i did so many errors today.*needing comfort guys - page 4

i'm a new grad and i've been orienting for about 8 weeks now.I should hve been starting my night orientation 2 weeks ago but i guess i'm not doing well so my preceptor suggested to my manager that it... Read More

  1. by   PANurseRN1
    Quote from SMK1
    I just thought that she meant she hasn't used dilaudid/hydrmorphone on a PCA pump before, not that she hadn't given it via other routes.
    If she was unfamiliar with this, then she should have asked for help.
  2. by   Imafloat
    Quote from Ann RN
    Nurses who "pocket" narcotics can be accused of diversion. Everyone should know this. Nurses that do divert often put narcs in their pocket, later claiming that they "forgot". So be careful. The excuse "I forgot" may not be good enough.
    I work in an open unit and I am so paranoid about narcotics that I make sure they are always in plain sight once they are in my custody. I make sure that someone reads the label and watches me waste before asking them to sign that they witnessed. I work in the NICU and the amounts we give are almost nothing (I gave 0.014 mg of a sedative last week) but I never want there to be a question as far as me and drugs are concerned.
  3. by   dijaqrn
    Chick pea I hope you're taking these posts to heart. Remember to breathe and review all of your rights before giving any medication and NEVER place a narc anywhere it doesn't belong. Patients love to take their meds "later"...put them away where they belong. If you actually didn't know what Dilaudid is please take a review course for pharm and/or carry a drug book on you. Being suspected of diversion is scary and not many other nurses or managers want to be involved. You are very lucky you had an understanding manager. Good luck, practice safely.
  4. by   Ubernurse
    So when I first started some months ago I felt inadequate. I felt like I wasn't catching on to my patient's diseases and making mistakes. Another nurse told me something that really put me at ease. She said you can't do everything and at the end of the day ask yourself "is my patient still alive?" If the answer is yes, she said I should continue. Just shake it off and take your time the next shift.
  5. by   linzz
    I too had some pretty rough times with a preceptor that thought that new nurses should not get any precepting or orientation, just learn as you go! So that was a real treat. Although I have only worked LTC as an LPN, the other posters are right about leaving pills, although I am sure that you just made an honest mistake. I will not leave pills for residents, they take them or I chart as refused. I worked at an assisted living facility and as some of the residents declined in mental abilties, they would stuff pills in their dresser drawers or under the pillow or mattress. One day I found that a lady had saved a days worth of regular timed oxycontin tablets and these were not charted as refused and she could not remember when she took her pills last.
  6. by   rose1135
    I am in my second week of orientation in the ER. This is a little off the original subject, but I am having trouble with the trade/generic name. I have been doing narcotic count, and feel kinda ignorant that I don't recognize a certain drug by its generic name, but I just keep asking!! And when transcribing meds, I get on the computer and look up other names, and indications, instead of just asking another nurse. This has really helped me to learn several drugs in a short period of time.

    I have also felt overwhelmed at my job. I had a pt. yesterday, and the pain was increasing, so the doc ordered morphine. After taking FOREVER to get it prepared (cause I am kinda slow!! ) I go to the room, get ready to give the pt the med, and after verifying her name and asking her allergies, she says "I am allergic to Morphine, I told you that!!" I then had to get a new order, and take even longer getting it ready. I eventually asked another nurse to administer the drug because I felt this pt was becoming frustrated with me!! I am just so glad I asked her to repeat her allergies!!!
  7. by   cuddlebug
    ok. You must really be so nervous or hypoglycemic from not eating that you are doing these things. I had an instructor once who was hard on me.
    She made me nervous so nervous I didn't think clearly. What i learned is that before you do something, say to yourself-ok what am i going to do? Am I leaving the patient's room with everything I came in with? Also, if you don't know what the med is- what for, side effects, contraindications, how to administer, safe range then look it up. Yes, it takes more time but it makes you safe. Be safe. Be organized. Be calm and incontrol.
  8. by   DutchgirlRN
    Quote from steelcityrn
    Even though you were responsible for the errors, no one was hurt.
    That was just luck IMO. It sounds that besides being nervous this new grad needs some extra time with just meds. Why on earth have 2 vials of PCA Dilaudid on you for back up? Makes no sense. When the pump begins to alarm that the medication is getting low, then you call and request a refill vial if there's not one in the pyxis. Never ever order two at a time! When it's delievered you keep it locked in the med room.

