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  1. Hi, as you know, I am off orientation. Been on my own for almost a month now. Things are going "ok", I guess. There are still alot of skills that I haven't gotten yet, and when I do get a new skill, I usually do end up finding help or advice. I haven't been able to get any foleys or NGs yet though. I have attempted IV's but the majority of our census are elderly, so don't have the greatest of veins, so I attempt, and they usually blow, so I get an experienced RN to do them for me. I don't have confidence to do them. I lack confidence in my critical thinking sometimes too.

    I had my first death, the patient was a DNR, and had been terminal, so no surprise, but being my first, it was hard to deal with.

    I had a situation where my patient's BP was low and was to get Lopressor. Of course, I didn't give it. She was walking, talking, and alert. She did complain for dizziness when first sitting up. At any rate, I called doc, he ordered to hold the Lopressor (duh, I did that) and to hang fluids at 100/hr. She was heplocked. So, I did and two hours later, her BP was still low. It was at the end of the shift when vitals were obtained for their shift, and I happened to look and see her BP. I told the night nurse about the situation and she looked at me like I hadn't done my job correctly. I told her I called the doc and what he ordered and I followed orders. The patient was 88 yrs old, had an old pacemaker. I don't know what more I could have done. I kept an eye on her often, checked on her, etc. I did manual BP's after the aides got vitals to verify the BP. She had no other symptoms. The doc had been in earlier that morning and saw her labs and saw her too. What could I have done more? Any thoughts?

    I don't like being made feel like I am a retard by the night nurses when I give report.

    I want to yell: HEY, I AM A NEW NURSE HERE, I AM ON MY OWN AS A BRAND NEW GRAD RN. I DON'T KNOW EVERYTHING, I AM STILL LEARNING, I WASN'T BORN A NURSE. I AM HUMAN!!!!!!!!!!!!!!!!!!!!!!!!
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  2. 18 Comments

  3. by   DolphinRN84
    As a new grad myself, I don't think there was any thing more you could have done. You did all you could. And yeah I definitely hear you. I work in a pretty good floor but today I just felt like I was going too slow and I had two patients. I felt like things didn't go the way I wanted, and I felt like I kept messing up. I guess it was just one of those days. It was kind of busy during the day and the shift went by so fast. Oh well....I hope things do get better...oh and I'm on my third week of orientation. I'm sure you're doing great.
  4. by   bigmona
    you did what you could, so don't let the other nurses bully you or give you attitude. i'm not sure if you said you did this- but the only other thing i might have done was recheck BP 15 mins before shift change to see if the fluids had any effect, and follow up with the doctor again if not. you can also assess the temperature and cap refill of her extremities to see if she's perfusing, and encourage PO intake (unless contraindicated). and just document and keep good notes. all you can do, and it sounds like you did that. it's easy to get intimidated by the years of experience other nurses have, but you did the right thing and like you said - it's not like we're born knowing this stuff.
  5. by   wonderbee
    As the previous poster stated, the additional step of evaluating the success of your intervention and making an additional phone call to the doc would have completed the care on your part. The doc may very well have said nothing else was to be done, or he/she may have decided to order labs at that point; check H&H. The pt. may have needed blood or transfer to a unit for administration of pressors. There's no reason for the other nurses to look at you like you have two heads. You're new. You learn. Just don't mistake their instruction for criticism. Even though the pt. is 88, the nursing process is still the same.

    This first year is a rough ride. It'll get better.
  6. by   RNLisa
    Oh, I wasn't saying that she is 88 as if that didn't matter. I was just painting the picture of the situation alittle better. I had called the doc at around 5 pm, then we had to restart her IV (It went bad), by the time that got done, the fluids didn't get hung for another half hour or so. Then, at 6:45 pm, the vitals were obtained for next shift, and I happened to look at them and saw her BP was still low, about the same as before. During the time the fluids were hung and before next shift, I had been checking on her, I did tell her to drink more, gave her some juice, water, and offered her coffee or tea. She was joking around, talking, walking to bathroom, etc. I ran all this by the other RN's working that day and they told me to do what I did. I think maybe the next shift RN thought I should have called the doctor again, or something. The doctor knew her pressures, knew what her labs looked like earlier in the day.

