ADVICE PLEASE For A New Medsurge Nurse (Off Orientation)

[MedSurgeRN1998]

But first, let's give some background info...

I from nursing school in May 2021 and was so excited (yet nervous) to finally become a nurse! Excited because I had finally made it! Nervous because Covid had seriously impacted my clinical experience and the amount of hands-on experience I had received. Cut to September, when I finally start my first job on a Medsurge floor on dayshift. I am extremely thankful to be on dayshift might I add. My orientation period was 3 months and I have been solo for exactly 9 shifts. My first few days were overwhelming and I required quite a bit of help from my charge nurse. The following shifts I believe I've been managing pretty well (or at least I thought I was). However, I notice that I keep making some stupid mistakes and it's really getting me down. Mistakes such as:

1. Doc put in a C-diff test order--> I did not collect the stool sample during my shift as things got so busy and it honestly just slipped my mind.

2. Accidently placed a pt refused fentanyl patch in the medication return bin instead of giving it directly to the pharmacy. The pharmacy had called my unit and reported a missing narcotic. The patch was easily recovered and returned to the pharmacy by me, but I still felt so incompetent. I was warned that I could potentially get written up. However, I genuinely did not know that I had done something wrong. 

3. The doctor asked me to put in an order for a suppository for one of my patients, but I got so busy I forgot to do it. The doc ended putting it in about 3 hours later and the pt ended up refusing it anyway. (Not that it makes it okay)

4. I needed to hang IV antibiotics for one of my patients. Something I really enjoy doing and pride myself in. As I've become very confident in my ability to work with the Alaris pump and set up infusions. I connected the vial of powdered medication into the fluid bag. I set up the secondary and primary tubing to perfection. I start the infusion and leave feeling like a rockstar! Only for the night shift to tell me the next morning that I didn't break the neck of the vial, allowing the powder medication and fluid to mix. Therefore, for 30 mins the pt only got normal saline during the piggyback. Thankfully nightshift caught the mistake and re-administered the antibiotic THE RIGHT WAY. 

5. Also, I've come to the conclusion that I suck at putting in IVs. In orientation, I put in at least 4. However, since I've been solo I've needed help for almost every IV I've had to do, which has been about 5. 

6. Forget to call my pt social worker. 

7.  I was discharging my pt. I told him to notify me when he called someone to come pick him up so that way I can arrange his wheelchair. Well, about an hour goes by (I had been checking up on him during this hour might I add) and I ask him if he had called anyone to come pick him up. He responded, very angrily might I add, that his ride had been waiting for almost an hour. He then had to wait an additional 50 minutes for the wheelchair (bc this pt was in no condition to walk).

All these things make me feel like I'm somehow failing at my job. I'm not sure if I'm just being hard on myself or if I genuinely am doing a bad job. My manager and other nurses tell me I'm doing extremely well considering that we are on a Covid floor, we are understaffed, and that I'm new. However, it just does not feel like it. 

[Emergent, RN]

Sounds like normal stuff to me. I remember forgetting to break the neck of an antibiotic when I started at a place where you had to do that, and was coming from a place where they would come up pre-mixed from Pharmacy. The next nurse took a photo copy on the photo copy machine of my error and wrote it up but never said anything to me about it. I got the write up with the photocopy of the antibiotic bag from the Xerox machine ?, and of course I felt foolish but now I look back and think that the whole thing was silly the way it was handled. That was before people had cell phones.

[Jordan Nacalaban, BSN, RN]

Hi!

It is normal to feel overwhelmed out of orientation days. You will be hyper-alert on all the errors, especially when trying to navigate yourself on the new job.

Take a deep breath. You are doing the best you can as a new nurse. It might be helpful to have a to-do list for your shift. Prioritize them as you go. 

What helped me when I was new, I wrote in my little notebook all the things I was supposed to do along with the patient rooms/initials. I checked them off as my shift moved along. New orders from doctors are added as they are confirmed.

I also made a quick time block for myself. Time for assessment, check labs, charting, meds, re-assess rounds, check orders, other patient care, and more.

As for the missed orders, that suppository order - the doctor needs to put the order in the system himself; it's not STAT.

The c-diff order probably had to be on your list as you first rounded with the patient during the bedside report. It isn't great to miss a lab order when you're busy and only realize it at the end of the shift. Sometimes it happens. Maybe make a red pen note or check/refresh orders frequently during the shift on your time block.

Putting IV requires practice and patience. It seems you're getting there; keep at it. However, even the most experienced nurse will still need help sometime or another. 

The patient probably forgot to tell you that his ride arrived. You specifically asked him to tell you when that happens. All we can do is get them transportation to go out the door as quickly as we can. 

It was great for the other nurse to remind you what happened to the antibiotic vial. You'll be more careful next time. The pharmacy can adjust the timing when the dose is pushed back. 

As for the narcotic, it probably wasn't explained well about narcotic returns. I'm glad you could trace the fentanyl patch and get it sorted out. Hospitals are very strict with diverting controlled substances.

As you continue to get acquainted with patient care, handling the duties, and the unit flow, you'll be able to find your rhythm and routine.

You are worried about what could have gone wrong, and how it affected you means you are willing to learn and grow. We all face something that opens up as a learning opportunity. Breathe. Pause. Good luck on the Med-Surg floor. 

[Nurse Beth, MSN]

You are not failing, and you are being very hard on yourself. Most people have NO IDEA of the cognitive workload nurses face. Hang in there, it gets better ?