[epsilonprodigy]

Hi guys, I have been lurking for a bit and find this site sooooo helpful! I have reached the conclusion that in nursing, we all have our horror stories of maltreatment, hard lessons and shattered confidence from being one of the "eaten young." That said, my story in a nutshell.....

I started as a new grad in the PICU in '06. Unlike most of my new grad class, I was lucky enough to have one consistent preceptor (most had about 52!) She was an elderly lady who mostly took care of the chronic kids, which remained true with me as her orientee. My fellow grads were having plenty of drama with their multiple preceptors and very sick kids, but my preceptor and I got along famously so I kept my mouth shut even though I didn't feel that I was learning appropriately. My last two weeks of orientation, I was put with a different preceptor and started getting the REALLY sick kids. I made a scary error with an insulin drip during this time (luckily was small, caught right away and the pt. was fine!) I think this was the beginning of the slide of my confidence. I came off orientation all the same and did fine for a year and a half. Then we moved to a new unit which I found to be really tough, because we suddenly had to rely on our techs much more who were not used to doing work. I remember thinking "I think this will be fine for older nurses, but for me.. it's just enough to knock me off my perch!"

During this time, I made what was viewed as a serious error, although I'm sorry, I still just can't understand what the big deal is. I had a severely contracted neurologically devastated pt. who I needed to load with phenytoin (toddler age but about the size of perhaps a 9 month old). I had only an estimated weight and was not comfortable giving the weight-based med on this alone (which didn't sound accurate.) Since we didn't have an appropriate scale for the kiddo, or a bedscale, with the help of a tech I got the kid onto a baby scale to at least get a ballpark. Neither of our hands were ever off the patient, and we were able to keep him hooked to the vent the whole time with no issues. I verified the weight and gave the med. Later that day I was pulled aside and talked to about my "unsafe judgement...." I was devastated and told the "powers that be" that if that was their take, I'd do anything to improve.... even drafted an improvement plan and asked for resources to improve my "critical thinking." It was a downhill slide from there.... later got "dinged" for a silly documentation error where the monitor captured a CVP while a med was running.... all the while I tried to take what was said to me seriously.. said (and meant!) that I'd do anything to improve. After being assured by the educators that I'd done a fine job professionally and would surely come out OK, I was "forced to transfer" by the manager... she even had the nerve to tell me that she hoped I'd come back in a year or so after I'd "built my skills" because I was such a "pleasure to work with and a hard worker." What gets me is that other serious errors made by others, and myself, like the insulin.. were not even brought up during any of this! It was all about the #$%! baby scale and CVP!

So anyway, they said they'd give me a reference to anywhere I wanted, and I went for the Trauma Center, which I'd been considering anyway. There I met another new grad who was booted from the floor for something equally stupid. I love the new people I work with but am ALWAYS ALWAYS terrified that I will make a bad call, etc. that will get me in trouble or fired (although I don't worry about making a TRULY BAD call, I know I know my stuff and am safe.) I just feel like we are all dodging bullets all the time, if I don't see someone for awhile I wonder if they got fired for something ridiculous, I'm always scared that people are talking crap about me despite generally very good reviews... How can I rebuild my confidence so that I don't create a self-fulfilling prophecy?!

[epsilonprodigy]

Sorry guys, I was just reading my post and should clarify: I think I made it sound like I gave the phenytoin based on an incorrect weight. This wasn't the case. They were upset because I'd put a big kid who was a fall risk on the baby scale. Everytime I try to explain this to someone, they're like what?

[Mulan]

Sounds like they are more concerned about themselves and covering their azz. A fall would have been a big deal for them, now that falls are no longer being covered by insurance.

Sounds like you insured the safety of the patient while being weighed. I would think it would be a bigger error to give a med based on an incorrect weight.

I don't know what you're talking about re: the documentation error, but they are probably concerned about their azz on that one too.

It's probably just that floor and you'll do fine on the new one.

Just keep telling yourself, you know what you're doing and you're doing great!

[Mijourney]

Direct patient care is scary sometimes but it sounds as though you're doing just fine because you are trying very hard to be conscientious and a hard worker. Yes, you do have to stay focused working with patients, but I believe you can do it! My experience is that generally, it takes a nurse approximately three years to really be a confident pro. It may not take you that long or it may take you longer. If you find that after another six months to a year at the bedside, that you still don't feel confident enough, consider going into insurance, research, or medical records. Best wishes in whatever you decide.