA.
I have always known hospital nursing isn’t something I really want to pursue. I want to go to graduate school and become an NP and get certified in Public Health. Maybe when I get there I’ll realize all this craziness was worth it!
January 27th, 2008 at 9:48 am
Lindsey, I have the same issues you do. I, too, had those experiences when I was a PCT. I thought that would change when I became an RN, but I still have trouble politely telling my patients I have to go do something else. I work in a nursing home, and the residents like to tell me stories. Some of the rarely have visitors, and they become hurt or even angry when you don’t let them finish. The only thing I have to offer is another vote for prioritization. If you know you have to start an IV for a patient going to OR, then see that patient first. If you know there is a “needy” patient in the bunch who needs a lot of assistance or attention, save that patient for last (unless there is some pressing reason not to).
If you can try to plan who you see when based on what must be done sooner, you might have less trouble.
I, too, am planning to go to grad school to become a nurse practitioner, and I am pretty sure the craziness will definitely be worth it!
January 27th, 2008 at 7:04 pm
Definitely get an idea of what the potential needs of your patient might be at the absolute start of your shift. If your patient has a history of incontinence, maybe see them first and get them on the commode even if they think they can wait a little longer – who knows when you might be back there!
It saves time in the long run. Also, I like to bring things that I can *anticipate* my patient needing – a pencil to fill out their menu, a pitcher of ice and water/juice with cups and straws, linens, etc. It saves time instead of going back and forth.
If you do need to grab something, ask if you can get them anything else while you’re out. When ever one of my patients asks for a PRN medication, I always ask if I can bring anything else for them.