:spin: My head was spinning. I had two simultaneously important tasks. One guy needed constantly monitored, he had a gallon of golightly coming out his little colostomy about every 10-20 minutes. The aid was helping but I also needed to keep an eye on things and run when he called. (it filled up quickly)
Another pt recieved an order for insulin drip and Q2hr checks while NPO for a procedure that night. Pts sugars had been in the 300's for days and the target was to get them to 120-150. Drip first, so I went in to prepare her for the drip and give a pain med.
Murphy's law : Of course at that time the IV was failing. I got the equip but was unable to start one. I immediately told the RN in charge. She said she would come and try it. I said the pt. needed a drip. I kept running between the other guy and her and my other pts.
The NTL tried and failed to get an IV. We called the resource RN. She couldnt do it. Again I said, well she is ordered a drip, needs pain meds and needs antibiotics, is NPO, and its now awhile since the order and almost an hour past her 1st time for her BS check.
Suddenly it registered with the NTL the doc had written these orders now almost an hr ago. Though I had told her then,when I asked for her to try the IV, I guess she didn't hear me.
Immediately she called the doc, got a picc order, got an interim insulin order (her BS was still 300+ and the picc RN was unable to get up there for a bit.) They were unable to start the Picc at this time, so he got an IV in finally. The NTL then stated she was taking over care of the pt. :uhoh21:
Later she said I should have said something sooner, I should have called the doc and gotten an order to get insulin via shot while we were waiting, etc. I should have asked for help sooner, I should have moved faster on this, been more proactive, etc.
Okay I am in my first year, I didn't do it right and constructive criticism is good and she was kind, and later gave me the pt. back.
But meantime I was in tears and six years old for about 20 minutes.
ARRRGGG. I was late with all my charting and had to stay over two hours. I felt incompetent and frightened as Im on a new unit for my third week and am afraid they will send me away.
How do you handle this kind of criticism. I had never even done an insulin drip, no one up there was able to start the IV. I just cried and went on break as the NTL told me to and started back.
Jan 17, '07
Sounds to me like you handled the criticism fairly well. You aren't supposed to like it! But you did recognize that it was intended to be constructive, and it sounds like you learned from it.
Having very recently been where you are, I try to look at it like people are finally treating me like a grown up nurse, rather than a fragile newbie. If you think about it, you don't learn a lot from everyone telling you how great you're doing. Negative feedback stings, but we all need it.
I had a somewhat similar situation with a patient having multiple seizures. We couldn't get IV access. There was no PICC nurse on the weekend. The surgical team on call couldn't even get a central line started. A flight nurse did finally manage a peripheral in the hand, but you can't give dilantin through the hand. And I had five other patients who required attention, too!
At one point, one of my favorite doctors was a bit critical. Civil, but critical. It was discouraging, but it made me think. If these had been Grand Mal, we would have called it status epilepticus and shipped the pt to the ICU. But they were partial/complex and the patient didn't appear to suffer from any particular one of them. Sats were fine, mental status back to baseline every time--concerning, but alarming?
Our standard of nursing care is that any patient seizing has an RN present throughout the seizure, frequent vitals and neuro checks after. I couldn't be present for every seizure (5-10 minutes apart, total of 50 during a 12hr shift) and in the end at least 4 nurses participated in her care. So, if I ever see the same thing (or anything remotely like it) I won't hesitate to start screaming for an ICU bed. She needed 1-on-1 care.
With our peripheral access, the doc prescribed fosphenytoin, and we finally did break the cycle of seizures. The doc and I both felt the patient would be okay if we could just get some dilantin in her, and she was, but we couldn't do it. Rectal diazapam helped a little. IV lorazepam through a site the surgical team placed in her foot helped a little, but that site wasn't trustworthy for anything else. Finally getting a site in her hand eventually did solve the crisis--but in the process, I learned a lesson I won't forget.
The thing is, I don't think I was a bad nurse when I didn't know what to do. Actually, I knew what we needed to do. We needed a good IV access. But I'm a better nurse, now, because the stress of that situation forced me to think about options I didn't pursue fully (I did mention that I thought maybe she was too acute for a floor bed, but I wasn't very assertive. Next time, I'll be more assertive.)
PS I know just what you mean about feeling 6 yrs old. This was one of several times I would have been happy just to lock myself in the med room and let the real nurses handle it. The solution, of course, is to call for back-up from the "real" (i.e. more experienced) nurses, but to hang in with them and do whatever you can do. And it is helpful if you can take a few minutes to regroup, afterward. After my first code, my CN ordered me to go smoke. Smoking, crying--whatever--you don't want to be doing patient care when that parasympathetic nervous system finally kicks in.
Last edit by nursemike on Jan 17, '07
Jan 17, '07
It also depends on the type of critism for me too...is it actual professional critism or a **tch out is what I consider.
However, with both I feel that I am at work and will turn it around into a positive as much as possible! I find that that phrase "what can I do to improve on this area, I want to suceed in this department" really is a helpful thing! It points to wanting to problem solve, self improve, professional, and points to wanting to work though it for the sake of the department...and you may just get some awesome advice! If not, it makes the person critisising you take a step back and think!!!! (that can be a benificial thing).
Don't take vague responses either like "you need better time managment skills"...of course, we all can from time to time...I want to know specifics! "what do you think I could have done in this situation to better my time managment skills?". Again pointing to probelm solving, professionalism and making them think too!
Once I started doing this, I started looking at this as a more positive thing, a bit of CYA, and definately scored bonus points!
Then once that is all done, and I get home...well then it is MY time to be myself. I have punched pillows, cried, had a few cold ones, called a friend to console me, got a hug from family and cry on their shoulders...etc! But typically now, since I use the above process...I actually don't feel as bad and am thinking of ways to overcome it..and maybe a bit of pretend justice for the person that reported me...LOL! (I never get even for that...they have to report...but I can day dream of what I would do in a revengeful world can't I??? LOL!!!!!!!!!!!!!!!!!!).
Another good idea is journaling...I like doing that and come back later on an typically giggle at the situation and myself! Yes I use whatever words I want to...and some times I am shocked at my mental language! LOL! Can be amusing!
OH and some helpful advice because we have all been there...when I come into situation where I need to be in two places at once...I go to my RN supervisor/manager and state professionally and frankly that I can not safely do both tasks and to help me find a way to get the jobs done. That puts it into their hands to assist, and that is their job! Sometimes I get very lucky and another nurse takes over that task or all nurses keep an eye on one patient while I do the rest for the one that is most complicated and priority (which can be hard do choose some days!). I would certainly ask for help or advice in those situations...at least if anything you have brought the situation to light to managment (again probelm solving) and addressed your limitations with them in a professional mannor (and do it that way..no whining or complaining). Most importanly you warned them...so they can't be too ticked if things don't go perfectly!
Last edit by Antikigirl on Jan 17, '07