Waking up at night to worry about patients

[missninaRN]

Apparently I'm not worrying enough during the day. Now I'm waking up at night to obsess over whether I did anything to harm my patients. (I'm working as nurse tech while going to nursing school.)

I had an elderly lady last week that needed to be changed into a clean gown just before the end of shift, which involved clamping the IV line and disconnecting it to thread it through the arm of the clean gown (she had normal saline running). I know that I reconnected the line, but I woke two nights later, up in the middle of the night, worrying that I hadn't unclamped the IV line-I simply can't remember if I did or didn't.

If I didn't unclamp it, I'm wondering how long it would take for someone else to notice. Surely the pump would start to alarm, right? Surely, if something had gone wrong and it was my fault, I would have heard about it by now (6 days later)?

My instructor says I tend to obsess when I go home from clinicals/shifts, and I know that she's right. She says it's not necessarily a bad thing, that it will cause me to be more careful (I'm definitely checking that IV clamp from now on), but I can't help but think that waking up and lying there, worrying for hours, is not a good thing.

So, would leaving an IV line clamped cause serious harm to a patient before it is discovered?

[TrudyRN]

Also, since it was the change of shift the expectation that the oncoming nurse would assess the IV and hopefully quickly catch any problems.

Good luck! :nuke:

She should absolutely not rely on the new shift making rounds right away. Hopefully, that would be done. But we can't ever count it.

[allantiques4me]

OMG! I used to work at an extended care facility on the brain injury ,vent and TCU.I would be a nervous wreck almost the whole time I was at work.A lot of responsibilities on my shoulder.I would wake up in the middle of the night just to call the facility cause I always felt I had forgotten to do something.All the other nurses said I was a wonderful nurse,but I had enough of that environment and moved on to a more relaxed paced facility.I still occasionally wake up and obsess,but not as frequently.I needed to leave for my own mental health.Maybe you need to find another area as well.

[snowfreeze, BSN, RN]

The IV pump will most likely alarm long before the peripheral IV clots and needs replaced.

[missninaRN]

Ditto, except, make it 40 years!!!

Don't worry; the pump would have alarmed VERY shortly after if you had not unclamped it!!

Oh my. Do you mean to tell me that I may be obsessing like this forever?

I appreciate the input from everyone. I do hope that the RN did her hourly rounds-it's hospital policy-but of course, there is no guarantee that she had the opportunity to do so on schedule. It has been a week now, so I think that I would have been called if there had been a problem. I'm going to check in on the patient when I go back this week.

[leosrain, BSN, RN]

I think one of the most important lessons to learn as a nursing student and then as a new grad is what is important to worry about, and what isn't important to worry about.

I have been a nurse for less than a year, and I'm still trying to figure this out. I will admit that I get it wrong sometimes. I have at times worried about things that aren't significant at all, and at other times I shrugged things off as unimportant that were definitely significant.

There's not a single nurse on this planet who hasn't forgotten to unclamp an IV. This is particularly annoying when a medication is supposed to be running and you find it still there an hour later. Often, if I start my shift and notice a clamped tubing...I simply unclamp it and go about my day.

Worst case scenario is that the IV site was lost. These things happen though! In that case, I would simply resite the IV and move on with my day.

It's all about taking these little details in stride and not letting them destroy you!

I'm not immune to this worry. The other day, I started an IV on a patient right before going home. When I got home, I was absolutely convinced that I left the tourniquet on his arm. I couldn't get rid of the nagging thoughts and eventually called the hospital. I felt silly....

The ones that really get to me are the patients that go downhill, particularly if we have to call a code etc. I sit there awake at night and wonder if I could have prevented it, or what I could have done better.

Remember, it's just a matter of learning what is, and what isn't important to stress out about. If you let every little detail become a massive issue, your anxiety will definitely get the best of you, and nursing will simply destroy you.