Hi I am a fairly new nurse. Graduated from school a year ago and was hired into the ER straight away. Been on the floor for 11 months and on my own the last 5 or 6. I work at a community hospital with a fairly sick patient population, not a trauma center.
I feel like I'm okay with the normal run of the mill stuff, but I am still terrified of critical patients and I know that I need to grow A LOT in this area. The issue where I feel most unsafe is when it comes to managing multiple drips and medications. I found myself in a situation the other night where the entire ED was slammed, acuity was high, tempers were short, and help was slim, and I was getting multiple patient's that were very sick requiring medications I'd never given before, plus others I have had limited experience with. I felt so uncomfortable and had so many questions, but was afraid of annoying the my overtaxed coworkers. I felt paralyzed by the whole situation. I found the pharmacy was no help (asking how to give glucagon for beta blocker overdose - told me to read the directions in the box, which were only for hypoglycemia so they were less than helpful). Also had to give cardene for the first time (patient was in hypertensive crisis secondary to cocaine toxicity) and the drip book was nowhere to be found so I could even figure out how to mix it. Was told to switch the cardene to nitroglycerin - can I just turn the cardene off or does it have to be titrated down first? Just some examples of my questions. Other nurses either didn't know the answer, or told me information I now question after I got home and googled it. For example the charge nurse had me start the cardene at 0.5 mg/hr and titrate up by 0.5mg, but I later read to start at 5 and go up in increments of 2.5. Or was the 0.5 appropriate because he was a renal patient? All I know is the guys blood pressure didn't budge and I had to ignore my other patient's for about an hour while i played with one medication.
I felt like I needed my hand held all freaking night - and yes I'm inexperienced but I should be doing better than this! Left work with no self-confidence worried about being a bad nurse and unsafe and thinking I need to give up ER nursing (but it was my dream and I've barely started!). When I am dealing with these high risk medications I feel like a caveman blindly swinging a club, but I don't have the knowledge or finesse to manage everything that is going on, or even recognize where I could get into trouble. I get the inkling that some other nurses just hang the meds, keep the vitals stable and don't worry about anything else - let the ICU finesse everything. Is that really our role with critical patients in the ED and the best I need to do? Or am I overthinking to the point where I'm ineffective. I feel like I don't know what I don't know, therefore I don't know what questions to even ask (a mouthful, I'm sorry).
So I guess what I've come up with a long winded way of asking what resources are out there for learning how to manage the critically ill patient with multi-system issues - specifically medication centered? And given the situation above, what other things am I missing and what other things could I include in my "action plan" to improve? How do I conquer this crippling self doubt? Any advice would be welcome. Thanks!