    Never leave pain medications or any other kind of medication in the patients room. If they don't take it, waste it, whatever it is. These issues seem so basic nursing to me.

    If you haven't grasped these concepts yet then you shouldn't be practicing on your own just yet. This is not a slam in anyway, it is good sound advice for the patients safety and your license. Everyone learns at a different pace. It takes some grads longer than others. Discuss this with your manager. I don't know what your facilities policy is but never refill a PCA or change the settings without the presence of another RN. I've been doing this for 31 years and still don't do it alone. It's too easy to get distracted with too many things on your mind and set it for Dilaudid when you're really inserting Morphine. Two heads, in this case, are better than one.

    Good Luck!
  9. by   nj1grlcrus
    I am still a nursing student, but I will pass on what my clinical instructor told us Thursday night. She said, "I think some of you are confused over my role as your instructor. I am not here to test your clinical skills, we do that in class, I am here to help you. You can ask questions, and admit that you don't know how to do something, that's why we are here to work TOGETHER." I am still wrapping my mind around that, but it is a much less stressful situation than to think I am constantly being judged. I think you should ask for more time in orientation, and take the additude that you are working together, not that you are performing a job with a critic watching your every move for a mistake. When unsure, fell comfortable asking questions, ask for help if you feel overwhelmed, take a deep breath, and don't worry if the other nurses are laughing, you will be laughing about yourself, too, when you are more experienced. That was the second point the instrustor mentioned. She said, "Just think of how much more you know now, than when we first started." She seemed like such a hard-ss, but she is really on our side. So is your preceptor.
  10. by   DarciaMoonz
    Hi chick pea. Sorry your having such a hard time. When in doubt check it out. There are a few meds. I had to check out a few meds. that I didn't know, and I just popped out the med book and looked them up. I made my error on my 3rd day, and have since learned. I am looking for a new job because of some safety issues surrounding the facility, and the state was just in. Just check and double check, and don't get your hopes dashed too much. It is a learning experience.
  11. by   morte
    Quote from chick_pea
    Thanks for the correction.It's well appreciated.Actually i don't really use ' dilaudid' very often i just usually use hydromorphone coz that's what comes up in the pyxis this was the first time i handled a pt with a dilaudid PCA.The two vials was suppose to be reserve i requested it early from the pharmacy because it usually takes them a long time to send up a new vial.But i know no amout of rationalization that can justify what i did.
    I know leaving narcotics in my pts room was a really huge mistake and boy will i remember this for the rest of my life.My manager told me that after this she was sure that i would be the safest person in giving meds because i sure will remember this.
    it would appear that some of the persons assuming that the OP didnt know that hydromorphone and 'dilaudid' are the same thing missed the quotes in her post?
  12. by   chick_pea
    to jill your profile is set so you won't receive personal msg.

    thank you sooo much jill.yeah you got me.there had been much speculation on that post of mine.i wanted to post to clear myself up but thought what the heck?just let them be.thanks a lot you nobody understood me better.yeah, you were absolutely right i had my mind set on my mantra not to make a mistake for my preceptor will surely prolong my orientation with her. and i had been through hell. I had this other preceptor that would fill in for her when she's not around and i just love her! she would ask me if i needed help or if there is something she could do for me. If the day is not to busy we would sit down and she will ask me if i had questions or if there is anything that i wanted to know.or if the day was busy we would sometimes discuss things on our way to the garage.I just wana hug her whenever i see her.I also learned a lot when i was with her and that is without terror and perturbation.sigh...anyways i'm on my own now.Thanks for letting me vent and for your private msg.I am closing this particular chapter of my life now.I am so thankful of this site i get to meet great people.Thank you so much and God bless..
  13. by   suespets
    re: unattended meds.reasons not to leave w/ pt. he may forget them,they may get dropped (or some lost) on floor. that takes time to replace them, so ur not saving time at all. some other pt. may find or get ahold of forgotten meds. pt. may take them .(2 hr's later) just explain it's ur job to watch pt take meds.u could even tell him he might lose them etc. u could say "I will come back later,if u can't take them now.good luck to u.keep trying!

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