Feel like I'm too dumb to be a nurse

[coconut3431]

I've been working as a nurse for 4 months. Today, i had a resident's family member come in and say that she (resident ) doesn't look right. The family member said they told the other nurse that she is getting worst and worst. Now, this is the first time I had this patient. So, I take her vital signs everything is normal. Her o2 was 92. I even get an rn to come and recheck her to make sure. The rn rechecks her and says nothing seems out of the ordinary but that she'll call the doctor to order blood test to make sure. So I call the doctor. The doctor tells me to get a chest xray and blood work. So i get the chest xray done, and send off for bloodwork. Chest x ray reveal pneumonia. I thought the chest xray was sent to her office. So I wait on the doctors call, meanwhile i finish passing out my meds. She calls at 5 pm and says its 5pm why haven't I call her? I tell her my reason and aplogize, she says I need to take better care of my patient. I have people lives in my hand. During my shift i an taking the residents vital signs they are normal. Towards the end of shift change i tell the nurse taking over what's going on with the patient. She goes a takes her vital signs and they are really low. They send her out and call the doctor . The doctor tells her she should be reported, and that this is unacceptable. The nurse says you right she could've died. I can hear the cna's saying she's a nurse, you think she would know. Im sitting there looking stupid. I feel like I'm too dumb to be a nurse. Does anyone have any advice, became i am thinking of quitting my job.

[coconut3431]

She called for xray at 5 pm. Doctor called back at 8p.m. Meanwhile, i am still checking her vitals signs every 4 hrs as ordered. When she called back she ordered to give kephlex. Vital signs were fine, at end of shift was a little late taking vital signs cause trying to catch up on med pass. Which is no excuse. Do shift change tell the nurse she have to do vs every 4 hrs. She says great your behind she sends cna to go take vs her o2 was at 60. We run and get oxygen bring her o2 to 100. Try to take BP it was low, nurse calls doctor. Doctor says I was late giving her xray results. Long story short she was sent out, I come in the next day the nurse tells me she had to go to icu cause she was septic. I feel really ******.

[Davey Do]

Okay. You were monitoring the patient. The doctor gave you orders for an antibiotic, based on information, including the results of the x-ray. You said, "Vital signs were fine". You reported to the oncoming nurse. Then, the patient decompensated quickly.

The doctor said, "late giving x-ray results". Moot point.

Patients are going to sometimes get worse no matter what we do, coconut.

You cannot take responsibility for the inevitable.

[Davey Do]

Since we're talking about mistakes, one just came to mind: I almost made a huge mistake last night.

Patient with a tendency to be combative is on bolus tube feedings and gets Cardizem q6hr. Two RNs from other units are working with me. Both are not "comfortable" with the feedings or med administrations. Since they may be the RN on the unit when the regular RN isn't there, I want them to be reminded of the process.

I have one RN with me for the q4hr tube feeding. Check bowel sounds, placement, residual, and the bolus tube feeding went well.

The other RN is present for the med administration. Check placement, pour crushed, diluted Cardizem into the 60ml syringe and forgot to check the BP and pulse!

Luckily, the tube was still clamped and the BP and pulse were above the "hold" parameters, but I could have made a huge mistake!

And I've been doing this for 33 years!

[AlwaysLearning247, BSN]

You didn't do anything wrong, use this as a learning experience. How do you know if the results were reported earlier that she still wouldn't be septic? She could have have PNA for a while and by the time you get IV ABX delivered to the nursing home she probably still could have been septic and sent out. You can't blame yourself. The doctor should have followed up on the X-ray anyways. You're still a very new nurse. Every nurse has stories where they wish things could have gone differently. You'll always be following up on X-rays and labs now. Good luck to you!

[smartassmommy]

Next time the CNAs start their Monday morning quarterback routine just look at them and say, "Really, where did you go to nursing school?"

They don't know what they don't know.

[Aloe_sky]

Did you ever make a huge mistake in your years as a nurse?

