"If I Only had a Brain......"

[RiverNurse]

LOL... singing it loudly...

Seriously, all, I've been at this a *whole* seven months now. Yesterday was busy, heparin drip - with the patient getting a TEE... then she had rt lower abd pain - dr ordered a stat CT scan (goodie for me - I called it to his attention)... Then I had a psych patient that had security called on her the night before for her violent behavior - that needed a blood transfusion... but no IV access... a transfer to our floor from ICU... two of my patients were in isolation...

Another pt needed a VQ scan but it was cancelled. Instead, he was scheduled for a CT scan and taken off the floor before I ever knew it (frustrating). The pt refused the test. He was brought back up, I talked and talked to him about needing the test... he as eventually taken down for a VQ scan - IV access on him was nearly impossible - so dr ordered a VQ scan.

Then - I get a phone call while I'm trying to get the phlebotomist to draw the initial aPTT for my heparin patient - I'm told she's already drawn it (but I didn't see her or talk to her directly) - I start the heparin, then she comes waltzing in the room to take the draw. That can be handled, I suppose... Then it's the lab on the phone again - a lab alert - saying that another of my patients (VQ man) has a positive blood cultures. I finish my med pass - make sure the T&C for one patient has been drawn, that my pt with the heparin is comfortable, that my two isolation patients have had their respective wound dressings changed and that they are comfortable and pain free and that my bipolar patient is resting comfortably... and I process a discharge.

By this time it's shift change. I report all I can... feeling as if I'd done the job well... except for the hanging of the PRBC's and a UA needed.

At two am I awake from one of those nightmare sequences - I was playing some type of board game with my manager and somehow I could not finish the game and kept losing the pieces (they weren't marbles, either... lol) and remembered in my semi conscious state that I didn't get the results for the VQ scan - and didn't call them to the doctor... I told the oncoming nurse about the heparin and when it was started, but I didn't order the subsequent aPTT... so I call work... the charge nurse says it's all been taken care of and that I need to go back to sleep and to FORGET about work... which I do...

Then, at 2 this afternoon it struck me like a brick... I failed to call the doctor and failed to inform the oncoming nurse about the positive blood cultures.

As I sit here and write this - I am wondering if I'll have a job next week - if my license will be intact. I usually keep things written down or take action immediately - but this time - it was so busy - I was being pulled in 20 directions - I truly did forget - and have no excuses.

I've been working on time management - over and over... but sometimes I really just blow it. I would eventually like to be at a place where I'm respected and looked up to by my peers... but I don't think that will happen anytime soon. Most days at work I am nauseous and my stomach is in knots... today - after realizing I'd forgotten about the positive blood cultures, my stomach is in knots again, I'm queasy and panicky.

Just when I think I've got it, it's gone.

Help me out here, guys and girls... I love the work and I love my license. I wouldn't do anything else - and am truly here by choice (and Providence, I believe) - and not just for the money.

I know this post is scattered. My brain is fried and I don't feel well. Just looking for more input and support.

Many, many thanks,

Shawna

[imanedrn]

This is purely from MY perspective, but I don't call the doctors over every "significant" lab value (unless it warrants drastic, immediate attention), particularly when I know the doc will be in to review the chart soon enough. Not to mention the fact that I have FIVE other patients to care for. Yes, X value may be significant, but so are the lab values AND meds, AND orders (ETC!) for those other FIVE patients. This is not putting one patient on the back-burner but merely prioritizing -- which is the crux of what makes bed-side nursing bearable anyway!

Also, I'm the type to review ALL previous results -- whether they're positive OR negative, and I hope the nurses to whom I report do the same. There will ALWAYS be instances where you "forget" an item that seems radically significant when you awake from a dead sleep 5 hours after your shift ended.

As previous posters on other threads have noted, nursing is a 24/7 job. Since each nurse can't be there for 168 hrs/wk, we MUST hand off care -- and BELIEVE that the next nurse will continue to care for "your" patients -- and even take care of some of the things you might have forgotten -- or just plain didn't have enough time to complete.

In reality, your license is (probably) not hanging by a thread over this one. You're experiencing REAL nursing!