    I guess I always second guess myself and probably always will, but I just felt like I was being looked at like I didn't do everything that should have been done. I haven't worked since that day, I work Friday of this week. I am so curious as to what ended up happening to her.

    Thanks for the posts. I guess from now on, I will call the doctor for everything.
  7. by   RNKay31
    Hey Lisa, glad to know things are looking up for you , all the best hun!
  8. by   RNSuzq1
    "I don't like being made to feel like I am a retard by the night nurses when I give report.

    I want to yell: HEY, I AM A NEW NURSE HERE, I AM ON MY OWN AS A BRAND NEW GRAD RN. I DON'T KNOW EVERYTHING, I AM STILL LEARNING, I WASN'T BORN A NURSE. I AM HUMAN!!!!!!!!!!!!!!!!!!!!!!!!"""""

    Lisa, I think all of us New Nurses can relate to this. On a floor I recently left - I tried to give really good end of shift reports - most of the experienced Nurses would make notes, ask questions, etc. Unfortunately, there were a few that made us "new guys" feel like total idiots. They'd sit and stare at us, not write anything down - it was like everything we were telling them was absolutely useless information and they were only humoring us sitting there listening to us. I'd be giving them info. on at least 5 very different patients and always asked - don't you need to write any of this down - they'd just say, no honey, just tell me what you have and I'll take it from here. They might as well have patted me on the head, told me the real Nurse was there and I should just run along.

    After I gain some experience, I hope that I'll be able to take new Nurses under my wing and help them out, instead of making them feel like they're not worthy to be my co-workers.
  9. by   CarVsTree
    Quote from RNLisa
    Oh, I wasn't saying that she is 88 as if that didn't matter. I was just painting the picture of the situation alittle better. I had called the doc at around 5 pm, then we had to restart her IV (It went bad), by the time that got done, the fluids didn't get hung for another half hour or so. Then, at 6:45 pm, the vitals were obtained for next shift, and I happened to look at them and saw her BP was still low, about the same as before. During the time the fluids were hung and before next shift, I had been checking on her, I did tell her to drink more, gave her some juice, water, and offered her coffee or tea. She was joking around, talking, walking to bathroom, etc. I ran all this by the other RN's working that day and they told me to do what I did. I think maybe the next shift RN thought I should have called the doctor again, or something. The doctor knew her pressures, knew what her labs looked like earlier in the day.

    I guess I always second guess myself and probably always will, but I just felt like I was being looked at like I didn't do everything that should have been done. I haven't worked since that day, I work Friday of this week. I am so curious as to what ended up happening to her.

    Thanks for the posts. I guess from now on, I will call the doctor for everything.
    I'm sorry the other nurse looked at you like you had two heads, but honestly, I might have done the same thing depending on how low pt's BP was.

    You say her BP was low. How low? How much lower than her baseline. Were you helping her to the BR. She complained of dizziness, not sure I would let her ambulate, definitely not w/o assist. Why did it take over an hour to get IV access? Why did it take another half hour to hang the fluids? These are not acceptable timeframes. I would have called the doc to let him know we couldn't get a line in if the BP was critically low.

    BTW, tea and esp. coffee are diuretics, they will only serve to lower her blood pressure. Not sure if decaf coffee/tea will.

    Always ask the other nurses on your shift when you're not sure what to do.
    Last edit by CarVsTree on Nov 25, '06
  10. by   RNLisa
    I did ask my "other" nurses on my shift what to do, and believe it or not, I did what they told me to do. The IV access was taking so long because she was 88 years old, bad veins, I tried once, another nurse tried 2 times, then another nurse got it after 3 times. The patient has been having low BP's since admission (about 24 hours), first it was like 104/50's, then on my shift it was 98/50's, then when I called doctor, it was 88/high 40's, stayed that way even after fluids. The fluids did not take a half hour longer to be hung, I hung them AS SOON AS IV ACCESS was obtained, by one of the most experienced nurses on my floor, I might add. I asked their opinion on EVERYTHING I did. I DID help her to Bathroom, DUH!!!!!!!!!!!!!!!!! I also helped her to sit up and reposition herself. BUT, I also had other patients too, and there was ONE instance where she got up on side of bed by herself and sat in a chair. The lady lived at home and was used to doing things by herself. AT ANY RATE. I did everything I could do in my shift. I can't wave my magic wand and make an IV site appear.

