Just another new nurse needing some advice :(

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    So I work on a surgical floor (our med & surg is separate) and I'm feeling a bit irritated. I feel that communication basically sucks and information is being lost all the time. A perfect example of this what happened with my patient tonight. Dr.X did a lap choley on my patient and consulted primary dr.Y for medical management. Dr. X says to continue home meds, I call Dr. Y do get further orders because of some abnormal lab values unrelated to surgery. Dr.Y calls and is on the phone with another nurse about her patient. The other nurse turns around to me and says "Do you need Dr. Y still? She's in a very big hurry" I tell that nurse (who was also my preceptor a month ago while I was in orientation) what I was needing. She asks the dr. Herself and while she was still on the phone, she writes on a paper what to do in response to my question and also writes to make sure we get a dig. Level. I tell that nurse "we are getting a dig level in the am" she is still on the phone but nods an ok. She hangs up and walks away. At this point I have only a couple of labs on her-- no dig level until the am though. The digoxin was due so I gave it because dr.X said to continue the dig. Dr. Y comes in on the end of my shift and says "Oh this is wrong! I told dr. X to hold dig, this pt is dig toxic I said to hold this!" of course I fessed up and told her it had already been given I told her I was standing by the phone when she talked to the other nurse and I thought I might of heard her say dig toxic through the phone but all I was told was to get a level which we are doing in the am. I thought she had just said "pt. has a history of dig tox so make sure we are getting those levels" The dr. Was clearly frustrated with me and says "no no no no!" I just don't know what to do... I don't know how I could have handled this differently. Clearly I should have taken the call myself but when everyone is so rushed there isn't really time to assert myself in a situation like this the dr. Would have hung up before I could get on the phone. Plus I trust that nurse very much since she was my preceptor and also one of our charge nurses. No one, I repeat No one, told me she was dig toxic! In the chart? Nope. How was I supposed to know? I just feel like stuff gets missed a lot, I feel like I spend countless hours looking for information and stuff still gets missed. I feel irritated that I bust my butt all night for hours and at some point it always comes back to one of my coworkers or a dr. Looking at me like I'm a freakin idiot. I'm frustrated!!! Is it ever going to get better?
    Last edit by xxlilkacixx on May 24, '12

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    I empathize with your frustration...but why do spend "countless hours" looking for information. Do you have your lab results in a computer? If so, this is much faster than flipping through pages in the chart. Next, it is very hard to trust your own judgement in the beginning, but when in doubt, do not give a med like dig, without a level first. Did the pt. have a cardiac consult? If so, and you are questioning a cardiac med, it is THAT specialist that you need to contact. You will get the hang of it, med/surg is a LOT to learn. OR you may never feel completely comfortable like me, after four years on the floor lol.

    Don't beat yourself up and at the end of the day, trust your instinct and don't let people make you feel like an idiot. I did this to myself for too long until that thick skin developed. You'll get there and I promise it does get better..
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    If the other doc hangs up before you could get to the phone, you call them back anyway. It's your butt, and the pt's safety on the line.

    Where do you keep labs? Aren't results under tabs in the chart or on a computer? I agree. You should not have to dig for hours. It sounds to me your system is a bit broken.

    You will get the hang of it. It's difficult when you have a lot of Md's on a case. One orders a med and another comes along and dc's the order. Ugh
    Last edit by tokmom on May 25, '12
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    This is actually a pretty classic scenario of why you should've insisted on talking to the doctor yourself, a hectic unit is more likely to have mistakes made as everyone is running around with a hair-on-fire mindset.