[RiverNurse]

I am sure that everything will be alright. This first year is incredibly rough - right up there with nursing school... This list is an incredible resource for input and support. I am glad it is available.

Shawna

[cherokeesummer]

Ditto on the above!!!!!!!!

[canoehead, BSN, RN]

If the patient was already on antibiotics then they wouldn't do anything about it (probably) until the C&S was back. No worries.

RIGHT- AND thanks a WHOLE lot for brain-worming me!! Now I have to go google the words so I can pass it on.

[RiverNurse]

You know - as I re-read my post, I can actually "see" how much I've grown in the past few months. LOL... at least my fretting is about higher level things at this point... As a friend of mine said, "You've reached higher levels of misunderstanding!"

:chuckle

Take good care and thanks for bending your 'virtual' ears!

Shawna

[NPs4health]

It sounds like you had a really tough day...I've been a nurse for only a little over a year now and I'm still not really feeling 100% confident. There are just good days and bad days. And I still wake up wondering if I forgot to do something and if I'll be in trouble for it. But I've found that hospitals are so short of nurses that even the worst nurses have been able to stay on the unit(not that we should be bad nurses, but to know that if they're gonna fire someone you won't be the first to go) So don't worry and just keep trying!

[Tait, MSN, RN]

:icon_hug:

Everything will be just fine, the doc will get his results, the patient will get his meds, the blood will hang. Do not fret over these details. Yes they are important, but if everyone is doing thier job they will catch the values as well.

[Morettia2, BSN, RN]

wow do we work in the same hosp??? It sounds like you were given the mother of pt. assignments, and you sound like me trying to take care of every little detail.

I know it is easy to say don't stress, but I know how you feel.

Just think, you did your best with what you had. And as far as the V/Q Scan, the MD will read in the notes, either it's a low or high probability. Half of the time on my floor I find out the pt. had a V/Q scan done, and not a single nurse knows about it, b/c no one has bothered to read the progress notes. I pick it up in the MD's orders, ask the MD and check the notes. I also check the computer to see if there was a result.

Don't stress, you had lot of things going on, you did your job, and all of your pt's made it through your shift.

Just take a deep breath, think why you became an RN in the first place and get some sleep..Believe me ,I know it is easier said then done:beercuphe

[RNcDreams]

I just got home from a terrible evening as well, and I am almost at the 1 year mark.

I feel for ya.

All anyone can expect from us is our best.

Nursing is a 24/7 job. The next shift should be checking labs anyway.... it will get done.

Sleep well :)

[WM_84]

My shift was great today, until I discovered a doctor's order wasn't followed through by me. It was written the shift prior, but was to be put in action on my shift. The ironic thing about it is that I was on the phone with the doctor looking at the bag of IV fluids ordered because he wanted to add something to it. Turns out I was looking at another pts bag.

I didn't realize this until the end of the shift, when i went to retrieve the bag from the med room and it was gone. Thats when it dawned on me that I was looking at the wrong bag for the wrong pt. Pharmacy has limited hours on the weekend, so I couldn't just call em up. I told the oncoming nurse about this situation and she said she'll bring it to the MDs attention when he shows up tonight. I fault the night nurse for not catching this (cause it was written on her shift, she had the pt on the prior ngt shift) and seeking clarification and I fault myself too. Perhaps thats why she was so willing to help. I had all day to clarify this, but didn't realize the problem until someone pointed it out to me. I was so busy all day. 6 pts swamps me. I'm 2 months new into nursing.

Before I left, night nurse and I found out the order was written incorrectly. This order also required an additional protocols sheet for the MD to fill out. The IV fluids wont be given until we receive clarification. Thank God the pt isnt a critical one.

I felt so defeated when I was leaving the floor. I told myself, "Why didn't I realize that?", "Why didnt I look at that order a little bit closer", "If I had my nursing cap on (lol) and thought a little bit more critically, I would've caught that."

I also thought to myself, either way, everything will be taken care of, by the morning. I've been doing so well so far, that I cant believe I had this type of a brain fart. : X

Thank God I have the next few days off.