I am a nursing student working as a pct to get the clinical experience-and I have noticed a trend with some of the nurses I have worked with.
If their patients complain of pain or itching or something, so I go tell the nurse and inevitabley a banter starts between the nurse and the patient. The nurse says they can't have this or that or there are no orders written and the patient is wanting something. This leaves me the messenger and the middleman-going back and forth. All the while, I'm thinking to myself, Why am doing this? Why doesn't the nurse just get up and go talk to HER patient?
Is there a tactfull way to say something to the nurse (along the lines of, "Get up off of your butt and go address YOUR patient!")? Or am I way off base here? I don't want to burn any bridges or upset anyone, but should I as a pct say something?
I like to think that when I am out there working as an RN that is not how I am going to treat my pct or my patient....any advise would be great.
Selena
 |
|
|||||||||||
 |
||
search realityrn
sign up for weekly cartoons, tips, and blog posts
Register to win a pair of RX Medical Silver Fox Crocs
|
|
|
 |
December 5th, 2007 at 8:40 pm
I am also a nursing student working as a PCT. You see all kinds of bad practice out there. My advice is to use these examples to motivate you to be the best nurse and to do “best practice” as much as possible.
As far as the situation goes, maybe you could tell the nurse that the patient wants to speak to him/her. Just don’t get involved. Also, you can tell the patient that you as a tech don’t deal with medications or things like that so it would be more appropriate for them to direct their questions to the nurse.
Good luck in school!!
December 6th, 2007 at 4:08 am
When you compile that list of ‘bad practices’, soon into the first month or two you will have to strike off one or two of them because you don’t have time. You’ll keep up with the most of them, but on the odd day, time will prevent you doing a couple of other things you wanted to do. Eventually, when you get proficient at being an RN you’ll find yourself doing lots more things than you ever used to and some of those other things will have to take second priority.
That’s when you ask your PCT to assist, to do those things you wish you had time for but don’t.
Of course, if they’re just lazy (and you can be sure they’re not just taking a well deserved 5 minutes) then I’d sit there with them and ask stupid questions until they just decide it’s easier to do it themselves. 😉
December 6th, 2007 at 12:30 pm
I too am a nursing student working as a PSN( PCT), and I sometimes see this. I think as a nurse, we are the patient’s advocate, either for their pain management, a procedure, whatever. So when the nurses don’t respond accordingly to a patient’s pain b/c there is no order, then they need to be a patient’s advocate and find out why? Why are they in pain? Why isn’t there an order? Call the doctor and find out. I know that takes time, but that is how I would do it.
December 28th, 2007 at 1:36 am
thanks for the advise-I have to say that it is hard to take the time when the nurse has 5 patients and I am responsible for 15-little different-I just feel that it is his/her job to get up and speak with the patient since nurses are advocates for the patient-and what I was relaying to the patient wasn’t good enough- she wanted to talk to her nurse-I was told by the nurse that “I am not going into that room” it was a crappy situation to be put in and I am taking it as a learning experience-how not to treat the pt and how not to treat the pct…..and my feeling if she has time to go smoke and what not she has time to talk to HER patient….
December 28th, 2007 at 7:58 am
How, as a PCT, are you responsible for 15 patients?
Nevertheless, to offer something more practical:
From the little you have stated, and excuse me for reading between the lines as I may be way off here, it seems as tho the pt concerned may be one of those ‘difficult to please’ pts and the nurse may be one of those ‘got no time to do difficult today’ nurses.
Comments of: “The nurse says they can’t have this or that or there are no orders written”
..indicates there are clinical reasons that need to be given to the pt and, as there is always something to give the pt, orders can be written up for something. At the least, 2 minutes with the patient to explain the issues is part of their job.
Comments such as :I was told by the nurse that “I am not going into that room” – would indicate that there was already a nurse-pt issue going on.
This is a frequent clash of issues/needs that seems to have lasted as long as nursing itself has (read “The Unlikeable Patient” postings for more info) and is not easy to resolve (otherwise it would have been long gone).
It sounds pathetic, and it is, but there are times where perhaps a nurse realises her patience is being tested by a pt and it is in everyone’s interest for a little time-out.
Sometimes it’s helpful in those situations to facilitate or mediate between the two parties.