I once bolused versed by programming the I.V pump wrong (programmed "Versed stat" instead of Versed). BP tanked and the pt was out like a light! Luckily the nurses that were on that night didnt make me feel stupid. I honestly hate working with nurses that act as if theyve never made mistakes. Believe me, you are not dumb, I still make mistakes and I'm still learning.

Our goal O2 usually >95% but even if it goes to 92 we generally do not freak out. We have continuous O2 monitoring where I work. Some pts reading will fluctuate and alarm if it's lower than 90 or 95. Usually you will see nurses just silence the alarm and monitor it. We check the waveform, change the pulse ox or change location, a nurse I know will not even bat an eye at 88 unless she gets a 2ND reading from a portable reader....we continue to monitor à nd if still no change then we tell the Dr. The Dr will always ask how long it's been

[Cola89]

This doesn't mean you're too dumb. It means you're learning- and there's a lot to learn in practice! I think it takes a few years to hone your practice. Just be committed to learning and improving. Oh, and find a few good colleagues you can run ideas past.

[Neezy84]

I hate this...nurses pick on new nurses Sooooo much it's like they try to be better instead of taking you in and telling you what you could have done differently. Nursing is a fickle ***** vitals can change in a second if something is wrong...4 months is not enough time to figure out problem solving babes give your self more time( and experience) don't let those people make you feel differently you finished school passed your boards that's an accomplishment all in its self! It takes a special person to be a nurse. My few months of nursing was hell! I cried everyday now I'm teaching xoxo you'll be ok your not dumb but also be careful and use the knowledge I know you have

[RNrhythm, BSN, RN]

I would guess that the two most common errors at my LTAC (paper charts, no scanners) are:

1) New nurse confusing Percocet and Norco

2) Giving a med that has been discontinued/changed after you received report

[TJGJRN]

Coconut3431... you are just fine! Nursing is full of self doubt and self congratulations.

I think you are right on track and doing well at just 4 months because you took action to get X-ray and labs ordered. That's huge!! Nursing is not just about soothing and reassuring but also about taking measures to ensure "worst case scenario" is not unfolding.

I have been an RN for 38 years... it takes a tough constitution to have longevity as a nurse but these circumstances are the one's that will make you great. Yes, others will blame and say "you should have"... but YOU look at what you DID and take those criticisms as input. Imagine an invisible bubble around you so the words will not be arrows but hit your bubble and you can disseminate and consider without destroying your core; that kindness deep inside that drove you to healthcare.

There are always choices of what tasks to perform and how to prioritize...ALWAYS! You will not always choose correctly because people are living and their conditions will change even though you made the right decision at the time. Over time and experience you will note subtleties and know each doctor/NP/PA's idiocincricy's. Another provider may have checked that x-ray or called you back.

Please stay in nursing... you are JUST what nursing needs. You are not defensive but analytical. Just keep considering what you did right, what you may have done differently. In 1-2 years you will not believe how snappy and decisive your assessments and interventions are! You will have some stellar self talks on how well you are doing! It just takes time and there are no shortcuts to gaining experience.

Hang in there! It gets better and the family and patients will appreciate your being their advocate!

[Abby10]

Oh honey, if she dropped all the way to 60% with a low blood pressure she's most likely septic and has multiple systems involved. A PO antibiotic an hour or two earlier was not going to change it, maybe a day before. Could you have called the doctor with the result, yes, could you have checked her sat when you have her the med, yes. Would it likely have changed her going to the hospital no, at least when you sent her in they knew why. Live and learn.

[BlueDawnRN, BSN]

None of this is your fault. It's not your fault that you didn't know the MD wanted you to call back with results, and not your fault the patient was septic. The patient would have been sent out either way. You did the best you could and the patient is getting the care s/he needs.

Yes I've made lots of mistakes, some big and some small. We've all made them and we all know what it's like to come home feeling like crud and doubting our ability to go on. I find that it's rarely one person's fault when a mistake is made. It can always be traced back. Did they cover in orientation the protocol for communicating test results to the MD? Doesn't sound like they did. Did the doc ask you to call back with the results? Nope. You were monitoring the patient. Septic patients can go downhill suddenly and fast.

Next time a patient is septic, you might be the first to recognize it.