Wednesday, September 28, 2005

So then she asked me...

"Where's the lumbar dressing?"

"On his lumbar spine, over his lumbar drain" I replied.

"But where's the lumbar area?" she persisted.

This from a fourth-year, last-semester, about-to-be-released-on-the-world student nurse.

At that point I sat her down with a stack of reading material and told her to research the patient's diagnosis, come up with a care plan, and know what his damned medications are so she wouldn't tell me again that Tessalon Perles were an antibiotic, and to have it done by today. That way, she'd be able to actually take care of and interact with the patient.

Which would've been fine, had she not kept wandering around, asking if she could *do* stuff. As in, "Can I watch you admit this patient?" "Can I open that lumbar drain for you?" (NO!!) "Can I ride this unicycle down the hall while singing 'Tosca'?"

Finally I wheeled around in the hallway as she followed me like a puppy, levelled my finger at her, and, reverting to Theater Geek/Abortion Clinic Jo, said, "You do not have the chops to be following me around. You need to do what I told you to do two hours ago so that you can be productive and safe tomorrow. Right now, you are neither safe nor productive, and you need to fix that."

So she, predictably, took herself into the bathroom and cried. She's afraid I'm going to fire her and she won't graduate.

She's right to be afraid. Very afraid.

Frankly, if you're in your fifties, dedicated enough to get a BSN, dedicated enough to go through all the crap that comes with being a "nontraditional" student, then you're old enough and tough enough to do what you're told by somebody who wants you not to screw up irretrievably.

All of which paled in comparison to the question asked by another of the students.

I'd asked her to catch a set of vitals on a patient, a fresh post-op, who'd had a right arm and shoulder amputation. This is a beautiful girl in her early twenties with an advanced and atypical case of chondrosarcoma.

So there's nothing to the east, shall we say, of her right collarbone. Nothing, that is, but a big slanty white gauze dressing with three Jackson-Pratt drains hanging out of it. No arm, no shoulder, no nothin'. There. Is. Nothing. There. Except an obviously fresh postop dressing.

Nursing student first tried to take a blood pressure on the patient's non-existent right arm. I had to redirect her to the left.

Then she asked me, as we left the room, "So...what did she have done, anyway?"

There. Is. No. Arm. There. What the hell do you *think* she had done? Rhinoplasty?

Sweet Christ on a pogo stick, I need a drink just retelling it.


Anonymous said...

When I got to the fourth paragraph from the end of your post, my eyeballs exploded. Please send dark glasses and a voice recording of the last three paragraphs.

Unknown said...

Oh my gosh. While I admit it sounds like these girls lack a good deal of common sense, maybe their school just isn't preparing them well.

UnsinkableMB said...

Oh geez. Scary stories... I just graduated last May and never heard of anything that bad. Maybe it's because my school is militant about clinical compentencies!

HypnoKitten said...

Having just graduated myself (from an ADN) I have to say that my clinical instructors were more like you, and wouldn't think of letting me near a patient unless I already had a care plan in place (for at least the major diagnosis), interactions between major problems (i.e. what effect the pt's infection has/may have on their lung CA), and a complete list of meds they were on with reason, interaction, and side effects. We had to come the night before to get our patient assignments/diagnosis/meds and go home and look them up and make out a care plan. Do they not do that?

Honestly, I would have said the same thing - there really is no excuse, and she's dangerous. And that's not to say it's her fault completely - there has to be someone grading her progress and passing her forward into the next quarter.

Anonymous said...

I'm a 4th year BScN student from Ontario and i'm disgusted. I certainly know this stuff, and i'm 99% sure every single one of my classmates would as well.

What the hell is that?! :/

- Hollie

Brooke said...

Oh man... firing might be too good for her.

HypnoKitten said...

I can't ride a unicycle, though... ;)

shrimplate said...

If you are a student nurse and you come to me and you do not know what a medication is, I'll have you go look it up.

If, however, you are a nursing instructor and your students come to me woefully unprepared, I will embarrass you in front of them, but in a manner so subtle that in the end you will wish to buy me extraordinary new stereo electronic equipment from exquisite custom companies of Cambridge, Massachusetts origin.

P.S. I already have Martin-Logans. Thanks, though. And those are made in Kansas anyways.

Marie said...

*raises hand*

I last took an anatomy class in tenth grade, close to ten years ago now, before going on to major in anthropology. *I* know where the goddamn lumbar area is.

Sheezy pete. The whole thing is depressing.

Kim said...

Well this is freakin' scary! I've been a nurse for 27 years and I STILL am looking up things every day. I was so young in nursing school (a teenager!) but these sound like mature adults in their 30-50s. That student may have cried in the bathroom, but she will never make the same mistake again. She'll learn more from the constructive criticism than she will from a million drain-drainings.
Love the blog, by the way...

Lioness said...

I am speechless, don't know what to say to this. ???? !!!!!

And my heart is breaking for that poor girl.

Anonymous said...

Too many mentors are afraid to fail students, or be critical. Personally, I think that challenging the student's knowledge and capabilities is the best way to help them learn. It works for me anyway.

Ann (bunnygirl) said...

Oh, for doG's sake. It's been over 20 years since I took Anatomy & Physiology class, 19 years since I quit pre-med. And yes, I know what the lumbar area is! I can can converse intelligently about the any part of the spinal column, although who outside the medical profession would want to?

It makes you wonder what else the poor woman doesn't know. If it were me, I think I'd tell it to her straight, that she's got some scary gaps in her knowledge and she's going to hurt or kill someone some day.

If I was feeling nice, I suppose I would choose words that suggested the fault might not be hers, but that of her educators. But no matter how she got to this point, it's her responsibility to rectify the situation. Fast.

Anonymous said...

... and thus concludes a well-written essay on why I could never be a clinical instructor for a nursing program. ;)

J said...

She does not need to graduate, not yet. Patient safety is at stake here. Just from her questions alone, lets me know that she should not have passed the first level.