1. Tell the pt the nurse is busy and not sure when available; can I pass on what you need?
2. If the pt doesn’t want to tell you, feed back to the nurse that pt X has an issue and won’t talk to you about it. Go do your own thing.
3. If the tell you, get the info, take it to the nurse and also the necessary stuff eg med chart
4. Leave the med chart & issue with the nurse. Go do your own thing. This forces a behaviour to deal with the issue (even returning the med chart to the pt bed if that’s where they’re kept) and inevitably, once the issue is in front of them, the nurse will remember they are responsible.
They’re not likely to complain about you as they need to admit to not attending the patient in the first place.
January 27th, 2008 at 9:26 am
Mr. Ian, when I was a PCT on a busy cardiac step-down unit during nursing school, there were days I was responsible for 40 patients! If I was the only PCT, then they were all mine! I, too, had to play middle-man between patients and nurses, as Selena does. It drove me nuts! I walked around the unit declaring “I can’t wait until I’m a nurse, and I get paid to sit around doing nothing!” Yup, I’ve been there! Well, I don’t do that to my CNAs, but I’m still running around like a chicken with my head cut off. I wonder, if I’m this busy as an RN, how on earth did the RNs who drove me crazy have all that free time to sit around chatting about yet another stupid baby shower? I never have the time to do that! Selena, you are learning a shameful truth about nursing: there are lazy nurses!
Selena, remember that you will never treat your CNAs or patients like that. For now, tell the RN that it is his or her responsibility to assess the patients’ pain and simply walk away. If he or she won’t do this, have a chat with the patient about his or her right to complain, be it to a nursing supervisor or, preferably, in writing (be sure to get the nurse’s full name for the patient). An official complaint should get the nurse in enough trouble to change her ways quickly! Does that sound mean, or spiteful? Yes? Good! It is NEVER acceptable, no matter HOW difficult a patient is, to ignore their requests for pain medication. Besides, a nurse has to assess the patient’s pain to decide to give prn meds or call for an order (it is not acceptable to say there is no order – the nurse should get one, then! God, I can’t believe how incredibly lazy some of my colleagues are!), and assessing pain is not something a nurse may legally delegate to a PCT.
January 27th, 2008 at 7:23 pm
I have found a very tactful way to remove yourself from a “go tell my patient XYZ” situation. “I am not comfortable explaining/discussing XYZ. I think you need to discuss this with him/her.” It works both ways.
However, get as much information from the patient as possible – What is your pain level on a scale of 0-10? What would you like for the pain? On the unit where I work, our nursing assistants and externs are allowed to ask that question and I really appreciate it when it’s for the room at the opposite end of the hallway!
And there should always be an order in for pain relief. If there is no drug ordered or it isn’t time for another dose, alternative therapies are available such as heat, cold, repostitioning, and distraction. Sometimes the patient just needs to pee!
If the patient complains of itchiness – and his/her skin isn’t dryer than the Sahara desert – there might be some sort of allergic reaction taking place and the nurse needs to take some sort of action.
March 22nd, 2008 at 10:55 pm
thanks for the comments I finally got back here to read them all- want to know the most ridiculous thing of all??- the pt. was the other pct’s patient and not even mine-very frustrating!!I realize though that some pt.s are more needy or what not and they will try everyone’s patience but my feeling is this: I am not always on my best behavior when I am sick or postop or whatever so I guess I need to remember that-as a nurse and a pct….bottom line-plus you can’t please all people all the time no matter what so…it is what it is…personally I think she was reacting to something in the ted hose or scd’s but what do I know….ha!?
April 1st, 2008 at 2:19 pm
Ultimately it is the RN’s responsibility to go and actually ASSESS her patient’s condition (be it pain, itchiness, or any other issue) for herself. In this case she is DELEGATING an assessment to an assistive personnel, which according to the Wisconsin Nurse Act, is absolutely not allowed!
As far as tactfully telling her, just let her know that you, as a PCT, cannot assess a patient, that is her job (and the whole reason she has the license and you don’t).
I hope this situation works out! And like many of the other responses say…remember this nurse as an example of how NOT to be a nurse and how NOT to treat your assistive personnel!
Good Luck!!!