Feel like a horrible nurse!

  1. Last nights shift made me feel like i never even even to nursing school!

    I have a pt with esrd and heading for dialysis at 0800. He has many serious problems but this is what i am focusing on. His bp rises around 0445 to 166/89. I next check it around 0545 and its 168/98. I get hung up on a note in the system saying notify physician is systolic is >200 or diastolic is > 100. I decided to call at this point figuring it was close enough and im becoming really nervous about it. I bring up the nephrologist note again and realize is says diastolic > 115! I started talking it over with another nurse and we are pulled away. By this time its around 0720 and the np is 170/101. The attending is there; i showed him the note that i saw and that the pt was going to dialysis and i was concerned with bottoming him out. He said i should have called when his diastolic was >90. He put in prn meds and added another bp med. He was really nice, took time to talk to me about it
    The note was by the nephrologist. Not the attending.

    I still feel crappy. 1) should have went with my gut i thought the note was ridiculous. I was suppose wait till he was in crisis mode to call?! 2) i should have talked to my coworkers about it more to make a better decision about that note 3) should have went to my charge 4) i know better!!!

    Its my 6th shift after orientation which was 6 weeks. My first nursing job! I work on a tele/stroke unit.and i love it! Just feel so inadequate. Feel like i miss a lot. I knew i would feel this way just starting out and some days are just harder than others. I feel like i am getting more organized and finding my groove, then this happens amd i feel lile a horrible nurse. Ill of course harp on the mistske from last night and forget about all the good i did.

    Nursing is hard.
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  2. 33 Comments

  3. by   Wuzzie
    Ummmm, if the order said call when >115 why would you call when it's >90?
  4. by   cleback
    Some pts bp drops during/after dialysis and the nephrologist will actually hold bp meds the day of dialysis. So a higher bp wouldn't necessarily alarm me. You did follow orders as well....The physician should have ordered to call when above 90 if thats what he wanted. Without knowing any more of the story that would necessitate tighter bp control, I would not have done anything differently.
  5. by   JBudd
    Don't sweat it, you did fine; you brought to the appropriate people's attention; you are new and the attending knows it, and took the time to explain and teach. You're in a good place.

    So, now you know... call if you feel the slightest need to, do better next time.

    Hey! you did notice it, you didn't ignore it, you repeated it.... stop beating yourself up {{hug}}
  6. by   RotorRunner
    You did great. You monitored your patient and notified the appropriate provider when there was a change. It sounds like the order wasn't super clear to begin with, and it's good the physician talked it out with you and added a PRN.
    Listen, you are a new grad nurse. You probably won't feel like you really know what you're doing for another year (if that). That's normal. The best nurses are the ones who know what they don't know, and aren't afraid to ask questions and advocate for their patients. It sounds like you are going to be that nurse. Go easy on yourself.

    P.S. My first job as a new grad was on a tele unit. It's hard work, and you'll learn a lot. Best wishes.
  7. by   brownbook
    WOW, you sound like super nurse to me! And the attending being nice and taking the time with you. You know you only get six, "I'm a horrible nurse," self flagellations a year!

    (Well....maybe you get 12....that's how many I get to be honest!)

    You need to save those up for something way more of a serous than this!

    And why isn't my insert smiley face working?
  8. by   kp2016
    Do not crucify yourself. End stage renal patients routinely have BPs that would horrify a nurse in any other area of practices.
  9. by   quazar
    The fact alone that the physician calmly and nicely sat down with you and took time to explain things without flying off the handle says that a) he's a pretty decent fellow to work with and hopefully is a reflection of the rest of the unit and b) it wasn't as bad as you perceive it to be after all.

    Also, you did the right things: you were going to call the physician, and when you were unsure about your own judgment, you sought out your coworkers for help. That's great. You're doing fine. Next time this happens (there will be a next time), you will know better. It's okay.
  10. by   RNKPCE
    I expected to read something " horrible" from your title and I didn't. It's hard when you are new and don't know what to worry about and what not to worry about. A lot of dialysis patient's blood pressure will trend up close to their dialysis appointment and be significantly lower after. The nephrologist is probably comfortable letting it run higher than a primary knowing he was going to have a treatment soon and from past history.

    You did fine. Don't beat your self up over this.
  11. by   Ben_Dover
    Nah.... no big deal! Having that hemodialysis that morning should have had made an impact on that patient's blood pressure "being where it should be."

    P.s.
    There will be a few patients that will not just respond to any BP medications regardless of what you do until they get their hemodialysis! But be always on the guard and follow your doctor's parameters/orders and keep them posted if the BP is not getting under control and then document.
  12. by   Insperation
    Seriously it's soo hard... I'm in my first 3 months on the floor and some days I just feel like a moron. I try to ask questions but everyone is so busy. I don't have 5 minutes to wait for the charge or another nurse, ya know? I have to just keep moving.

    I just do it. I keep showing up. They haven't told me to stay home yet! :/
  13. by   Verygreennurse
    You guys are all awesome! Thank you so much for the suppport. I knew this would be hard. And i am definitely the type of person to beat myself up over things like this. My preceptor gave me good advice and I am going to try and stick too it. If your gut tells you to call... call. Just so someone knows.

    So happy to be part of a community that is so supportive!! Thank you everyone!!!
    Last edit by Verygreennurse on Jul 7
  14. by   Tenebrae
    Quote from Wuzzie
    Ummmm, if the order said call when >115 why would you call when it's >90?
    Yup

    You aren't a mind reader, if the doc wanted you to call when the systolic was >90 he should have put the order in

    Stop beating yourself up for not being perfect. It sounds like you handled it the best it could have been handled

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