2 cents?

[carbaminohemoglobin]

i just started a new job after taking maternity leave and i feel like i'm quickly developing the reputation of being an idiot...

1) one night in the beginning of a holiday weekend, my cmt told me we were out of a psych med for a pt. when my supervisor came around, i told her.. she told me to call the emergency pharmacy number and get it re-ordered asap, which i did.

2) same night, a pt, with history of cva, crawled out of bed. he was way more confused than usual. speech was slurred. he was leaning to the side; couldn't stand up straight. wouldn't raise his head to look at whoever was speaking to him. could barely walk. vitals were stable. just started on xanax tid 3 days ago and had 6 doses of the new order. called supervisor. since he was previously a hospice pt, she called the family for direction. family wished to go with dr's orders, so, under her instruction, i called him. the dr was ***** that he was called at 0030 for a pt who was lethargic; "it's the middle of the night, i'm lethargic too! we'll deal with it tomorrow!" and hung up.

apparently, the day nurse that relieved me received calls from:

--the pharmacist: he called to follow up on the psych med order. the day cmt found a few extra doses hidden in the card that my cmt had overlooked, and because of the doses found a rush delivery wouldn't be necessary.. this was relayed to the pharmacist and he was ******.

--the dr: he was mad because he was called in the middle of the night for someone who was lethargic. "let him sleep it off, for christ's sake! he'll be alright!"

--the family: they were worried about dear old dad. they thought he was "on his deathbed." the day nurse made it sound like no big thing and the family ended up being upset; thought we had made them worry unnecessarily.

the day nurse told her supervisor and several other people that i had been calling the dr and other people all night for "stupid things" and that she had to clean up my mess all day. when all of this got back to my supervisor, she stuck up for me, but the damage had been done. gossip had ensued.

yesterday evening, i was relieving that same day nurse and was told in report that a certain pt had been acting strangely. later in the shift, my cna told me this pt had dark, foul-smelling urine. checked her vs; they were fine. i wrote up a little note and faxed the dr. anyway. when i gave report to the oncoming nurse (different day nurse this time), she told me that was her normal behavior & somewhat scolded me for faxing the dr. with it.

the facility is in a bad part of town and there have been problems with strange men hanging out in the parking lot.. when i took my break, i spotted a man i'd never seen before, in street clothes, sans badge, walking behind me. i went to my car and locked the doors. by the time my break was over, he hadn't left.. i was afraid to walk back in! i called my job and asked for a friend to meet me at the door. she called the supervisor, the supervisor brought 2 big male employees downstairs with her. my cell phone rang and the supervisor told me that everything was okay; i could come back inside. when i got in the lobby, there was the guy, the super, and the 2 male employees; they all laughing (except the strange man i saw). i guess he was an employee that never wears scrubs and had forgotten his badge.

oh my god! how much could go wrong?! it just seems like one thing after another.. i didn't think i was an idiot, lol, but maybe i am... this is really getting to me!

[mom4josh]

I don't think you're an idiot. I think you have had a couple of incidents that have thrown you for a loop, and you're probably nervous since you have been off for a while on maternity leave. Don't worry! Take a deep breath, try to remain calm, and maybe just take a minute before you make decisions. If you have a close friend at work who understands the situation, maybe you could talk to her to get some perspective and advice.

On the situation where you were on your break, I don't blame you for that at all. Anyone who works there should have their badge on at all times, whether they are in scrubs or not. You had every right to feel intimidated. But you are okay, and that's what's important.

Try to shake everything off and start over your next shift. Good luck!

[Sparrowhawk]

Awww honey!! *hugs*

[crb613, BSN, RN]

If I had a pt acting as you describe...I would be taking action too! I have seen these symptoms before and od/stroke comes to mind. So ALWAYS go with your gut! If it turns out to be nothing....fine! What if it were the other way and you had not called???? I will advocate for my pt if I notice any change that I feel needs attention. If the doctor, other nurse are upset...oh well! Don't doubt yourself, you seem like you are trying to do the best for your patients so never apologize for that. I would in the future double check on the meds before I placed a call. The guy in the parking lot....yeah I would not have trusted that either!

[silentRN]

you just gotta remember, we're all idiots who pretend to know something. I've come to the conclusion that no one knows anything. Just gotta go with it.

[noahsmama]

Everything you did sounded like the right choice to me, with the possible exception of not double checking if you were really out of the first pt's psych meds or not. I'm glad to hear that your supervisor stuck up for you. Hang in there!

[PostOpPrincess, BSN, RN]

I call that the "post-baby syndrome."

It lasts until you get rest and sleep. I think by the time your baby goes to school...j/k you just need to find your groove back...

[TakeOne]

To me, it sounds like you did just fine. I'd have called the pharmacist and the doc too if I had these same events to deal with.

The only thing I might have (might have) done differently is check the patient's med card myself first before calling the pharmacist. But I wouldn't waste time kicking myself over it and neither should you. Besides, you ran this stuff through your supervisor first and were instructed to make the call. Your supervisor didn't check the card either and didn't suggest that you check it, so there you go.

Never mind what the nurses on other shifts say. It means nothing. You did what you were supposed to do, and if you got it all documented you should be sitting pretty right now.

[carbaminohemoglobin]

thank you all! i feel better now..

about the psych meds: looking back, i suppose the issue could have been prevented by checking the med cart myself. i didn't, because it was the cmt's cart! i'm approached by cmt's fairly often when a med needs to be reordered & if it's not a narcotic (i double check those), i just go ahead and reorder it.. the "hidden doses" were in a part of the cart that the evening/night cmt doesn't venture... nevertheless, the next time i find myself needing to reorder a med asap on a holiday weekend from a mom-and-pop pharmacy after hours, i'll check myself. lol!

thanks again!! :]

[back2bRN]

Give your "baby-brain" some time to re habituate to work... we've all been there, even the ones who adamantly deny it. At least you are aware of things. Good luck!