I am in my 5th week off orientation, trying my hardest to stay positive.
Today was by far one of the most challenging, frightening, and stressful days I have had yet.
The dept was full to the brim with patients, and I just don't feel like my skills are up to par yet.
At 7a, I had a "hold" waiting for a bed, who needed about 15 am meds, had a blood sugar of 388, needed regular insulin, NPH insulin, fluids, 2 units of blood, a MgSulfate bolus, and hourly pedal pulse checks in addition to q3 hr H+H draws. (leg hematoma post ortho surg, low H+H)
-- I can't recall if I documented the pedal pulses hourly, I neglected to mix the two insulins because I was so focused on getting all the meds out that I overlooked that option (which the patient called me on... ugh), I'm reasonably sure I should have re-drawn the H+H and never got to it before he went up to the floor because....
my next patient at 7a was a Telemetry hold, who also had about 15 am meds, was kept NPO per orders, and the MD never wrote for the pt to have a stress test, had a sliding scale ordered for insulin but the doc never filled it out the sheet, and needed IVF @ 80cc/hr that I never hung because.....
my next pt was a psych hold waiting for crisis evaluation, who was never sectioned and never had security put with her per the NOC shift because she was not SI/HI and was compliant....
She ended up signing out AMA.
Shortly after patient #1 left the dept, around 11am, a second was placed in that room that ended up going to ICU, because he had a pericardial effusion, 10mm pulsus paradoxus (10 point drop in BP with inspiration?), and an INR of 3.8. He needed Vitamin K, 2 units of FFP, and had an 11 beat run of VT that I had to give 40 meQ of Kcl for.... while the first 10 meQs were infusing, he began to have burning at his one IV site.... so the float RN had to pick up my slack and start another...
Shortly after this pt left, I got another pt in my next room who had a HR of 160, mild CP, hx of NIDDM, lowish BPs..... needed IV Lopressor, IV Dilt, several EKG's, and the person who drew his blood in triage didn't draw a troponin.. so that was added on late (MD wasn't happy)
And while I am trying to manage him, I have another lady plopped in my room who ends up having an elevated troponin... along with her K being hemolyzed and her cbc being coagulated, both of which have to be redrawn.
The other older lady I have in my 4th room around 4 in the afternoon ends up having a PE. Fabulous.
I feel like all I did during this shift was put out fires that I created by being slow, unfocused, and frazzled.
I feel like I would be a better trashman than I am a nurse
Here's to you...:cheers: You really did a wonderful job holding it all together, you REALLY did. I can tell you are going to be a great nurse, just hang in there. Maybe your next shift will be much better. :redpinkhe
as others have said, they were all alive when you left!
you have a great eye for detail and triage, and i would let you be my nurse any day. i've got 15 yrs in (not er!!) and a shift like that would find me under a gurney in fetal position!
pepperann35
163 Posts
Here's to you...:cheers: You really did a wonderful job holding it all together, you REALLY did. I can tell you are going to be a great nurse, just hang in there. Maybe your next shift will be much better. :redpinkhe