Checking in after one month

[nurse4theplanet, RN]

Hello my allnurses buddies!

It's been awhile since I've had time to cruise the forums, much less post anything...but here I am after one month of being on my own.

Orientation lasted six months after graduation. My first preceptor put in her two weeks notice half-way through my orientation (had nothing to do with me lol), so I had to switch to a new preceptor to finish out.

And they were as different as night and day, to say the least!

But I survived, and now I have been a real nurse (carrying the full responsibility) for a full month. It has felt like an emotional rollercoaster.

Sometimes, I beam with pride when I see myself picking up on things quickly. But most days I feel dumber than dirt, like all my self-esteem has been ripped away. I am amazed at how many questions I have still. Not about pt care and conditions, necessarily; I expected that. More about paperwork, facility policy, etc. reguarding situations that never arose during my orientation.

Everyone is very helpful and supportive, which is why I chose this particular facilty and floor (ICU). But sometimes you ask a question and get 4 or more different answers! LOL

I don't feel like a nurse at all, but I don't feel like a student anymore either. It's a strange place to be in..."new grad". In school, I excelled among my peers. But in the real world, my skills are as green as they come surrounded by nurses with years of experience. That transition alone is difficult. I am very aware of my lack of confidence and I keep telling myself that it is going to take time to feel comfortable (semi) in my role. Maybe "seasoned" is a better word. I'm getting good feedback so far. I hope I keep doing well and start to feel more confident.

[Diary/Dairy, RN]

Keep up the good work! Being a new nurse will be different than anything you encountered in school and the transition will be a bit of an eye opener.

As for why you get different answers from different nurses, every nurse will process information differently....You have to find your own answers to be able to explain things to your patients. Allow your more experienced peers to guide you, but come to your own conclusions. Things are going to get better as you get more comfortable of your skills and knowledge.

[pagandeva2000, LPN]

I feel like an idiot as well. I constantly worry about what to do in case of an emergency, or if I am gaining enough experience in the clinic I work in. At times, I think that the patients and family know more than I do. But, when I compare between what I knew when I started to now, a year later, I did learn more than I thought. It is just that there is so much more to learn.

What gets to me is that many of the things that are actually happening are not written in the resources I was told to count on such as drug guides, books or such. Someone told me the other day, for example that a heparin drip must be hung with normal saline. I never had to do this (I worked only 6 weeks of med-surg as part of my orientation), but I plan to work there again per diem and if I had seen an order for heparin drip, and normal saline was not also included, I would have hung that joker alone! My drug books don't say anything about this!!

What I do know is that experience is the best teacher and I have to have the faith that the Creator will protect me and my patients because my intent is good, I do not want to harm. I will keep asking questions until I fully understand, I continue to visit this site because it has loads of information and I also read periodicals to be updated as often as I can. You'll be okay; just be sure you don't act like a know it all. Those are the worst, and people will let them hang themselves.

[nurse4theplanet, RN]

I know exactly what you mean about "unwritten" policies and things that others just expect you to know because, "everybody knows that." For example, our radiologists won't read XRs after hours unless its a dire emergency and they get a call from a physician. So there is no such thing as a stat PCXR for NGT placement (which is the hospital policy) at 3AM. I spent an hour one night trying to track down the XRay tech and figure out why my PCXR was not done because I had meds to give and TF to restart before another nurse finally explained to me that it would not be done until 6 or 7am and that "everybody knows that."

[Mommy TeleRN, RN]

Pagenda...I do not recall having NS the couple times I've had a pt on heparin drip. Are you sure the person who told you that was right? Perhaps "they" had a misunderstanding?

[NotReady4PrimeTime, RN]

Pagenda...I do not recall having NS the couple times I've had a pt on heparin drip. Are you sure the person who told you that was right? Perhaps "they" had a misunderstanding?

Hmm... when I mix up a heparin infusion I always use NS as the diluent. It can be mixed with dextrose or Ringer's but our standard practice is to mix it in NS. Perhaps that's what was meant, pagandeva. We mix it so that 1 mL per hour gives 10 units per kg per hour and run it at the ordered dose.

[pagandeva2000, LPN]

Pagenda...I do not recall having NS the couple times I've had a pt on heparin drip. Are you sure the person who told you that was right? Perhaps "they" had a misunderstanding?

I can only state what the person told me. I have not ever had to hang it before, so, I wouldn't know right now. What worried me is that my friends are telling me there is no policy. I plan to start working med-surg per diem in my hospital really soon, and would like to know before I do something unsafe. I have only been an LPN for a year, and am working in a clinic, after doing 6 weeks of med-surg orientation. There are a few things that would make me wonder, now, after hearing this, and if this occurs, I have to see a policy. I didn't see such documentation in my drug books, so, inquiring minds certainly want to know.

[pagandeva2000, LPN]

Hmm... when I mix up a heparin infusion I always use NS as the diluent. It can be mixed with dextrose or Ringer's but our standard practice is to mix it in NS. Perhaps that's what was meant, pagandeva. We mix it so that 1 mL per hour gives 10 units per kg per hour and run it at the ordered dose.

Thanks for the clarity. Is the NS hung as a piggyback that runs free?

[NotReady4PrimeTime, RN]

Thanks for the clarity. Is the NS hung as a piggyback that runs free?

Not unless we're having patency problems. Our patients are usually pretty fluid restricted. Let's use a 10 kg post-op Glenn shunt patient as an example. Their total fluid intake for 24 hours would be 500 mL or 20.8 mL/hr, and would have to include three pressure lines each running at 3 mL/hr, morphine at least 1 mL/hr, midazolam at least 1 mL/hr, milrinone at 1.5 mL/hr... so we have about 8 mL left for the heparin, maintenance and any other infusions we might need. So to mix the heparin at our standard concentration of 1 mL/hr = 10 units/kg/hr, I would mix 5000 units of heparin in a total volume of 50 mL NS and run it in with whatever it's compatible with. If I have to run it peripherally then I might put either a D5W or NS drive running at 1 mL/hr behind it to help maintain the IV, but I'd be taking that 1 mL away from something else. I know for people who don't work peds cardiac surgery that sounds pretty bizarre, but it's what we do.

[Mommy TeleRN, RN]

Jan that makes sense. Pharmacy mixes ours so I didn't even think about the NS that is IN with the heparin. Pagenda maybe that is what the person meant?

I wonder if they meant that you shouldn't run other things with heparin besides normal saline? Although there are things that are compatible with heparin (can't name them right now being a newbie lol..but I know I've seen it in compatibility charts..although you have to be SUPER careful of dosaging...of course I was taught to get a 2nd nurse to do the pump with you to avoid making an error)

So much to learn huh? One day we'll be the seasoned pros teaching the newbies lol