    I did take offense to your comments, suemom2kay. But, as you can see, I answered them. Another thing, I "offered" her tea and coffee, she wasn't a coffee drinker, and she refused tea because she didn't want it. We do have decaf tea.

    See what I mean about judgemental nurses? I AM A NEW NURSE, STILL LEARNING!!!!!!!!!!!!!!!!!!!!!!!!!
  11. by   Epona
    I have a question here that has just jumped into my brain after reading this post.

    Do DOCTORS belittle each other and "pick" on new doctors as it seems some nurses do to new grads.?? I have heard of nurses fussing at new grads. Yelling at them to make them feel small. WHY? Do docs. do this to new docs.?? I am curious.

    Thanks.
  12. by   CarVsTree
    Quote from RNLisa
    I did ask my "other" nurses on my shift what to do, and believe it or not, I did what they told me to do. The IV access was taking so long because she was 88 years old, bad veins, I tried once, another nurse tried 2 times, then another nurse got it after 3 times. The patient has been having low BP's since admission (about 24 hours), first it was like 104/50's, then on my shift it was 98/50's, then when I called doctor, it was 88/high 40's, stayed that way even after fluids. The fluids did not take a half hour longer to be hung, I hung them AS SOON AS IV ACCESS was obtained, by one of the most experienced nurses on my floor, I might add. I asked their opinion on EVERYTHING I did. I DID help her to Bathroom, DUH!!!!!!!!!!!!!!!!! I also helped her to sit up and reposition herself. BUT, I also had other patients too, and there was ONE instance where she got up on side of bed by herself and sat in a chair. The lady lived at home and was used to doing things by herself. AT ANY RATE. I did everything I could do in my shift. I can't wave my magic wand and make an IV site appear.

    I did take offense to your comments, suemom2kay. But, as you can see, I answered them. Another thing, I "offered" her tea and coffee, she wasn't a coffee drinker, and she refused tea because she didn't want it. We do have decaf tea.

    See what I mean about judgemental nurses? I AM A NEW NURSE, STILL LEARNING!!!!!!!!!!!!!!!!!!!!!!!!!
    Not sure what you took offense to. I'm glad you talked to the other nurses on your shift. I didn't know what you did or who you talked to or how low the BP was because you didn't state it in any of your previous posts. Thus my advise to consult them. In your post it sounded like it took a half hour to hang the fluids. Now after re-reading, it sounds like the whole thing took a half hour. I am just trying to help you learn by asking pertinent information. High 80's over 40's is a lot different than 70's over 40's. Still need to watch closely, and call the doc back if the intervention did not work. Which it did not.

    You didn't need to SHOUT at me in your post. I was merely looking for more information. None of the information you just gave me was in your original post.

    BTW, I wasn't being judgemental, just trying to get more information and give advice based on what information I had at the time. This is how we learn.
    Last edit by CarVsTree on Nov 25, '06
  13. by   CarVsTree
    Quote from Epona
    I have a question here that has just jumped into my brain after reading this post.

    Do DOCTORS belittle each other and "pick" on new doctors as it seems some nurses do to new grads.?? I have heard of nurses fussing at new grads. Yelling at them to make them feel small. WHY? Do docs. do this to new docs.?? I am curious.

    Thanks.
    They're worse! Not all nurses belittle and pick on each other.
  14. by   RNLisa
    Quote from suemom2kay
    You didn't need to SHOUT at me in your post. I was merely looking for more information. None of the information you just gave me was in your original post.

    BTW, I wasn't being judgemental, just trying to get more information and give advice based on what information I had at the time. This is how we learn.
    I am sorry, it won't happen again.

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