What's wrong with me??

  1. So I am a new grad who just started orientation (wednesday) on a med/geriatrics unit (exactly where I wanted to be!). Each nurse here has 16 patients. The first two days went pretty well, but those were calm days. My coworkers are amazing and soooo kind with me, I already feel like I've been there for 3 months! The only thing is that I realized that I had issues that could compromise my orientation.

    First, is that I absolutely suck at drawing blood! I can start an IV most of the time, but drawing blood even with a butterfly has been an impossible task. So far I've had about 20 attempts and I can count on one hand the times I got it. Everyone tells me it comes with practice and I understand I should give that a little more time.

    The biggest issue is that I really have trouble focusing on one thing at time. Like if I am charting my assessment on a patient and an order for another patient would come up I'd take care of that thinking Ooooh it will only 2 minutes. It's like I constantly have my head in the clouds and I made my first mistakes yesterday. After a doctor made an order suggesting something, we have to call the patient's doctor so they can say whether they agree with the order or not. If they do, we have to write Ok, Dr. X, on the order so everybody knows they've been informed. I called the doctor but forget to write okay on the order so the evening nurse called the doctor again and he was mad we kept calling him about this. I also got an order to cease all Dilaudid for a patient and new orders of Morphine. Ceased the regular and PRN between regular doses, but didn't see there was PO Dilaudid. I just noticed that I forgot when pharmacy sent us back little stickers to show us what's in their system now. Yesterday just before shift change we received an IV antibiotic to give STAT to a patient, so I started it but completely forgot to sign it before I left. I went back this morning to sign it.

    I just feel like I shouldn't make such mistakes since my days were less busy than some of my friends who started at the same time as me who are on CRAZY units with 10-13 patients too.

    I needed to vent, but I was also wondering ; did any of you had similar issues when you started? How did you get over it?
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  2. 12 Comments

  3. by   blondy2061h
    16 is an insane number of patients. Some of the issues you're facing are odd to me. Getting a second doctor to sign off on one doctor's order? Pharmacy should be helping to look for duplicate medication/therapy orders. Are you using paper charting? If your hospital used barcode scanning if you're following procedure it's hard to miss signing out a med. Charting an assessment will take you less time so you'll be less likely to get distracted if you know you can whip that out quickly. And blood draws will definitely get easier.

    I kind of get the impression you're not in the US?
  4. by   canoehead
    You are learning. As you get used to the system you'll miss less. You'll be able to think of better ways to get through your chore list too. For now, write on the order sheet immediately, and finish one thing before starting another if at all possible.
  5. by   CrunchRN
    About blood draws. Look at both arms and then you need to feel the bounciest vein and go in low and slow.
  6. by   vxxen
    Quote from blondy2061h
    16 is an insane number of patients. Some of the issues you're facing are odd to me. Getting a second doctor to sign off on one doctor's order? Pharmacy should be helping to look for duplicate medication/therapy orders. Are you using paper charting? If your hospital used barcode scanning if you're following procedure it's hard to miss signing out a med. Charting an assessment will take you less time so you'll be less likely to get distracted if you know you can whip that out quickly. And blood draws will definitely get easier.

    I kind of get the impression you're not in the US?

    Yeah, I live in Quebec and everything here is paper! That leaves more place for mistakes, gotta be extra careful
  7. by   Morainey
    Sounds like the regular old learning curve to me. Even a seasoned nurse starting in a new place can be confused by the order systems and procedures.

    I had to learn to draw blood at my current job. I used to dread it but now I actually enjoy drawing blood more than starting IVs. Practice is key.
  8. by   OlivetheRN
    Girl (okay, I'm assuming here, forgive me if I'm wrong), it's been like 4 days! You gotta give yourself some credit where credit is due! The number of patients that you're juggling at one time is a lot, and as a new grad it's a steep learning curve with a quarter of that amount. As a PP said, focus on one task at a time until it's completed, unless of course an emergent situation comes up, then move on to the next.

    I don't use these for myself because I work in the ER, but you might benefit from something like a brain sheet to help organize your day and tasks. I did like them for when I was still in school and doing clinicals on med/surg floors. They helped me have a visual of what needed to be done all in one place without having to go into everyone's separate chart to see specific orders, med times, etc,and this may be particularly helpful for you given that you guys do papercharting. It also let me quickly do a loose plan of my shift (that usually went to $&*% quickly, but the thought was nice lol)
  9. by   chacha82
    Use face sheets, make "to do" lists and scratch off as you go along. Review as the day goes on. My preceptor taught me that during my capstone and it has proved super useful, especially if you're still doing paper charting.

    Some things need to be done RIGHT away. If a patient is on a gtt or fluids that get d/c at noon, don't "come back" to that one...it's way too easy to forget and next thing you know whatever's been infusing for way past its stop time.
  10. by   Kooky Korky
    Just be patient with yourself. Use a warm cloth, does your facility have ultrasound for spotting veins, etc.
    Use all the methods there are to locate good veins.

    There are too many patients.

