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Discussion

Advice- moved to level 1 MICU

Soo I recently made the switch from a small ICU unit to a MICU in a level 1 teaching hospital. Just some background, I have 1 year ICU experience. Ever since my arrival, I have felt the staff not be the most welcoming and setting me up for failure? To make matters worse, long story short I had a pt with chest tube, requiring replacement overnight (I am day shift); chest tube must have not been sutured in correctly, bleeding from entrance site-- after night shift applying pressure and re-suture-- no more bleeding. Patient hgb stable-relatively unchanged. I arrive in AM, labs look fine, assess site again no bleeding- I give AM lovenox (70mg). Night shift charge heard about it filed incident report- unit director asking me to now verify all my meds with preceptor-- director stating giving the lovenox to a bleeding patient was a new grad thing. Clarified with their was a thought process to it-- pt showed no signs of bleeding for me, PLT and labs looked fine. 
Fast forward to end of my orientation, director accusing me of giving blood products to a patient without consent-- her excuse my name was in the chart. I said no, that was not me, I am proactive and always get consents or verify before doing anything. I can guarantee that was not me. Given I am new and rememeber the times I have given blood products during my orientation. My director, however, was focused on making her point of view and stated to not forget to complete the basic tasks (such as obtaining consent before hanging blood products). 

Ever since I started at this facility, I am unhappy. Shift anxiety to the max! Today is my off day before working my first 3 in a row, by myself, off orientation. I just feel like I am constantly walking on egg shells and my job is at jeopardy. Any advice?!?? 

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    I would have given the Lovenox too. The temporary cause of the bleeding was handled. Did you ask to see the blood administration form? It must be obvious you did not initiate the transfusion.

    Is it just this manager that is picking on you.. or are there other staff members involved?

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    • Author
    30 minutes ago, Been there,done that said:

    I would have given the Lovenox too. The temporary cause of the bleeding was handled. Did you ask to see the blood administration form? It must be obvious you did not initiate the transfusion.

    Is it just this manager that is picking on you.. or are there other staff members involved?

    Thank you! I have asked various nurse friends and we all agree we would have given the lovenox.
    The director just said my name was in the chart, could not confirm I administered the blood products. Unsure if just picking on me? The unit is not too fond of her, however. 

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    Sorry to hear you've had a tough transition. Not that it's okay to do, but I think that in some places, they're a little harder on nurses with *some* experience because they don't want you coming in thinking you know everything. You're not a new grad so you don't have as much time for them to orient and evaluate you.

    Now that you're on your own, things should change. When they see that you can function competently on your own you'll be under less of a microscope. Try not to freak yourself out ahead of time unnecessarily. Focus on your patient care and the things you know you can control. You can't control the attitudes, actions or words of other people so just let them go knowing that you're doing your best. Good luck!

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    5 hours ago, ar2d2 said:

    Ever since I started at this facility, I am unhappy. Shift anxiety to the max!

    For now don't let them stress you out too much. Make up your mind that you're in control of how much you let them bother you. See what happens in the next couple of months of being on your own.

    Without being too obviously curt, I have very few words for people who try to mess with me (like the transfusion consent thing you described). Basically, "I was not involved with that transfusion. Is there anything else? [If not, bye]." At some point you have to send a straightforward (but not rude) message that you aren't going to be messed with; you aren't going to spend your time or emotional energy on the matter. Fair or not, the more time spend defending yourself and "flailing" (trying too hard to answer their every criticism) the more there is to pick at and the more picking that will be done.

    Just gather yourself together and buckle down a little. Stay calm. You can handle this. Focus on your patients. ?? Good luck.

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