Not fast enough

nrsang97, BSN, RN · Nov 22, 2008

They want to talk to you becasue you didn't get the U/A fast enough on a pt who couldn't pee. You had no tech to assist you, and too busy to cath? I think they need to give you a break. You were slammed. You had 2 d/c's, 2 new pts one asthma, one CP, and this guy who was also new? Anyone would have been overwhelmed. Where was your preceptor? They should have helped you.

I am no ER nurse by any means, but this sounds like a insane assignment. Anyone could see that you were too slammed to worry about the U/A at that moment. You were doing the right thing by getting the CP and asthma pts seen and assessed then go back to knee guy and get his U/A by cath.

I think your preceptor needs to be more available to you. If you feel you need help, ask of course.

I am getting the feeling that you may need a different precptor that is more supportive and helpful to you.

Good luck to you.

RiverNurse · Nov 22, 2008

Well, the way things have been going in orientation, I've been attempting to transition away from her coattails - but - the way it has been applied is as follows:

My preceptor has a backseat role now and she is "not the nurse" and will do "tech" like activities when asked (sometimes) - however - she has "taken over" when a full arrest has come in (thank goodness). I think, though, it has been a bit much for me. I truly do NOT want to leave - despite the "overwhelmed" feeling I get during the first half of the shift... that "overwhelmed" feeling is completely natural, and I think, in time, will become more manageable.

Interestingly enough, but probably unrelated... the nurse manager quit suddenly last week. Just came in and announced it was her last day. Now all sorts of things are up in the air. I knew something was going on - being so new in this department, though, I couldn't quite put my finger on it.

I hope to hear from more from more nurses. I want to hang in there b/c I know I am a good nurse - sometimes though - the self doubt just takes over.

Thanks a bunch,

RiverNurse

nrsang97, BSN, RN · Nov 22, 2008

I still think your preceptor should be somewhat more supportive to you. You should have been able to delegate the task of obtaining the UA to her when you were busy like that.

lpnflorida · Nov 22, 2008

Hang in there. When you go to your meeting state the facts only. If there is something more you need in regards to your orientation do not be afraid to ask for it. The worst they can say is no. Ask what areas they see that you need to work on to bring your performance up to their par level. I always hated this one, but usually they have an idea of how many patients we " should " be able to handle. What the documentation should be etc. Keep an open mind. Being new anywhere is difficult, but well worth the reward of making it through the trials and tribulations of learning.

TraumaNurseRN · Nov 22, 2008

Some good advice so far I think. I would like to add something a bit different though. Are you portraying confidence? You sound willing to agree with their assessment of you without explanation or expressing yourself somewhat. When the physician said what he/she said...You should have honestly stated, my priorities were to my CP and SOB patients at that time. At least in my ER it is. Don't let the docs stomp on you.....some docs like to torment until they get to know you and know your work knowledge/ethic. Secondly....it's gonna take time for you to use time management wisely....and there are going to be many days just like the one you had......you just have to work with acuity first....and realize...ER Nursing or nursing in general isn't a job that you get done with things and go home at the end of the day. There's always going to be something to do. At some point you have to demand help for the acuity, and then on the other hand realize 30-50% of patients that come to the ER....don't need to be there.....They are the least of your priority if you have a high acuity patient. Hang in there.....:wink2:

**canoehead, BSN, RN** · Nov 23, 2008

A UA on a knee pain is at the BOTTOM of my list of priorities- the knee bone is connected to the thigh bone- not the bladder.

Chest pain, or SOB- there's your priority- and don't be afraid to say so. If he wants a stat UA he can 1)write it like that, 2) order IV fluid, 3)go have a sincere talk with the patient himself, 4)ask a tech to check in with the patient frequently since the RN is busy with critical patients.

Watch one of the experienced RN's prioritize, and talk to your preceptor about dealing with this doc. It'll be educational, and with some coworkers, docs included, once you let them know your priorities are with the sicker patients they'll leave you alone.

cookienay · Nov 23, 2008

Hmmm... I am sort of wondering why a knee pain turned into a metabolic acidosis? (unless I read incorrectly)

Anyhoo... my advice is keep going. Sounds like you can get this. One of our new nurses 3 years ago was a nightmare. Now he is training for charge and a fantastic nurse. as long as you keep your priorities staright, don't let the docs harass you. Best wishes and keep us posted!!

