day 2! and i left sobbing!!!!!

[erin01]

hi,

i hope you guys can help me feel better:crying2: I was just let of orientation i work on a tele unit and was really nervous to be on my own. But the first night went really well, i really felt supported with everyone willing to help. But it has back fired! I had a crazy night of a pt getting bld, no nt, and 5 patients one of them a new admit from er. When i got report she was on a cardizem drip going at 10cc a hr. hr was 132 but had drop down. now i have never had a patient on this before so i was already panicking and asking everyone about it .I know cardizem is a serious cardiac med and iv even stronger. When the patient came up her med record had orders on how to adjust the rate according to her heat rate! this made me even more nervous and i stopped and asked again, at this point i was told to increase it since her hr was still 132 and see how she does and if no change call the dr! Well this made me nervous again so i kept asking different people and getting different answers! Finally some one step up and said we are never to touch this rate! and stopped the med told me to take her bp and called the dr!!!!!!! whole******* to say i was up set is not the word. I knew something was wrong, but i also thought i had support and it back fired. I have never felt so bad! i was overwhelmed all night and then this=( By the time i was to leave i was in tears but made it to my car. I got a call from my manger who explained it was not my fault but we are never to titrate meds on this unit! Well now i know that!!!!!!!! But i really feel discouraged and am really thinking of quitting. I dont work again for a few days so its giving me time to think about it and figure out what i want. I expressed my concern to my manger that there are a lot of new nurses on this unit, and one of them i was working with that night! I asked her if she new this policy and she said no! so i told him something must change since u have new nurses there has to be away to make sure we all know this before we let off orientation! any thoughts or adv? I just think if i wasnt smart and new something was off........ this situation could have been sooo much worse!

[Tait, MSN, RN]

First off... :icon_hug: it's ok!

Second...take a nice, slow deep breath.

Ok now continue to breath as you read this :)

Welcome to the floor! First off I am sorry you had a rough night, but it is definitely just a part of learning. You will have great nights and you will have awful nights (and it totally ok to cry after the bad ones, and sometimes even after the good ones!). As you progress and learn the bad nights will become less and less I promise!

I work on a complex cardiac floor with lots of drips etc and even we also do not titrate Cardizem or Nitroglycerin to name a few. In fact the only drip we adjust at all is Heparin per a protocol, so when in doubt, call the supervisor! It sounds like there are a lot of mixed responses on the floor and this further forced a decline in your night. Try to find someone you can rely on, who is knowledgeable on your floor, and if you can't, talk to your manager about who you are scheduled with for awhile until you get all the protocols under your belt.

Also try to find where procedures/protocols are listed so you can research your own answers if you aren't getting what seems to be the right response from your floor.

Remember nursing is a complicated balance of speed, knowledge and reactions, but have faith that eventually those pieces fall into place. Already, just from this one incident, you will never forget that Cardizem's base rate is 10ml/hr and that if it isn't controlling the heart rate you need to call the MD, and that it is not titrated on the floor.

Now this doesn't mean that every lesson has to be difficult, but be aware many of them are.

You will be ok!!

Take Care,

Tait

[erin01]

THANK YOU!!!!!!!!!!!!!

[CrunchRN, ADN, RN]

Hey girl - tele units are the toughest!

You learned a lesson that you will never forget - cool!

No patient was harmed - cool!

Other shifts will be much easier than this or at least seem that way - cool!

Rest up and carry on!

[Lucky0220]

I've been reading your posts and it looked like things were going better for you. I am so sorry you are having these issues. It is not fair for new grads to have to go through this! What I do not understand, tho, is there not a charge nurse on the unit during your shifts? Especially if you are saying that most of the nurses are new. Tait always has great advice; I hope things get better.:heartbeat

[erin01]

i believe it was charge who told me to titrate!!!!!! i went to her because i had her as a precept before which is why i did the titration, and it was a fairly new nurse that caught the error

[twinmommy+2, ADN, BSN, MSN]

Sometimes the docs try to squeeze by and get a cardizem drip admitted to the floor. I have seen that done once but the patient was not to be titrated, just continuous at the same rate.

I hope you have a better night next time, and keep it up, you were right to keep asking for help and when something doesn't seem right it usually isn't. Go with your gut.

[Tweety, BSN, RN]

Sounds dreadful. There are going to be many many days like that I'm afraid. Your coping gets better with time. Take care of yourself.

[CaitlinLiz]

That really stinks. Although I can't say I know exactly how you feel I had a couple of run ins like that when I was in my CNA program. It's frusterating when you get completely different answers from everyone it pulls you in a million different directions. I hope your next shift is so much better!

[morte, LPN, LVN]

seems this problem went all the way back to who ever accepted the admit.....should have been going to the unit....

[highlandlass1592, BSN, RN]

seems this problem went all the way back to who ever accepted the admit.....should have been going to the unit....

Uh, Cardizem doesn't necessairly need to go to the unit. There's some info we weren't given here, like other VS.

[highlandlass1592, BSN, RN]

I'd concur with other writers that you need to become more familiar with your unit's policies and procedures. It also sounds like you need to do some studying at home regarding common meds you may have to use on your floor...the more you understand about how a med works, the less you will panic when you are presented with a patient needing that med. Nursing Made Incredibly Easy has a couple of great books..one on Pharmacology which may help as well as a book on Critical Care which could help you gain understanding of how the meds will affect multiple systems on your patients. Keep at your studying, it will pay off.