Am I overreacting?

Triddin · Oct 8, 2018

Sounds fine to me. Eventually you have to gain experience. If you're uncertain, look up thr hospitals policy regarding caring for epidurals (many years in and I still always do this when I can't remember or feel uncertain). Ask those with experience or your educator.

As long as it's in your scope of practice, you can't really refuse to care for a patient because you haven't encountered that skill.

LovingLife123 · Oct 8, 2018

How do you think you will learn? You simply ask questions and learn when you aren't sure about something.

missmollie, ADN, BSN, RN · Oct 8, 2018

You can always ask for help from a co-worker, and they can explain how it works on your floor. Also look up policy. If epidurals are allowed, then don't pull it out, ensure the medication is for "epidural" only (not IV), and ensure you hang it correctly.

JKL33 · Oct 8, 2018

Hi all
Opinions of a new grad receiving a patient with an epidural when never being exposed to one while I had a preceptor or anyone else on my floor having much experience with one?

There is no categorical problem with caring for a type of patient or a particular scenario that one didn't care for while working with a preceptor. One shouldn't have an expectation that orientation would cover every scenario one might encounter during the term of employment.

But there is a potential problem when no one on the floor is well-equipped to help. The question is whether or not assistance (from somewhere) was provided.

Second thing - this is more about patients than new nurses. Although a newer nurse needs to call up relevant information already learned and also needs to utilize real-time resources, this is far from a "new nurse should get over it" scenario to a patient. This is someone's healthcare. Yes, there are a lot of new things that will be encountered during beginner years and to some extent throughout a nurse's career. In this particular example, though, I think in-person supervision and assistance is non-negotiable.

brownbook · Oct 8, 2018

You do need to ask. Never ever feel stupid to ask, say I don't know about that. You posted that your co workers didn't have much experience. So obviously you did ask them. When, if, co workers are no help ask the charge nurse or nursing supervisor. Tell them you aren't familiar with epidural patients and need to know what to do, what to watch for, etc.

Even call whomever gave the epidural, or whatever unit the patient came from. I assume an anesthesiologist gave the epidural and a PACU nurse, or transport aid, brought up the patient. Call PACU say you have never cared for an epidural patient is there anything specific you need to be watching for.

Situations like this will happen again. Whomever is giving you report on a patient, the nurse from a prior shift, etc. if the patient has a medication, medical device, procedure you don't know about tell them you don't know what that is and ask them.

All this asking sounds time consuming and few if any nurses think they have extra time for anything. But the reality is it would probably take less than 5 minutes for "it" to be explained. And save you and the patient a boatload of time and trouble.

Jedrnurse, BSN, RN · Oct 8, 2018

Some hospitals have clinical nurse educators that can help walk you through things like that. Are you lucky enough to have that resource in your place?

psu_213, BSN, RN · Oct 8, 2018

There are a few less that ideal circumstances in this situation, but use this as the opportunity to become the "expert" on your unit about epidurals. You certainly don't want to run yourself thin, but you have an chance to impress by doing the research on care of epidurals, and then disseminating that information in a cogent manner.

MamaBeaRN · Oct 8, 2018

How else will you be able to take one in the future? This is your chance to get exposed and figure it out. Better with a preceptor than when you're on your own. You will have many firsts in nursing, you can't refuse pt's because of the lack of experience.

OldDude · Oct 8, 2018

And, when you walk out at the end of your shift and no one has died, it's been a good shift:up:

llg, PhD, RN · Oct 8, 2018

Situations like this will happen again. Whomever is giving you report on a patient, the nurse from a prior shift, etc. if the patient has a medication, medical device, procedure you don't know about tell them you don't know what that is and ask them.

It never ceases to amaze me that nurses will neglect to ask. That's what report is for.

macawake, MSN · Oct 8, 2018

Hi all
Opinions of a new grad receiving a patient with an epidural when never being exposed to one while I had a preceptor or anyone else on my floor having much experience with one?

I'm a Scandinavian nurse and what you describe would actually be considered problematic here. In order for a nurse to care for patients with either an epidural or intrathecal cathether they would have to attend a one-day class. That usually happens during orientation if your first job is in a hospital. A couple of times I've seen messages on my hospital's intranet that a certain floor won't take patients with epidurals because not enough nurses on the shift are certified. It doesn't happen often, but I've seen it a few times over the years.

Even as a recently graduated nurse you're of course expected to know aseptic technique but the class covers things like the checks you need to do apart from pain assessment and vitals, which you check for all opioid administration. Things like how to assess motor block/bromage scale, which dermatomes are are affected, urinary retention etc. Of course you also need to be aware of the signs of the possible, rare but serious, complications like for example subdural hematomas, abscesses and meningitis. When removing a epidural catheter it's important to know the patient's coagulation status and what checks need to be made after the removal.

What I've written doesn't cover everything there is to know about epidural analgesia and isn't intended as a guideline/advice. I only wrote this to illustrate why I think it's important that a nurse receives training in caring for patient's with epidurals. I work and practice in a different country and what's standard practice here might not be the same in the U.S.

OP, I echo the advice from other posters. Hopefully you have access to a clinical nurse educator who can help you gain proficiency.

I don't know if I'm interpreteing responses correctly here? It seems that other posters aren't very surprised or bothered by the fact that the other nurses on your floor don't seem have much experience with epidural analgesia either. I don't know if that's normal? Personally I find that less than ideal if it's a pain treatment method that's commonly used for your patient population.