Feeling Incompetent

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Specializes in Nursing Instructor.

OK so here's what happened. I work in a freestanding rehab facility. I had a patient last night who was supposed to have a PEG tube placed and she had to go over to the hospital to have it done. While she was there, her respiratory status dropped and they were unable to do the procedure. They sent her back to us after stabilizing her. When she returned, I immediately took a set of vitals and called the doc to find out what he wanted me to do with her. The regular doc was not on call so I got a different one. I was told to go ahead and restart her IV fluids D5 & NS at 100 cc/hr. Here's where my newness in the field takes over. I restarted her fluids and documented in my nurse's notes the conversation that had taken place with the doc on call. The original order for the IV had not been discontinued. This was exactly what she was on when she left us 5 hours prior. So what I didn't know was that I needed to write a new order for it. I also didn't know that I was supposed to write the conversation with the doc in the PROGRESS notes NOT the NURSE'S NOTES.

So, we have this charge nurse who has been a nurse for 15 years. Everytime I ask him a question about ANYTHING I get like a deer in the headlights look. (No you Moron Lactated ringers will not help maintain her glucose levels!!! He actually asked me this the other night when this same patient's BG was 78, she was NPO and I had no way of keeping her up. I called the doc myself and got her changed to D5&NS) There was an order in this patients chart to notify DR. So&SO about this patients condition and what had happened with her PEG tube placement. When I went to take the order off last night he said there is a note here to do that in the morning so it is taken care of...don't take it off basically.

SO at 8:30 AM I get a call from the Assistant DON wanting to know what happened with this patient and where did I get the order to start the IV on her? And why wasn't Dr SO&SO notified of the changes? I explained to her what had happened and she set me straight about how it should have been done. I understand that ignorance is no excuse, I should have asked questions. But what I don't get is why she had to make me feel like a total idiot in this conversation. I also explained what happened with this charge nurse to her and she said she already had a call out to him. Here is my concern there, he has been known to lie to get himself out of trouble before. Is my license on the line for this already?

I have to go back in there this afternoon and my confidence is now in the toilet. Maybe I should just give up now and call it a day?

Specializes in OB, ortho/neuro, home care, office.

Well - I think it will be okay. You will need to write the orders you took, and the doctor will have to verify it. As long as you talked to him, and put it in your nurses notes, you will have a time and what was said. Just transcribe them into a progress note and that should take care of it by most accounts.

Specializes in Nursing Instructor.

Thank you for the quick response. I am sure it will be OK, my confidence is just a little shaken. The assistant DON really was very nasty about the whole thing and quick to point out that as things stand right now it is my word against Dr. SO&So and that she was pretty sure this doc would not back me up. I asked her why wouldn't she and her response was Why would she? I am so confused I don't even know what to think right now

Specializes in OB, ortho/neuro, home care, office.

I still think, if you wrote it in your nursing notes then you will be fine. I don't feel your DON was justified in being that way to you. I think you should remind them that you are still new, and that your sorry for the mistake, but you will take care of getting the order written when you come in, because you DID take an order. Who cares what the doctor says now as long as you get the order written before he/she gets a chance to change their story. Go in this morning if you have to and take care of it. It really shouldn't be this big of a deal, it was an honest newbie mistake for crying out loud.

Specializes in Nursing Instructor.

OK Apparently there is much more to this story than I am even aware of. I just spoke to the charge nurse on duty right now. I called to find out if they needed me to come in now and write the order as a late entry. She told me not to worry about it, look at it as a learning experience and that we would fix it when I get in this afternoon. But she also said that I was not the only one who was called on this patient (I get the feeling that it was also more than the deer in the headlights guy) and that she would explain it all to me when I get in today. Now I am wondering what the heck happened after I left at 11:30 last night. The patient was fine when I left with all VSS and a half bag of D5&NS still runing at 100cc/hr via PICC.

OK Apparently there is much more to this story than I am even aware of. I just spoke to the charge nurse on duty right now. I called to find out if they needed me to come in now and write the order as a late entry. She told me not to worry about it, look at it as a learning experience and that we would fix it when I get in this afternoon. But she also said that I was not the only one who was called on this patient (I get the feeling that it was also more than the deer in the headlights guy) and that she would explain it all to me when I get in today. Now I am wondering what the heck happened after I left at 11:30 last night. The patient was fine when I left with all VSS and a half bag of D5&NS still runing at 100cc/hr via PICC.

Know that you are going to survive this. PLEASE! I see that pounding heart, and it makes me feel so sad the way new nurses are treated. I can only imagine how many new nurses are going home getting ulcers worrying about losing their licenses after someone has ripped them apart for "not knowing". This is not a job you learn in a few weeks or months. I have been doing this for 30 years and am still learning new things all the time. Try not to let these people make you feel incompetent. You at least documented your conversation with the Dr. I would have charted it in the nurses notes as well.

Specializes in Nursing Instructor.
Know that you are going to survive this. PLEASE! I see that pounding heart, and it makes me feel so sad the way new nurses are treated. I can only imagine how many new nurses are going home getting ulcers worrying about losing their licenses after someone has ripped them apart for "not knowing". This is not a job you learn in a few weeks or months. I have been doing this for 30 years and am still learning new things all the time. Try not to let these people make you feel incompetent. You at least documented your conversation with the Dr. I would have charted it in the nurses notes as well.

Well I made it through work yesterday. I got called into the Assistant DON's office and spent the better part of an hour crying. She really was wonderful and basically told me that she didn't intend to upset me so much. She had just gotten reamed out by the docs and had calls out to three of us. But her point was more to say hey you screwed up, this is what you should have done. She told me in her words that right or wrong she will always back me up to anyone... of course if I am wrong I will get reamed out later. She also told me that she thinks that I have real potential, otherwise I wouldn't have been in there. She would have just written me up officially and called it a day. I came out of there feeling much more comfortable in my position and with my DON.

As far as the charge nurse who was there, he tried very hard to hang me out to dry. Denied ever having seen the order. I was told that they were taking my word for it and not his. They know what he is like and the DON said that she didn't want me to feel like my hands were tied when he is charge. She gave me some options I have if I ever question anything he is or is not doing in the future.

But her position on the whole thing is, it is over and done with. So I am feeling better again. Tell ya what though...an hour of crying with 3 hours of sleep makes for an exhausting day lol I was wiped out when I got home last night ~ Sapphy

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