Patient Shadowing Case Study

During the shadowing of an LPN’s normal workday, what roles/ job expectations did the nurse fulfill? The nurse delegated tasks to aides which was expected. Two patients asked the nurse if she could help them change their brief and the nurse was busy in a med pass and told the patient that she would get their aid. We spent the first hour of the shift going over the diabetic patients and finding out what their sugar levels were to be able to properly prioritize the most critical patient before dinner. The LPN that I shadowed did not fill the expectation of cleanliness however. She did not wash her hands once during the shift or between patients (including insulin injections, CBS, and medication pass). This made me really disappointed and I do not want to be a nurse like that. During the middle of the shift there was a call over the speakers that a nurse was needed outside (patients smoke) and we were the
nurse that they needed out there and found a patient having a grand mal seizure. This was an unfortunate situation but was awesome for me to see as a student because I now know what to do in the case of a patient having a seizure. In class we just talked about it but I was able to apply the lessons learned. The nurse I shadowed showed me what to bring with me when you get a call and what to do in the case of that situation.
What knowledge do you believe is essential for safe and competent nursing care? I believe that you need to know a patient’s baseline for safe and competent nursing care. If you know the baseline then it is easier to find an abnormal for a patient and implement medical treatment before a situation progresses. I also believe that you need to know what the medications are that you are giving patients. What to assess before, during, and after a you give a patient medications. What to recognize as a side effect and how to help a patient receive the maximum benefit of a medication. I also think it is important to know the route of administration of medications. Depending on a medication there are certain drinks to take it with (Fe and orange juice will increase the absorption, and taking some medications with tea will inhibit the absorption). The nurse I shadowed wasn’t able to answer my “question” about iron supplements where I knew the answer to my own question. Nurses need to be safe, caring, and thorough for competent nursing care.
Describe how your ‘shadow’ utilized organizational skills. The nurse I shadowed utilized organizational skills by having a routine. The first thing she told me she should have done was get report from the other nurse and count the med cart (she told me that she trusted the nurse and didn’t need to which raised a flag for me). The second task to do was check for new lab work and fax them to the doctor. Then she would go check all of the CBS of diabetic patients and give them their coverage before dinner. Next she would give medications to patients that were ‘easy’ taking pills and would then follow on to the patients that took longer or who were more difficult to deal with depending on the day. There were three patients whose medications were always red (past due) because it was in the system for 1600 but the patients refuse to take their meds until 2200 or 2300. Once this was done we got the call over the intercom that a nurse was needed outside and we went to help a patient having a grand mal seizure (on our side). We ended up assessing the patient, moving them to their room, and calling for an ambulance to take to the ED because the patient had hit her head. Then we did nursing notes, went over the treatments, and administered the last medications of the night. I left before the next nurse came in to give report to and to count off the medication cart to. By having a routine system the nurse I shadowed was organized and knew her patients.
Describe how your ‘shadow’ utilized prioritizing skills. The nurse I shadowed utilized prioritizing skills fairly well by doing the diabetics CBS before dinner to get coverage. Then gave the BP medications because that was more serious than a stool softener. The only meds the patients were on are insulin, BP meds, and stool softeners. She also had to get metformin and carbidopa levodopa on a schedule to maintain therapeutic effects (prevent seizures). There was a patient who had just came back from the hospital who the nurse kept a close eye on and made this patient a priority. She also prioritized the patient outside who was having a grand mal seizure (put them first) and shipped them out 911 and kept all the other patients on hold for 30 min.
What specific therapeutic communication skills did your nurse use while communicating with clients, families, physicians, and other healthcare personnel? Give an example. Some therapeutic communication skills the nurse used while communicating with clients was asking some open ended questions.
She also commented on items they had in their room and allowed the patient to respond. I did not really care for her style of therapeutic communication because I did not feel like it was genuine and I feel like the patients also felt that way and it did not allow for a trusting relationship. There was no interaction with the nurse and any of the family members so no therapeutic communication methods were observed. The nurse also did not talk to any doctors because there was a charge nurse that had that responsibility. From what I observed from the charge nurse answering the phone was very rude phone skills answering a call out by “We’re in a crisis what do you want”. All I could think of was she better hope that was the phone call for a call out and not a family member or doctor calling. I really do not have any examples of therapeutic communication methods because this facility did not communicate well or efficiently and I was not
impressed.
What leadership style did your ‘shadow’ practice during the workday? The leadership style my shadow used during the shift was a laisse-faire leadership. She did not really care if call lights got answered. She did not really answer patients calling out for a nurse. She did not acknowledge the behaviors of patients and let them do whatever they wanted. She also did not really care about counting her cart when she started shift and just assumed that the person she got the cart from she could trust? When the patient was having a seizure she did not look like she had any concern and actually told me that the paramedics do not like having this patient because she was caught administering herself injections of dilaudid. The nurse I shadowed is not someone I could call a role model for how I want to be a nurse and I feel like I learned what not to do when I graduate.
Give an example that explains the reasoning for your choice. An example of the laisse-faire style of leadership is when the patients were in their rooms calling out for the nurse to help them she would ignore it and continue her work and said that the floor has behavior issues. She also did not ask for assistance from aides in a timely manner when a patient would bring to her attention that they needed to be changed. The nurse was very nice but did not seem like she cared about doing things the right way and did not care about wearing gloves when giving injections of insulin or taking CBS which was horrifying for me to see; especially when she did not wash her hands.
Reflection Questions
After observing a normal workday, what nursing knowledge do you feel that you might need to review, prior to getting a job as an entry level Licensed Practical Nurse? After I have observed a hectic workday I feel like I will need to know the medications very well to be able to do a med pass efficiently. I know it will take some time but am looking forward to it. I might need to review the procedure for how to care for a patient having a seizure and what to do and what not to do. I would also need to look up the rights of a nurse before I start working because I want to know my scope of practice very well and know what I can do and what I cannot do as a nurse.
What do you feel will be your future difficulties transitioning from a student to a staff nurse? I feel like my future difficulties will be doing things to the book and not “efficiently” like the nurse I followed said. She told me that you will do nothing the way you learned it in school because it isn’t time efficient. I disagree though and feel like the proper way is the way I was taught in clinical and by the book. I will be responsible for what I do and how I document it and want to make sure that it is done the right way. I feel like I might have an issue with time management when I first graduate. In clinical I have only had one patient and the nurse on the cart had 20 patients. I will need practice with caring for multiple patients and being able to care for them by the time my shift is up. Also we have only done nursing notes in clinical twice and will need to make a nursing note for 20 patients in a shift which will definitely need to be time managed.