Long time lurker, 1st time writer. Very helpful site - thanks!
Couldn't find this issue listed.
A patient complained i didn't push her 4 mg dilaudid fast enough.
The patient has had long-standing pain issues.
I double checked my PDA after to confirm, min 2 minutes.
The patient wanted the charge nurse, who went in with me on the next occasion to coach me faster - 30 seconds.
I have seen others administer much faster than I learned in school, also.
I have been encouraged to consider using smaller amounts before, between & after to flush, to help me speed up.
The good news is my preceptor called the doctor who manages the patient's pain & got the PCA adjusted to better meet the need.
I am almost done with orientation. So, on a busy med-Surg floor, which they try to keep surg, & I have 5-6 patients, how does one manage:
q 15 minute neuro checks 1 pt, x 1 hr, q 30 x 1 hr, q 1 hr x 4 hrs, then q4
q 15 minute vs on same pt w/similar reductions over time.
q 15 minute dopplers on another, with similar reductions over time
q 15 minute blood sugars on pt 1 &
2nd guy (got him shortly before 1st guy) similar reductions over time.
q 30 minute pain meds for breakthrough pain when pca insufficient on pt 3.
(This is the patient noted in the first paragraph). Also q 6 accuchecks, TPN. I Nurse Draw her labs through central line.
Incontinence on pt 4 & replace wound vac dressing he pulled out, confused (possible dementia) while waiting for the wound vac to be replaced.
Hep flush picc.
Cognitive impairment pt 5, she's a feeder, roll q 2. Long hx very labile HTN, repeatedly requests same meds, already given - sleeping pills, anxiolytics.
K & Mg protocol, No IV access, Crush pills & put in pudding. SMALL bites. Accuchecks.
Complex dressing change with wound manager pt 6. Also long hx of difficulty controlling pain & need for breakthrough iv pain meds.
Most have iv antibiotics every few hours
The day nurse (who precepted me once) asked why i hadn't gotten pt 5 soup.
I told her that I asked the tech (twice)
She continued to look @ me, unsmilingly.
I think she wants me to do it. I just can't. 12 hrs. No meal break.
Unfilled Linen Carts
Missed doses that must be requested from pharmacy
Handwriting worse than kindergartner's printing
(I student taught kindergarten. Nurses computer document & chart)
Chart checks,
Adequate assessments
Care plans &
On-call docs who say "What do you want me to do about it."
When you call regarding severe HTN for which there are no PRN vasodilators.
(Most of the docs have been fine)
It would be nice to say the UAPs could do the vs, accuchecks & incontinence, but they are too few, overworked, underpaid & some shirk, as do some of my other co-workers.
The vast majority of my preceptors, who also often must charge, have been great - helpful & encouraging. I am also very lucky to have great co-workers-mostly. Sure there are some cliques. I avoid the gossip.
Working to overcome my perfectionist tendencies. (Some refer to as anal)
I'm learning bunches & love it, but I worry about the welfare of the patient & if I'm not up to the task of bedside nursing, I would prefer to get out before I hurt someone. I have been told I have good skills,
but must work on my time management. I will persevere. =)
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