¶ … Diary Entries Diary Entry

When we first start out in the nursing profession, there are often incidents that come about to test our ability to confront challenges head on. While these challenges often take the form of medical emergencies, they can also come from colleagues who may not always act in the patient's best interest. I experienced one such challenge early on in my student nursing career and the way I responded to it has weighed on my mind ever since.

What is the Problem?

As a young student nurse I encountered a man, Mr. A, who was experiencing severe arthritis related pain in his left hip. The discovery of this patient's condition and the ensuing conversation regarding his pain with the registered nurse on duty led to an ethical dilemma when she refused to administer his pain medication. Ultimately, this led to me feeling as though I had let down the patient because I did not stand up for his individual rights.

What Was My role in the Situation?

I was the nurse who discovered him in bed in the morning and the one to whom he expressed that he was in pain. It was then my responsibility to assess his condition and check to see when his meds had been administered. I was able to discern that while the regular dose of oxycodone had been administered at 0600, he had not been given a breakthrough dose since the night before when he had twice required it.

What Was I Trying to Achieve?

It was my intention that Mr. A should be immediately relieved of his pain by receiving the breakthrough dose as soon as possible.

What Actions Did I Take?

Since, as a student nurse, I was unable to administer the medication on my own, I informed the registered nurse who was responsible for Mr. A's care of his situation and the need to administer a breakthrough dose as soon as possible.

What Was the Response of Others?

The registered nurse replied rather curtly that she was very busy and, since he had already received a regular dose at 0600, he was not in need of another. She then sent me to help out elsewhere and I left, shocked, without knowing if Mr. A would receive the extra dose of medication he needed.

What Were the Consequences for the Patient?

As a consequence of this exchange, Mr. A was, at the very least, forced to wait longer for his breakthrough dose than was necessary and may not even have received it for several hours. This left him dealing with considerable pain that was normally relieved the breakthrough dose. So a patient, who could easily have been relieved of his pain, was left alone to deal with it.

What Were the Consequences for Myself?

For my part, I was left feeling guilty that I had not done more to relieve Mr. A of his pain. Also I was left intimidated by a registered nurse on duty who should me and the patient little concern or respect. All I could do for the patient was tell him that his meds were on the way, but even that did little to alleviate my guilt since I was not sure if this was true or not.

What Were the Consequences for Others?

The registered nurse was exposed to no consequences at all, that I am aware of, for her role in failing to promptly administer the breakthrough dose. Also, I am sure that it reinforced her belief that she was in charge and no student could tell her what she should do.

What Feelings Did It Evoke in the Patient?

I am sure that, for Mr. A, there were just strong feelings of anxiety as he waited to receive the medication that he knew could quickly relieve his pain. It may also have led him to distrust much of what he was told by the nursing staff in the future.

What Feelings Did It Evoke in Myself?

This entire episode evoked strong feelings of resentment in me towards the way the nurse had treated both me and Mr. A. This incident must have evoked similarly strong feelings of guilt for not getting Mr. A his medicine and not being completely honest with him about when it would be arriving.

What Feelings Did It Evoke in Others?

The registered nurse was already feeling annoyed and overburdened by her duties but having to deal with a nurse telling her what she should do only exacerbated those feelings.

What Was Good or Bad About the Experience?

The negative aspects of this experience are readily apparent. Mr. A was denied quick...

A registered nurse was allowed to believe that she did not need to take any student nurses' concerns seriously and that patients could wait until she was ready to deal with them. Also, I was left feeling very inadequate about my own experience and the way I had handled the entire matter. On the positive side, I resolved to never let anything like this happen to me again. I have decided, as a direct result of this incident, that I will be a stronger advocate for a patient's rights and that I will not be intimidated into accepting inadequate care for any patient. I also hope that I have become more sensitive to the concerns of student nurses who may be under me at some point.
What Was the Major Theme Within This Entry?

The major theme of this entry was the timely delivery of necessary medications and the inherent responsibilities of the staff to deliver the meds.

Diary Entry 2

Introduction

When I was presented along with a fellow student at a busy surgical ward, the staff seemed less than excited to have us there. The antagonistic and even hostile environment did not subside the entire time we were there and there were even several specific incidences of outright discrimination directed at my classmate. One such incident left her in tears and culminated in an apology from one of the nurses on the ward, but the tension that existed on that ward never relented.

What Was the Problem?

From the moment we set foot on the surgical ward for our training, we were treated as pariahs by the staff. We were ignored for some time and then finally pushed around from one nurse to another. When we reported to the registered nurse to perform a medical round, my classmate, "L," who is of Asian descent, informed her why we were there. The registered nurse replied with some profanities and said she could not understand a word L. said. I later found her by herself crying.

What Was My role in the Situation?

Both L. And I felt like we were definitely not wanted on the surgical ward when we arrived and for the entire time we were assigned there. I was there with her when she talked to the registered nurse and I felt just as shocked as she did when the nurse talked to her in such an inappropriate manner. Eventually I was the one who went to our university facilitator and reported the incident, prompting an apology from the nurse to L.

What Was I trying to Achieve?

Initially, L and I were only looking to be included in the regular routine. We were not trying to cause any problems or difficulties for anyone. By contacting the university facilitator, I was hoping to be able to force a friendlier atmosphere towards us on the surgical ward. At the very least I was hoping that the nurse would realize how poorly she had treated L. And would offer an apology, which she did.

What Actions Did I Take?

I contacted the university facilitator and continued to try to be as involved as possible in the regular ward routines.

What Was the Response of Others?

The nurse did offer an apology to L. after the university facilitator was involved. However, the overall environment on the ward did not change and we were never welcomed.

What Were the Consequences for the Patient?

While there were no consequences for any patients directly related to this, as they were not involved in the situation, a case can be made that the nurses on that ward showed as little patience with them as they did with us while we were there.

What Were the Consequences for Myself?

For myself, there was the continued consequence of always feeling like I was in the way and just a nuisance for everyone on the ward. I never felt fully accepted and I am sure that, as a result of my reporting the incident to the university, I was not held in high regard by the registered nurse.

What Were the Consequences for Others?

I am sure that L. felt like she always had to compensate for her minority status and probably felt harassed for her entire tenure there as well. The registered nurse, I am sure, was reprimanded for her behavior and forced to apologize to L, but otherwise she was unaffected and continued to behave in much the same manner towards us and other students.

What Feelings Did It Evoke in the Patients?

Again, the…