- 0Apr 17, '13 by JKimRNAs a newly graduated nurse, I am still in the midst of trying to grow in self confidence and improve my critical thinking skills. I have only been working as a nurse for four months now and there is this horrible doctor that works on my floor. This is not the first time this same particular doctor has chewed me out but this time, this was by far the worst.
Early in my shift, I received a critical potassium level of 2.8 and reported it to this doctor. She ordered me to start an IV 60meQ of potassium and to draw a potassium level stat after the IV was completed. To start off complications, the patient's IV site was infiltrated and I wasn't able to take the time to start a new IV until three hours later. She complained that the site was burning too much so I started it off at 50ml/hr instead of the prescribed 88ml/hr.
Later in the day, this doctor comes up to the floor and demands why the potassium level hadn't been drawn yet. I explained to her the situation and it was just horrible. This doctor raises her voice at me in front of the whole nursing station and says, "Then you should have called me and I could have easily written an order for KCl po! That her potassium was this low and that it's taking this long to get her potassium is ridiculous. This is just unacceptable!!" Silence fell from the whole audience and I just nodded my head and walked away. It took all the strength I had to not burst into tears.
Quite a few of my coworkers came up to me to hug me afterwards and it's well known that this doctor has a tendency to be this rude. I understand my mistake and it was a learning experience. If she had a problem that needed to be addressed, she could have easily taken me aside and I would never make the same mistake twice.
My day just went downhill from there. I had a new admit and a million new orders for my other patients. As soon as I clocked out for the night, I burst into tears. I dread going back into work tomorrow.
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- 2Apr 18, '13 by JessicalynnHugs to you! Keep your head up! There was no need for the MD to be that rude. I know it's easier said than done but these experiences will make you tough ;-) you sound like a very good and contentious nurse. Best wishes for the future.
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- 13Apr 18, '13 by RNperdiemThis is a situation in which you need to make use of your charge nurses or your co-workers.
If you cannot get an IV restarted right away, ask your charge nurse to help you.
I can't really condemn the doctor though, her commentary was centered about a legitimate concern for the patient.
We were all new once and do remember how fragile confidence is; I hope you feel better soon.
- 2Apr 18, '13 by gcupidIf it was that crucial the patient would be dead. Don't beat yourself up about it. Why didn't the doctor order PO from the beginning as well as an IV infusion just to be on the safe side?
If the patient is not harmed, say to yourself "these !"@&;# can kiss my ;($.... Overtime you will learn what to allow to stay on your mind. If you let many things get to you, it will harm your well being psychologically, emotionally, spiritually and physically. Do not let nursing steal your joy in life bc it has the potential to do so no matter how much of a calling you assume it to be.Last edit by Esme12 on Apr 18, '13
- 3Apr 18, '13 by TaitWhile it sucks to be yelled at, by anyone, and I don't agree with her approach use it as a learning lesson. Similar to med errors, you feel bad for a time, but learn a valuable lesson. Remember to ask for help, especially with critical values. Also, ask other nurses what to do for situations for painful KCl infusions. There are options for diluting it by running it into other existing fluids, using warm packs on the site etc.
- 7Apr 18, '13 by eatmysoxRNRemember to prioritize. What took you 3 hours to get back around to starting another IV site? A low potassium is serious stuff. What was their rhythm? Unless you were in a code, taking the ten minutes to restart an IV and start the potassium should be pretty close to the top of a to do list. She was probably upset because it was serious. She shouldn't have yelled at you though. Get help when you need it. Ask another nurse to help you. I will take the time to help others if it's important. Use it as a learning experience and continue to improve your prioritization. Hugs =D
- 17Apr 18, '13 by Esme12 Senior ModeratorWelcome to AN! The largest online nursing community!
While the MD's behavior is not excusable.....she is right to be unhappy. You are not going to like what I have to say........ You were in the wrong here she at least deserved a call back.