    I also feel the other nurse was playing a bit of the "alpha nurse" by taking over a function you should've done with her admonishment that the "doctor is in a big hurry". It takes very little time to calmly say, "I understand that and now please hand me the phone or I'll call her myself". You are off orientation but sometimes the senior nurses don't want you to take your place as a full colleague. Of course they will still be guiding you, but what happened was completely unnecessary. Best wishes!
    sauconyrunner likes this.
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    I can relate and yes I am in the same position. It gets annoy at time when your charge nurse (just one) I encounter recently talks to me a new nurse like a child. I understand I might not have many years experience as this charge nurse has but no doubt my skills will develop. This post helps me gain some confidence of what to do if this ever occurs to me.
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    2 points to help you here. There are many ways to handle this differently.
    Taking the phone call yourself, you have identified.
    Second thing is to actually find the Nurse who talked to the MD and talk to her.
    You made a lot of assumptions about what was said on the phone and also about what the other RNs nodding was about.

    I'm reading that you relied on a note, and overhearing part of a phone conversation to make some decisions for patient care.
    So you can see, in a more critical situation, how well that would go over if you had to explain that to your manager or anyone else.

    But what I do not understand is how anyone knew she was dig toxic, if she had no labs.

    If she had labs, then you know, you need to do a quick looksie at your patients labs. I know you are busy,but you would have known she was dig toxic, and no matter what else was said or done...you would have been in a much better place to take care of the patient.
    If she had no labs whatsoever, then no one knew she was dig toxic, but they may have suspected it. Of course...if you Suspect someone is dig toxic, and they are getting a level to assess for that, you might want to ask or think about "Maybe I should hold the med until the result comes back"

    Your unit is hectic and very busy, which makes things challenging, but you have to be assertive. If an MD hangs up, Call them back. It is their JOB, do not let them intimidate you. For a while, you may want to insist on talking to the doctor directly. You can do this. It does get better, and you are going to be much better at managing everything soon. Because you care (which is obvious), you are going to make the effort to get it and you will succeed!
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    Communication between members of the healthcare team has been identified as a major source of barriers to providing safe patient care. That's why so many facilities use the SBAR format for communication.

    I think you already learned the most obvious lesson, which is to talk to the doctor yourself. The not-so-obvious lesson here is one that I stumbled upon when I was new also. It's where you let the more experienced nurse lead you down the garden path in the wrong direction, because you lack confidence in yourself and you trust the more experienced nurse.

    The confidence piece comes with time and experience, and will have many, many ebbs and flows. Sometimes you will feel like the worst nurse ever and like a complete nincompoop, and other times you will notice how far you've come and how much you actually have learned! We *all* go through this.

    You need to learn how to cultivate your own inner voice and to stand on your own two feet. Take feedback and advice from your coworkers into consideration; don't put on blinders to those around you. They are your support and a valuable resource. But if your little inner voice is saying one thing and you're hearing another from those around you, don't just automatically disregard your instinct since, after all, they are more experienced and know more than you.

    So, lesson learned. Next time, talk to the doctor yourself.
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    Sorry I haven't posted in awhile I'm just now reading these responses! Thank you all so much for your input. I had looked at her labs that night she had not had a dig level drawn for us. Dr. Y sees the patient regularly that's how she knew she was "toxic". You may be wondering now why I used the term "toxic" that way lol. I came in the next day anxious to see what the dig level was and it was (drum roll please!!!) Normal! Hooray! So obviously it worked out, she wasn't even toxic! I did learn my lesson though, my confidence is growing, and I'll definitely get the info straight from the horses mouth next time. In reference to the digging I was speaking of, I was generalizing. Labs are able to be found in the computer but this was a new pt. with new orders (possibly including labs) that could be either in the chart or computer. We have a new system where orders are supposed to be entered in the computer but 1/2 the time they are still written. Sometimes they are written on progress notes too instead of under orders (which are now in a new place in the chart!) sounds fun huh?! Haha I've got it pretty much worked out now though and I'm feeling more comfortable! Thanks again for the input!
    nursel56 likes this.
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    There's some great advice here. I just wanted to send you a bug hug!!!! Hang in there!!! You aren't a moron. We are all human and entitled to our mistakes. The key is to learn, grow, and move on. :-)
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    Haha! I wrote bug hug. Lol. See-- we all make mistakes. Darn phone. Lol. Big hugs being sent your way.


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