Advice for struggling medsurg nurse

AceOfHearts<3 · Oct 13, 2016

I've been working as a nurse for about a year on a very busy tele unit. I honestly think this is something that just takes time. If you miss it once and it's pointed out you'll probably never forget it again. I still go palm to forehead at times when I finally make a connection. I'm missing less things now, but it's always a learning experience.

I had totally forgotten my facility has alert bands for latex allergies since I hadn't had a patient with one before. I then had a patient one day with a latex allergy and the on-coming nurse asked if the alert was on- it wasn't and none of the nurses before me had thought to place it either. A couple of months later I had a patient with a latex allergy again and I asked in report if the alert band was on. The off-going nurse, we'll call her Jackie, hadn't even realized the patient had a latex allergy listed. I gave report that night back to Jackie and said compression stockings the doctor ordered were sized and would be delivered. The next morning I was back and getting report from Jackie again- she said the stockings couldn't be used because they listed latex as a component (something I didn't even think about) and that she would have totally missed it if I hadn't pointed out the latex allergy. Both of us learned new stuff that we will never forget.

You'll start to get more comfortable with time. I had a situation a couple of weeks ago that I took charge of and got handled in a swift manner. I had a patient who should have been transferred up to ICU in the wee hours of the morning but the on-call doctor was lazy and wouldn't do it. I had had the patient the day before and was confident he needed intervention and to be seen by the providers first thing. I also identified a newly formed hematoma at a 3 day old femoral cath site (I've had a fresh cath patient start to rebleed from a groin site before- which I was told "never happens"- but I'd never actually had a patient with a hematoma before, so now I officially know what it feels like). I was confident enough on the phone when paging providers and I got someone there right away who also recognized the magnitude of the issue. The patient went up to ICU and had MAJOR interventions done. Later when thinking about the situation I realized I probably would have been at least a little panicked and needing help from my charge nurse a few months prior to this. Instead I was competent and confident enough to handle it on my own and let my charge nurse keep an eye on my other 3-4 patients until my critical patient was fully transferred up to ICU.

I know I still have a ton to learn. I'm still always asking questions and asking for opinions when I'm unsure. Most of the time what I was thinking was right, which is comforting. I also have newer nurses now coming to me and asking questions and other more experienced nurses ask for my input too. You'll get there, it's just going to take time.

NewMurse1014 · Oct 13, 2016

I agree with AceOfHearts

As far as giving/receiving reports, you will find a way to organize your brain. I usually give reports from "big" to "small" (1) the big picture (the diagnosis, why pt is here), what we're doing for them now, what we're planning to do to get them out ASAP (2) any pertinent/important/very abnormal findings (3) other small details or almost WNL findings. This is also something that comes with practice and time. Also as you encounter the similar diagnoses over and over, you'll start to connect the dots and focus your assessment on the related systems.

Lastly, don't be afraid to ask for help or questions. Your colleagues will understand that you're still learning. You can also jot down anything you don't understand and research at home. Stay positive and you'll "click" one day.

xanderfan · Oct 15, 2016

I've been working as a nurse for about a year on a very busy tele unit. I honestly think this is something that just takes time. If you miss it once and it's pointed out you'll probably never forget it again. I still go palm to forehead at times when I finally make a connection. I'm missing less things now, but it's always a learning experience.
I had totally forgotten my facility has alert bands for latex allergies since I hadn't had a patient with one before. I then had a patient one day with a latex allergy and the on-coming nurse asked if the alert was on- it wasn't and none of the nurses before me had thought to place it either. A couple of months later I had a patient with a latex allergy again and I asked in report if the alert band was on. The off-going nurse, we'll call her Jackie, hadn't even realized the patient had a latex allergy listed. I gave report that night back to Jackie and said compression stockings the doctor ordered were sized and would be delivered. The next morning I was back and getting report from Jackie again- she said the stockings couldn't be used because they listed latex as a component (something I didn't even think about) and that she would have totally missed it if I hadn't pointed out the latex allergy. Both of us learned new stuff that we will never forget.
You'll start to get more comfortable with time. I had a situation a couple of weeks ago that I took charge of and got handled in a swift manner. I had a patient who should have been transferred up to ICU in the wee hours of the morning but the on-call doctor was lazy and wouldn't do it. I had had the patient the day before and was confident he needed intervention and to be seen by the providers first thing. I also identified a newly formed hematoma at a 3 day old femoral cath site (I've had a fresh cath patient start to rebleed from a groin site before- which I was told "never happens"- but I'd never actually had a patient with a hematoma before, so now I officially know what it feels like). I was confident enough on the phone when paging providers and I got someone there right away who also recognized the magnitude of the issue. The patient went up to ICU and had MAJOR interventions done. Later when thinking about the situation I realized I probably would have been at least a little panicked and needing help from my charge nurse a few months prior to this. Instead I was competent and confident enough to handle it on my own and let my charge nurse keep an eye on my other 3-4 patients until my critical patient was fully transferred up to ICU.
I know I still have a ton to learn. I'm still always asking questions and asking for opinions when I'm unsure. Most of the time what I was thinking was right, which is comforting. I also have newer nurses now coming to me and asking questions and other more experienced nurses ask for my input too. You'll get there, it's just going to take time.

You are some right. I guess it's just frustrating feeling always out of my depth. I guess I need to just accept that there will always be more to learn and that I probably won't ever find a true comfort zone but that I will get better and improve as I go along. I really appreciate you taking the time to reply.

Sammie

xanderfan · Oct 15, 2016

I agree with AceOfHearts
As far as giving/receiving reports, you will find a way to organize your brain. I usually give reports from "big" to "small" (1) the big picture (the diagnosis, why pt is here), what we're doing for them now, what we're planning to do to get them out ASAP (2) any pertinent/important/very abnormal findings (3) other small details or almost WNL findings. This is also something that comes with practice and time. Also as you encounter the similar diagnoses over and over, you'll start to connect the dots and focus your assessment on the related systems.
Lastly, don't be afraid to ask for help or questions. Your colleagues will understand that you're still learning. You can also jot down anything you don't understand and research at home. Stay positive and you'll "click" one day.

You are right. I'm starting to think I really need to do some independent research to make sure I understand some of the little things. I also need to be patient with myself because barring a few nurses most of my new colleagues have been super patient with my questions and welcoming. I guess I need to make the effort to ensure that I don't focus on the one harsh criticisms and take it as a learning opportunity rather than a put down. I just need to give myself more pep talks to be honest because in theory it's easy to say you'll be patient it putting it into practice is hard.

thanks for taking the time.

Sammie.

xanderfan · Oct 15, 2016

Cut yourself some slack, learn from your mistakes and realize you shouldn't know everything yet. I still don't, and I never will. Been a nurse since '01, tech prior to that.

I know you're right. I do but it's really hard not to beat myself because of the mistakes. I know we're our worst critics but lately I guess I've been extra hard on myself. I just need to maintain a better attitude, it's tough but I'm sure it's doable.

thanks so much for the reply

sammie

Cat365 · Oct 15, 2016

If it would help your anxiety about missing things you could look up the most common diagnosis that you see and write out what your focused assessment should include as well as interventions. I don't think that it is actually necessary. It sounds like you are doing a good job and learning, but it might help.