    The doctors need to talk to each other, not expect the nurses to ask Dr. B if Dr. A's order is OK.
    Your doctors are very spoiled in this area.

    Screw the doctor who got mad about being called twice. He should only hope that's the worst problem he
    ever has. There was no need to blow a gasket over a simple matter. I can see a little upset on his part,
    but honestly - such childishness.
  11. by   vxxen
    So tonight I've had my fifth evening off orientation and it was my first bad one. I came in to work to know I forgot to give one pill last night (it was ferrous sulfate so it didn't had any consequences on the patient). The worst is that I signed it on the MAR but got distracted and forgot to give it and didn't even notice!
    When others go on their breaks at 6PM, I am alone with 1 CNA and 1 LVN for 32 patients and sometimes it's just crazy? Like yesterday a super confused and agitated patient just walked into another patient's room and hit another patient with his cane? And today the same patient walked into another patient's room, pulled down his diaper (sorry I don't know which emglish word is more respectful for elderly people) which was full of feces, sat on a char and started putting his feet in the feces and made a big mess. While I had to handle this, there were many bells, a patient who needed supervision to walk got up and went to the bathroom alone, it was chaos! I probably looked like a headless chicken to the others. For the first time I had to start parenteral nutrition and the pump just kept ringing and I couldn't figure out why. Turns out the tubing was just misplaced. Had to get the other nurse to figure this out -.- Finally, I was alone for passing meds and installing half of the 14 patients for the night and wasn't done at all when everyone came to help; we were 6 in the room to install/pass meds for 3 patients and I almost started crying because I felt so slow and incompetent..

    Now I'm scared that next time I'll go to work we'll tell me that I forgot to give a med or something else, or that I did something wrong :'(
    I know this is a normal feeling but I've only been working for 5 days and made my first med error, I'm just a little down, needed to vent.
  12. by   Fmr_RNBSN
    Quote from blondy2061h
    16 is an insane number of patients. Some of the issues you're facing are odd to me. Getting a second doctor to sign off on one doctor's order? Pharmacy should be helping to look for duplicate medication/therapy orders. Are you using paper charting? If your hospital used barcode scanning if you're following procedure it's hard to miss signing out a med. Charting an assessment will take you less time so you'll be less likely to get distracted if you know you can whip that out quickly. And blood draws will definitely get easier.

    I kind of get the impression you're not in the US?
    16 patients isn't an insane amount. Try 30 instead. High census, no staff for relief and no help. That was when i first started out after 2 months of being on the job. Yes *sigh* , everything was on paper. Multiple medication orders were harder to spot. Don't get me started on the getting doctors to sign on their own orders!!! Blood draws weren't so bad if i was using a needle and syringe, but using a scalp vein set (butterfly) was a nightmare for me. Forgetting to sign orders after giving medication was common, until the management changed the system to include the prescription orders in the handing over.

    When you are new (speaking from experience) it takes time to adjust to the system. Half of the time, when you do reflect that is. You'd feel you could better manage your time. Being swamped (is quite common in the first year) Cheers!
  13. by   CoffeeRTC
    Quote from vxxen
    So tonight I've had my fifth evening off orientation and it was my first bad one. I came in to work to know I forgot to give one pill last night (it was ferrous sulfate so it didn't had any consequences on the patient). The worst is that I signed it on the MAR but got distracted and forgot to give it and didn't even notice!
    When others go on their breaks at 6PM, I am alone with 1 CNA and 1 LVN for 32 patients and sometimes it's just crazy? Like yesterday a super confused and agitated patient just walked into another patient's room and hit another patient with his cane? And today the same patient walked into another patient's room, pulled down his diaper (sorry I don't know which emglish word is more respectful for elderly people) which was full of feces, sat on a char and started putting his feet in the feces and made a big mess. While I had to handle this, there were many bells, a patient who needed supervision to walk got up and went to the bathroom alone, it was chaos! I probably looked like a headless chicken to the others. For the first time I had to start parenteral nutrition and the pump just kept ringing and I couldn't figure out why. Turns out the tubing was just misplaced. Had to get the other nurse to figure this out -.- Finally, I was alone for passing meds and installing half of the 14 patients for the night and wasn't done at all when everyone came to help; we were 6 in the room to install/pass meds for 3 patients and I almost started crying because I felt so slow and incompetent..

    Now I'm scared that next time I'll go to work we'll tell me that I forgot to give a med or something else, or that I did something wrong :'(
    I know this is a normal feeling but I've only been working for 5 days and made my first med error, I'm just a little down, needed to vent.
    This actually sounds like the acuity of my SNF/ LTC facility. I've been doing it for 20 years and I still have crazy days! I've learned to have a real good sense of humor, because if i'm not laughing....I will be crying!

    How long was your orientation?
  14. by   vxxen
    Quote from CoffeeRTC
    This actually sounds like the acuity of my SNF/ LTC facility. I've been doing it for 20 years and I still have crazy days! I've learned to have a real good sense of humor, because if i'm not laughing....I will be crying!

    How long was your orientation?
    I had 5 days of orientation, 4 evenings and 2 nights!

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What's wrong with me??