Analgesia Lost in Transfer!

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We are very fortunate that we are nurses, because we have jobs! Hopefully you love yours as much as I do mine. I have the pleasure of teaching nursing students. I teach at all levels, but right now I am spending a great deal of time with sophomores. Villanova University does not have the traditional two-plus-two program as most other baccalaureate programs. Our students begin learning about the profession as freshman, with topics such as communication, professionalism, aseptic technique, sterile gloving, and vital signs. Sophomores begin their year with physical assessment. The spring semester is very different, in that the nursing students have their nursing class for six hours once a week. Some weeks we teach the didactic part for two and a half hours and then teach in the laboratory for the remaining time. Other weeks the whole day is spent in the laboratory. This allows us to finish the entire course four weeks before the end of the semester.

During the last four weeks, each student goes to a health care facility and cares for patients. This provides the students the opportunity to apply the skills they have learned. They look like deer in headlights the first morning. The students freely admit that they are scared to death. After a brief orientation to the unit the students go to find and begin caring for their patient. Because of their anxiety levels, we have to repeat instructions and help them find equipment, and some students are so nervous they want the faculty to watch them as they take vital signs! Faculty have to interpret acronyms and handwriting for the students to learn more about their patients. By the end of the first day the students are exhausted and tell us that it wasn't so hard to put a patient on a bedside commode, change dressings, and ask a patient whether he had a bowel movement! This is exactly what faculty had been telling them all semester. Students comment about how hard it is to find some patients' brachial pulse—they need to be reminded to hyperextend the arm. When we ask them what their goals are for the next week, we hear, “I want to be more organized” or I want to do more of a “physical assessment.” Basically, all of the faculty are happy if the students do not faint, vomit, or cry the first day.

My first day with sophomore students was a close call as far as my goals were concerned. As I was taking the students on a tour of the unit, one student commented that her patient was not there. I assured her we would find out what was happening. After waving the students in to see their patients I asked about the missing patient. She had been discharged, so I had to find another patient quickly. I took the student into a conference room and explained what a laminectomy was and what the patient needed to have done that morning. She was in sheer panic mode, and I thought she was going to cry. I told the student to take a few minutes to look at the chart and then go see her patient. The student quickly returned to tell me that her patient was sobbing because she was in so much pain. In the hospital, the patient was given pain medications every two hours and here she wasn't. Now the student really looked scared! I asked her to find the nurse and tell her that the patient needed her pain medication and to check on the patient in a few minutes. The student returned saying she was dismissed by the patient. I told the nervous student that this had nothing to do with her, relax, and we will go in once the analgesic had time to work. Then the patient was on the telephone and, the student and I were standing at the nurses' station when the nursing supervisor took a call from the patient's son who wanted to know what is going on and why was his mother crying? The student and I listened carefully as the nurse told the patient's son that the physician who wrote the transfer orders did not order analgesics to be given every two hours. This made the student feel better.

On the other hand I was disappointed that I missed my teaching moment about pain and analgesia! Instead I praised the student for not falling apart and that her day should now should run more smoothly. Because it was her first day, I thought it was more important to focus on her needs rather than meeting mine. Maybe another opportunity will present itself. Next time you interact with a first-time nursing student, please be kind and forgiving!