A potassium of 2.8 is CRITICAL. These must be addressed immediately as the patient can exhibit arrhythmia muscle weakness, cramping, and paralysis.
Three hours to start the IV with an intervention is not acceptable. This lab value is not one that can wait. This is where you ask for help....go to your charge nurse a co-worker to help with the next task or start the line for you. Do you have a rapid response team? an IV team? Being a good nurse is also knowing when to ask for help and learning what to prioritize. Call the supervisor to ask her what other resource is available. I know I have started many IV's as a supervisor for situations just like this.
I know being a new grad is all about treading water and not drowning....((HUGS)). The first year (or so) is the hardest....but what new grads also need to remember are those "critical thinking" skills that were pounded into your head. If I do not so this right now can the patient die from this.....the answer is yes, so this becomes your priority.
Screaming at someone doesn't help them learn. Shame on her.
I am sorry you experienced this....we all make mistakes but what is important is that we learn from them. Know that the next time you will be better..
Sometime extra organization is helpful...here are some brain sheets to help you organize/prioritize.
1 patient float.doc
5 pt. shift.doc
day sheet 2 doc.doc
- 13Apr 18, '13 by GrnTeaShe may have been unmannerly but she wasn't wrong.
Now you have learned that a 2.8 is a critical K+ that can lead to fatal ventricular arrhythmias, that therefore a critically-low K+ is a priority over whatever the heck else you were doing, that K+ replacement can be done PO if you can't get adequate IV access (but you know what, this patient needed IV access anyway because of the risk of arrhythmias), and not to alter an IV rate without a physician prescription because it's out of your scope of practice.
And not to think it's all about you when a physician gets angry that a potentially life-threatening condition in her patient wasn't recognized by someone who should know better.
I have no doubt you'll never make that mistake again.
Furthermore, in a couple of years from now when you make some awesome save on another of her patients, you can remind her of this rookie boner and you can laugh about it together. Really. Been there, done that.
- 0Apr 18, '13 by applewhiternI agree that the doctor was right in this case. A critical potassium level takes precedence over other tasks. As a side note, our hospital policy states that potassium can run at only 10 mEq per hour. Regardless of how it is mixed, the potassium can only run at 10 mEq per hour. If it burns, we will run saline or the primary maintenance fluids with it, to reduce the burning effect. However, if your patient cannot take add'l fluids (like CHF) then don't do this. Some of our cardiac docs will simply order p.o. potassium, to be given every 2 hrs x so many doses.
- 2Apr 18, '13 by NurseOnAMotorcycle4 months... so you've just gotten off orientation recently? Someone experienced should have been keeping half an eye on you for support. I know with a super critical level like that the charge nurse knew what was going on and that you are still new. I would think they would have checked on you or sent someone to check to see if everything was ok.
I'm glad the pt is ok, and I'm sorry you got yelled at. I think that the pt was talking and performing ADLs so you probably didn't understand just how sick the pt was. I think someone dropped the ball by leaving you alone to struggle under the workload.
Give it a week, there is too much going on for coworkers to dwell on the new kid's issues for more than a day or two. It's not fun or interesting to harp on a new person doing new person things.
Had a new nurse come to surgical floor and drain full JPs every half hour or so and overheard her report "that's just how he is, he just needs nausea meds". I ran into the room to find a pale, sweaty, nauseous pt who was immediately put into modified trendelenburg for systolic in high 70s. (Didn't yell, btw.)
Coworker tells me she accidentally discharged a pt with their IV still in (long sleeves, pt even forgot it was there) and had to drive to their house to d/c it.
As a first year nurse, I had a pt of a very protocol loving MD who always ordered exactly the same thing on every single pt, including discharge criteria. Accidentally discharged a pt who was supposed to stay for a day longer than normal. The MD was ok with it and just called them at home the next morning to verbally assess them, but still...
as Vivalasviejas and others wrote: anyone who has never made an error is lying or too new to have made one yet.