"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"

Wednesday, January 12, 2011

Nursing Student vs. Employee: Who's Right?

Yay an ethical dilemma! Well, a mini one, I suppose. Here's how it played out:

Patient: suffers from schizophrenia/manic/bipolar/notsurewhatelse. Gets extremely, extremely agitated and hyper when anyone new comes into the room to do anything. Does not like to be touched. When he is in hyperactive mode, he has to touch everything, has to see everything, has to touch you in order to feel safe around you.Tries to communicate but it does not make sense.

So keep that in mind.

2 nursing students get assigned to him for the day because the instructor is intrigued by the feeding tube in him and wants the opportunity to teach her students.

There is one aide with the patient already, as he is a 1:1 and needs constant attention and supervision.

Setting: Patient is sleeping (rare occasion). Employee sees this as an opportunity to play cards.

Nursing Student (NS): Introduces herself to the aide. Approaches patient. "Mr. Smith" (not real name!). Patient does not respond. He is still sleeping. "Mr. Smith- I have to give you a bath." Patient does not respond...he is still sleeping. "Mr. Smith" NS rustles patients gown and shoulder. "Its time for your bath." Speaking louder.

Patient Aide (PA): "Um..He is actually sleeping. Do we have to do this now? He doesn't sleep often, I think its best if we let him sleep."

NS: "Okay. I'll come back later."

Nursing Student comes back later. With bucket of water, supplies and....her nursing instructor.

Yes, the Patient is still sleeping.

NS: "I'm back."

PA: "I see that. He is still sleeping."

NS: "Well, our day is almost done and I haven't done anything for my patient. He needs a bath and I need to do oral care, at least."

PA: "Well I'm sorry. Today is not a good day. He is sleeping and I do not want him to be woken up for a bed bath. He needs his sleep right now. When he is awake he refuses to keep his BiPap Machine on and his sats drop very low and it is a constant struggle to get it back on."

Nursing Instructor (NI): "Mr. Soandso, my student has been assigned this patient and has responsibilities to attend to his care, like all my other students do for their patients. She needs experience giving bed baths and oral care and working with the feeding tube."

PA: "Mr. Smith (not real name) won't let anyone except the nurses attend to the feeding tube."

NI: "Good. I'm a nurse."

PA: "This is really not a good idea. I do not want him woken up. I will be here for the next 8 hours with him, fighting with him because you and your student got him agitated over a bed bath. He doesn't like to see new faces, it is too much excitement for him."

NI: "Well I'm very sorry that we disturbed your card playing and I hope you can now enjoy a restful 8 hours of card playing because you are not diligent enough to do your actual job and take care of your patient. Goodbye."  Nursing Instructor and student march out of the room.

Later, they see me, an "Alliance", in the hallway.

NI: "Can you believe that aide? I am going to report him. He should be fired. He is awful."

I happen to know this aide based on him coming to do many psychiatric 1:1's on our floor and therefore am very grateful to his services. I also am VERY familiar with the patient.

Me: (playing dumb): "Oh, was Mr. Smith assigned to one of your girls?"

NI: "Yes, I thought it would be a great learning experience because of the feeding tube. I don't see what the big fuss is in waking him up, he is just sleeping peacefully, I'm sure he would fall right back asleep.."

Me: "Actually, this is the first time I have seen Mr. Smith sleeping in the last five days he has been here. If you had seen his behavior prior to today, you would not have handed him to a student as quickly, I don't think. He is a lot for us to handle and a lot for that aide to handle, especially because he is responsible for two psychiatric patients in that room (long story). Maybe next time you will get a feeding tube on a patient that will be more conducive to letting him or herself be a teaching example? I'll keep an eye out for you."

So that was that. I've been in both places, many many too many times. I have been that student. I have been that employee. Most likely, that very aide was probably on his fourth or fifth double shift and was gladly welcoming the opportunity to play cards while his patient slept. But that aide was 17-24 (Im very bad at guessing ages) and was assigned a job to do. Its not her call yet on whether or not its appropriate to go forth with nursing tasks. She is at the "Novice" stage in Benner's model, and is trying to do what she thinks is ultimately the right thing to do: Wake up a sleeping psychiatric hyperactive patient do give him oral care and a bed bath. Someone he has never met before.

I see where both sides are coming from and it was a tricky situation. Glad it didn't escalate into anything further.

The good news is, and strange news, is that Mr. Smith slept through it all.

No comments: