i feel like a horrible nurse

Virgo_RN, BSN, RN · Dec 19, 2007

It sounds like you learned some things, and I certainly hope that things work out for you. One thing that I would have done differently is that, upon noticing the inordinate amount of drainage, I would have asked another more experienced nurse to assess the dressings with me. I really feel that being new, asking for help is one of the best ways I can protect the patient and myself from my own inexperience. Fortunately for me, there are several experienced nurses on my unit who love to teach, and don't mind at all when I ask for their help.

One of the best pieces of advice I got when first starting out was to identify my allies; people whose experience and skill I respect, and keep their phone numbers on my brain sheet in case I need any help.

The other piece of advice I got was to triage my work. Instead of trying to get everything done, identify the most important things that needed to be done and do them first, then work on everything else. Keeping the dressing CDI would have been high on that triage list. Some other things might have fallen by the wayside to be passed on to the next shift out of necessity.

Lastly, the feedback that I keep hearing about the new grads (our floor is sometimes nearly fully staffed with new grads on a bad night) from the more experienced nurses is that it's the ones that don't ask any questions and don't ask for help that they worry about the most. It is a virtue to ask, ask, ask!!!!

Edited to add: I know that "I'm a horrible nurse" feeling well. The other night I worried and worried and worried that I had chosen to withold a beta blocker from a heart failure patient. I had my rationale for doing so, and even ran my decision past my charge nurse and asked if I should call the doc. He said no, just make sure that I document. Well, I couldn't help but ask a couple of other nurses, and they gave me their thoughts, I went home and looked in my pharmacology text, and came to the conclusion that the patient really needed that med and that I was a bad nurse! I was also worried the doc would come in for rounds in the morning and be furious that he hadn't gotten a call. I worried myself unnecessarily, because as it turned out, the doc discontinued the beta blocker the next morning. My instincts had been right, and I had wasted precious time beating myself up completely unnecessarily.

MrsCannibal · Dec 19, 2007

This is a real learning experience, and I will bet you will do things differently the next time...like nancynurse08 said, ask questions! Find someone to mentor you, someone that you feel comfortable with. I don't really believe that nurses eat their young; as a new nurse, I found too many experienced nurses who were more than willing to share their insights, time, and expertise with those of us who simply asked. Good luck, I hope this works out in a positive way for you.

cpnegrad07 · Dec 20, 2007

from NancyNurse08 "The other night I worried and worried and worried that I had chosen to withold a beta blocker from a heart failure patient. I had my rationale for doing so, and even ran my decision past my charge nurse and asked if I should call the doc. He said no, just make sure that I document. Well, I couldn't help but ask a couple of other nurses, and they gave me their thoughts, I went home and looked in my pharmacology text, and came to the conclusion that the patient really needed that med and that I was a bad nurse! I was also worried the doc would come in for rounds in the morning and be furious that he hadn't gotten a call. I worried myself unnecessarily, because as it turned out, the doc discontinued the beta blocker the next morning. My instincts had been right, and I had wasted precious time beating myself up completely unnecessarily."

NancyNurse08--why are we left to make these medical decisions? This "system" is broke; if a medical decision is needed, a doctor needs to make it. If that means having their cell number, we should have it. If it means hiring a doctor to stay on the floor, then the doctor should be hired. Instead, we are left holding the bag. And, in the end, the pt is the one who will suffer the consequences of this fragmented, herky-jerky, crazy-quilt "system" that we have.

I tell my friends, "If you get sick, try to avoid the hospital." Now, that says it all!!

Virgo_RN, BSN, RN · Dec 20, 2007

NancyNurse08--why are we left to make these medical decisions? This "system" is broke; if a medical decision is needed, a doctor needs to make it. If that means having their cell number, we should have it. If it means hiring a doctor to stay on the floor, then the doctor should be hired. Instead, we are left holding the bag. And, in the end, the pt is the one who will suffer the consequences of this fragmented, herky-jerky, crazy-quilt "system" that we have.
I tell my friends, "If you get sick, try to avoid the hospital." Now, that says it all!!

Why? Because we are thinking nurses, not doctors' handmaidens.

I *never* tell people to avoid the hospital if they're sick. Every thirty three seconds, someone in the US dies of a heart attack. The number one reason they die before reaching the hospital is because they delay seeking treatment. I, for one, want people to get to the hospital as soon as possible if they're having chest pain so that we have a better shot at saving their life.

Tait, MSN, RN · Dec 21, 2007

I agree with Nancy.

As a respectable and extremely valuable sector of the healthcare system nurses are trained to make decisions about our patient care. I greatly value the autonomy I have to make delicate and timely changes to my patients care. I often feel that nurses have a much stronger knowledge of subtle medication affects, we have the baseline of our pt there in front of us and our hands on the situation to help us determine wether to give that beta-blocker or not. I feel this is much safer than a sleepy doc at 0600 who might not even have the chart at hand in thier home.

Sometimes we make the right choice, sometimes the wrong, but so does everyone else. We are human after all, the best we can do is do our very best, strive to go beyond that, and take responsibilty at all times.

Taitter

emersushea · Dec 21, 2007

Thank you so much for your advice. I know I made a mistake and a pretty big one at that. I definitely have learned from it and know, that being a new grad, I unfortunately will probably make more. It is a huge learning process. In future situations, I need to think more critically and take more time making decisions but most of all, consult with my coworkers. Patient safety relies on it. So far I haven't heard anything from my nurse manager about the situation but I still have fears.

Regarding the post from CPNEgrad07, it is disheartening that physicians (especially at night) are so difficult to get ahold of but I believe it is our duty as nurses to be knowledgable and capable of making "medical decisions" such as holding a beta-blocker if our patient's condition warrants it. We must maintain the safety of our patients and many times, we know more about our patient that a physician might. I completely agree with you that the system is quite chaotic, and I understand where you are coming from with your comment about avoiding the hospital, but the majority of patients leave in a better condition than they came in with.

Virgo_RN, BSN, RN · Dec 21, 2007

Yes, you are going to make mistakes. But if you use your critical thinking and have a defensible rationale for everything you do and collaborate with your fellow nurses whenever you are uncertain, your chances of making those mistakes will decrease.

On calling the doc, at my facility we are required to run it by the charge nurse first so that calls can be batched. The CN decides if it's urgent enough to call now or if it can wait, or if a call needs to be made at all. A nurse can always disagree and call anyway if in their clinical judgment such an action is warranted. In my case, it is a scope of practice issue, as I am required to run my decisions past an RN. My CN did not think that my witholding a beta blocker warranted a call to the cardiologist. My preference would have been to call for parameters, but I deferred to my CN's greater experience and position of authority, and documented my actions thoroughly.

I'm not a big fan of "the system" either. But I do appreciate that nursing is an autonomous profession and that we are required to use our minds to think critically and make clinical judgments. If that were not the case, I would not be a nurse. I also appreciate that nursing is collaborative and am a huge believer in that. I don't think we should be practicing in a vacuum, but rather, should be helping one another with that critical thinking piece.

nursemike, ASN, RN · Dec 21, 2007

Thank you so much for your advice. I know I made a mistake and a pretty big one at that. I definitely have learned from it and know, that being a new grad, I unfortunately will probably make more. It is a huge learning process. In future situations, I need to think more critically and take more time making decisions but most of all, consult with my coworkers. Patient safety relies on it. So far I haven't heard anything from my nurse manager about the situation but I still have fears.
Regarding the post from CPNEgrad07, it is disheartening that physicians (especially at night) are so difficult to get ahold of but I believe it is our duty as nurses to be knowledgable and capable of making "medical decisions" such as holding a beta-blocker if our patient's condition warrants it. We must maintain the safety of our patients and many times, we know more about our patient that a physician might. I completely agree with you that the system is quite chaotic, and I understand where you are coming from with your comment about avoiding the hospital, but the majority of patients leave in a better condition than they came in with.

When I was very new, there was one neurologist I dearly loved. I was often pretty anxious about paging doctors--at the time, just using the paging system was a bit of a challenge. But she was great about never making you feel like an idiot, even when you were one.

So one night, after I was getting more-or-less comfortable working as a nurse, I had a patient who'd been admitted just before I came on, and turned out to be a bit of a nightmare. The resident on call was very new, and I was getting pretty close to panic, and at one point the resident took a call from the aforementioned doc--now his senior--and after speaking to her, handed the phone to me. So this wonderful, lovely doctor whom I jokingly called my future fiancee, pretty much read me the riot act. Completely civil, the whole time, but the worst part of the whole deal was, she was absolutely right. Did that ever sting!

I spent a fair part of the next day reviewing the situation in my mind, and learned a lot in the process. For one thing, when it was clear the resident on call was at a loss, I should have gone over his head, to her, right away. For another, I had five other sick patients to care for, and while I did ask the resident whether maybe this patient was too acute for floor status, myself, my CN, and two other nurses participated in this patient's care that night, and if I had it to do over, I'd be raising heck to get her into an ICU bed, or at least stepdown, until she was more stable.

It all worked out in the end. We got her stabilized, and she was fine, but as my sweetheart said, "This is unacceptable."

During a couple of tough nights in orientation, my mentor was prone to say that times like these build character (so it was good to have them during orientation). Character building doesn't stop after orientation, and it is good, but it also sucks.

Pediatric Critical Care Columnist · Dec 21, 2007

I'm so glad I work in an ICU in a teaching hospital... We are given a lot of autonomy, but we also have almost immediate access to a physician who knows enough about the patient and the plan for the shift that things get done ASAP. At the same time, I sometimes resent the fact that they're there ALL THE TIME! I've had shifts where one or more of them were in the room with me for the entire shift, tossing out verbal orders left and right but not bestirring themselves enough to get off the chair, walk over to the chart on the overbed table and write any of them down.

I've been doing this job for a long timenow and has earned the respect of the physicians I work with. If I make a decision over some facet of my care that is demonstrably in the patient's best interest without seeking an order first, such as holding a diuretic when the fluid balance is getting quite negative and BP is borderline, I know when I do talk to a doc, they'll agree with my choice. But reaching that state has taken me years. I've had to prove myself to seven different intensivists and a slew of residents. As Nancy said, if you've used critical thinking, taken a poll and can provide good rationale for why you made a choice, then you're a good nurse.

cpnegrad07 · Dec 22, 2007

I agree with Nancy.
...nurses are trained to make decisions about our patient care. I greatly value the autonomy I have to make delicate and timely changes to my patients care...
Taitter

trained--yes.

autonomous--no way.

I, too, would like to make necessary adjustments and even initiate solutions which are now out of my scope, but that is not the way it is. Yes, you can do that, and you can get away with it IF 1. the doctor knows and trusts you and 2. nothing goes wrong. But if either of those are not met, you are on your own.

We talk about autonomy in school or whatever, and i would welcome the opportunities that it would bring, but the fact is, we are the handmaidens of the hospital. If we weren't, why would janfrn write:

"I've had shifts where one or more of them were in the room with me for the entire shift, tossing out verbal orders left and right but not bestirring themselves enough to get off the chair, walk over to the chart on the overbed table and write any of them down."

???

GrumpyRN63, ADN, RN · Dec 22, 2007

There are 2 ( and sometimes 3!) sides to every story. The nurse, the pt,and the doctor in this case. I think you presented your side honestly and clearly. I think you know you could have done things differently,and now know next time you can {and will** You believe the pt didn't vomit, then she tells the doc another story...you will never know. You can't beat yourself up. Next time you will just check and change the dsg if it needs it, you are learning and will continue to do so your entire career. Certaintly doesn't sound like anything you should be terminated over. Good luck, you'll be just fine