Aneroo, LPN · Nov 23, 2008

A UA on a knee pain is at the BOTTOM of my list of priorities- the knee bone is connected to the thigh bone- not the bladder.
Chest pain, or SOB- there's your priority- and don't be afraid to say so. If he wants a stat UA he can 1)write it like that, 2) order IV fluid, 3)go have a sincere talk with the patient himself, 4)ask a tech to check in with the patient frequently since the RN is busy with critical patients.
Watch one of the experienced RN's prioritize, and talk to your preceptor about dealing with this doc. It'll be educational, and with some coworkers, docs included, once you let them know your priorities are with the sicker patients they'll leave you alone.

I agree. The chest pain without a doubt comes before the urine, PERIOD. Even if it's the same crack addict who's been in three times this week and just wants a meal, this really could be the big one, and until his EKG and primary assessment are done and shown to the MD, he's first.

What got me through was thinking "What will kill this patient first?". Got me through the priority section on the NCLEX and helped me as I was learning my job. Your preceptor needs to make herself more available- just because you're not a new nurse doesn't mean you don't need help. ER is a whole 'nother ball game than med/surg.

Also, don't be afraid to tactfully stand your ground with the doctor. When he's breathing down your back about a simple urine sample, tell him you're busy with a higher acuity patient (he might not have realized there was a new chest pain pt). He might get mad, but he's not the priority- the patient is.

mwboswell · Nov 23, 2008

I agree to your original post - I think your priorities (based on the limited clinical info you gave; were right on).....

I echo some of my other peers who have posted, like: who is your "back up"?, can you call the charge RN to help? can you ask one of the other RN's etc, etc, etc.

Based on your post, if they can't pee -they can't pee!!!!

i feel 45min to an hour is reasonable to wait for a self-void before insisting on a cath.

For myself, sometimes, after examining them, I just go ahead and give them the specimen cup and take them directly to the bathroom while i go chart. (I'm a NP). Not that this isn't my job, but ya know, sometimes, if you want something BAD ENOUGH you'll help out the nurses and try to do what you can for them......

In my NP career (where I work on equal level with the attending MD's) I don't think I've EVER seen one of them take a pt to the bathroom to get their U/A; nor have I ever seen them take a pt to CT scan, nor do a routine IV start when the RN couldn't get it ...all of these I do on occasion for my RN's!!!

My point; if that MD wanted it BAD enough, maybe they could have been checking on the pt to see if they had "results" yet in the urinal!!!!

AS far as the "meeting" goes, I would suggest you play up the positives/your strengths and do just as the others said; run them through how you PRIORITIZED these pt's care needs, as well you might also hit them with how you strived for CUSTOMER SATISFACTION also....

Hope this helps.

-MB

northshore08 · Nov 23, 2008

Based on your post, if they can't pee -they can't pee!!!! i feel 45min to an hour is reasonable to wait for a self-void before insisting on a cath.
My point; if that MD wanted it BAD enough, maybe they could have been checking on the pt to see if they had "results" yet in the urinal!!!!
AS far as the "meeting" goes, I would suggest you play up the positives/your strengths and do just as the others said; run them through how you PRIORITIZED these pt's care needs, as well you might also hit them with how you strived for CUSTOMER SATISFACTION also....

I echo your sentiments, MB. If the MD/NP directly requests urine from the pt, I find they "make shi-shi" faster (that's Hawaiian for pee!)

OP, you are doing a good job; don't let the b*****ds grind you down! All good suggestions from other posters. :nurse:

Hilinenursegrl · Nov 23, 2008

It seems to me that the comments made about you being a good fit in the ER are not based solely upon this one day. I can see that you were busy and I have had days like that. I can not really sympathize and I mean no disrespect by it, just that this job in the ER was my first out of school and I have done okay, without techs, we never have any here. So if ER is not the place for you maybe you would do better in less os a fast paced job.