I've been in the ED now for about 1.5 years. In the recent months, I've experience what I would call as "loss of confidence." I won't say that any particular incident occurred to cause this, rather a grouping of small incidents. I think I'll attribute it to "the more you know...the more you realize you don't know anything."
Firstly, I have had a few patient's recently that have opened my eyes. A frequent flyer with complaints of "pain" (pain every day all the time it seems) who actually ended up with a 90% blockage to the RCA. Another patient who was drunk and sitting up in his c-collar for the previous shift began to tell me he couldn't move his arms. He also was telling me how much of a ******* I was for making him lie down and keeping the collar on. When I came on shift and assessed him, he could move his arms initially. I did tell the physician, but thought he was partially full of it due to his affect...sure enough: central cord syndrome. Of course, both instances made me feel like crap/like I was incompetent.
Also, in recent months I made it a personal goal to improve my documentation/assessment skills. I put a lot of pressure on myself to complete at least 99% of the "required" documentation on each patient and lift myself up to a higher standard. In doing "what is required", I find myself drowning. I realize that prior to my attempt at stellar documentation/reassessments, I cut corners for a reason. Now that I'm attempting to "do things the right way" I find it near impossible to be an efficient nurse. I'm referring to things like: real time documentation (instead of doing everything after the fact.), finishing a med reconciliation, sepsis screen, suicide risk, belongings, linking gtts to I/O flowsheets, scanning all medications, women's health screen, etc... Conceivably there are about 12 different things in our navigator to complete for a patient.
If I get a nursing home patient qith 40 medications, who is altered (q 1 neuro assessment), and has increased wbcs, decreased MAP, and arrives with 3 decub ulcers I want to curl up in a corner and die.
For said patient I have to:
-Complete a full assessment.
-Complete a neuro assessment: pupils, speech, mentation, musle strength grading
-Complete a skin assessment and add a LDA for each ulcer with details of each ulcer
-Complete a seperate report for risk management stating said ulcers were evident on arrival
-Complete a sepsis screen (8 different parts referring to Increased WBC (or decreased), MAP, source of infection, febrile?, AMS?, doc notified?, interventions?)
-Update all medications (doses/frequency)
Prior to my recent attempts at stellar documentation, I would get the patient on the monitor, assess, and treat my patient accordingly (IV, fluids, abx....you know...ACTUAL nursing). THEN I would try to find a computer to finish documentation and only update important medications such as anticoagulants, current abx, and medications that could cause alteration in mentation/VS. I would always being documentation with LE (late entry) 10:00-Assumed care etc.... 10:22- PIV (20g) placed to RAC. NS bolus infusing as ordered. Full rainbow in the lab... 10:46 Notified MD of map of 49 etc...
How does the loss of confidence come in to play you ask? It seems that my coworkers are much better/more efficient documentation than I. I've asked, I've looked, I feel like they can adequately care for their patients and write volumes of free text notes without batting an eyelash. When I get the train wrecks or seriously ill, I feel like I should be ensuring their airway/circulatory stability before running to a computer to type "assumed care."
Forgive me if this is TL
R and/or recently discussed. Any advice would be appreciated. Has anyone had any similar situations? Please share. I just want to make sure I'm not alone in this.