Feeling like a terrible nurse

[RNexplorer]

At times, I feel worried about my ability to perform adequately in this profession. Patient was admitted from the cath lab. I was confused with the access site description. There was a single lumen central line at the access site, and I had never seen this before. I had wanted to ask the cath lab nurse to explain more about this access, but there were so many other questions I had about the patient. The report was lacking in so many areas... and she was in a rush to transfer the patient. In the hustle and bustle of things, somehow I forgot to ask her more about it. When the patient got to our floor, I asked another nurse about this central line and also asked a doctor. But I was still confused about it. There was so much to do with this patient, and I was running around trying to get it all done. There wasn't a lot of extra help this night, and I had a demanding family and ethical issues to worry about, as well as a ton of new orders, and all the patient had for access was this single lumen catheter at the access site...

By the time I had to give report to day shift, I couldn't explain the PCI access site to the oncoming nurse and she was pissed off (for good reason). I just feel so incredibly inadequate. This is basic stuff I should be doing. I feel like a terrible nurse sometimes, and I've been crying since I got home!

Just looking for helpful advice/comments/encouragement...

[HeySis, BSN, RN]

Are you a new Grad? or is this a new area for you? Sounds like one or maybe both??

The learning curve is pretty steep at first. I'm a new grad RN and I remember the learning curve I felt as a new LPN... it helps me keep the panic at bay, because I have the experience now to know I won't always feel overwhelmed.

It takes a while to know the normal flow/information on a new unit or speciality. Give it six months to a year, then the routine stuff will become second nature and it'll be hard to believe there was a time you didn't know those answers.

But be prepared... even after years, you'll come across something "new", a patient or situation you've never delt with before.

Or new research will change the way you practice your speciality to get better outcomes and you'll be in a new learning curve (though much less steep, because your skills, assessments, time management and such will be solid)

It's one of the great things about about nursing is the opportunity to continue to learn new things.

If you are new and this is a one time thing, don't sweet it. If it becomes normal for you to not be able to get your questions answered because you're "thrown in", you need to go to your manager or education person and ask for more training or orientation.

[RNexplorer]

HeySis, thanks for the encouragement. The problem is I'm not a new grad. I've been working for 3 years as an RN. I don't have this problem on every shift, but it happens once in awhile...

There's no excuses for it. I should have asked the cath lab nurse to explain the access site, but for some reason it got missed. I was running around like a chicken with my head cut off all shift, hoping I wouldn't miss anything, and I didn't even think about the access site after asking the doctor the one time. Boy did I feel like a stupid nurse when my relief came in.

This relief nurse has a way of making me feel really uncomfortable whenever we get report. She's always interrupting me asking questions and never having the patience to listen to what I'm saying. I lost my confidence and could barely communicate with her. It basically looked like I was a dumb dumb.

[HeySis, BSN, RN]

I'm so sorry, sometimes you just have a bad night.

And I've given report to people like that, and I have spoken up with "chronic interrupters" and said. I really am trying to get my report down to the most important communication I need to tell you in an organized (SBAR?, Systems?) way, please let me finish and when I'm done, if I've left out anything you need to know, ask. I'll answer the best I can and I'll add those items onto what I need to report to you in the future.

I find it does three things. 1. Draws attention to bad behavior on their part. 2. Lets me make a note, so I can tailor her report to what she needs. (and find out if I'm missing something without getting mixed up) 3. Maybe build her confidence that if she listens first, I will get to the info she needs in an organized way.

You may have had a cruddy night and not asked about the port, but it sounds like you never accessed it and caused no harm. Sometimes when we are short staffed, or it's been a "full moon" type of night, we have to take consolation in knowing we did the best we could and we did no harm.

And you can always find the answer now and add it to your knowledge base.

[RNexplorer]

Thanks for your response. It has really helped me put things in perspective and create something positive out of the situation. I will definitely find the answer and add it to my knowledge base. Also, I am looking forward to trying your technique with those chronic interrupters.

[iluvivt, BSN, RN]

There are just a few things you need to know if you should happen to encounter an unfamilar CVAD. Most importantly is where is the anatomical tip placement....does it have a blood return and is it asymptomatic. The tip of any CVAD should be at the low SVC or cavoayrial junction.Hemodialysis catheters should be in the RA but often they will be at the CAJ. It is also good to know when it was placed,if is tunneled or non=tunnelled,how many lumens,is it valved or non=valved , are all lumens patent with a brisk blood return and flushing well,is the dressing clean dry and intact.Since the patient came from the cath lab it was most likely placed percutaneousely and is an open=ended non valved CVAD.If you look at it the manufacture ususlly will have their name on the suture wing or sometimes the tail(s). Next time just look at it and check for confirmation pf tip location.You can also look through the chart and find the insertion note.Honestly I do not understand why the nurse was so angry bc he or she can do the exact same thing and is just as responsible for acquiring this information when using the CVAD.You can say,"Let's look it up together" and hopefully you did the assessment already.

[RNexplorer]

Thanks for this information. Do you know of any really good resources on CVADs?.. There are so many types and I'm often confused about them... Yes, I assessed the site and checked for blood return. I also tried to get more information from the physician, but his description of it was so vague.

I think the nurse was angry because I questioned myself and didn't quite believe that this CVAD site was also the site of the PCI procedure. It seemed strange to me. I think she was mad that I wasn't more certain of what I was reporting. I get that. I just wish she would have been more respectful and listen to me rather than interrupt every 5 seconds. I would never treat anyone the way she treats me during handoff.

[NurseMegP, BSN, RN]

Some people don't seem to think they'll ever make a mistake, but trust me I am sure that nurse biting your head off has given her fair share of crappy reports. We are expected to know everything, but the problem is, we're human too. Don't let her own ugly personality make you feel inferior. Google search your heart out, call the cath lab on a day you're not so busy and inquire then. Learn from this to better yourself as a nurse but don't let it make you feel so horrible. Best of luck!

[TriciaJ, RN]

HeySis, thanks for the encouragement. The problem is I'm not a new grad. I've been working for 3 years as an RN. I don't have this problem on every shift, but it happens once in awhile...

There's no excuses for it. I should have asked the cath lab nurse to explain the access site, but for some reason it got missed. I was running around like a chicken with my head cut off all shift, hoping I wouldn't miss anything, and I didn't even think about the access site after asking the doctor the one time. Boy did I feel like a stupid nurse when my relief came in.

This relief nurse has a way of making me feel really uncomfortable whenever we get report. She's always interrupting me asking questions and never having the patience to listen to what I'm saying. I lost my confidence and could barely communicate with her. It basically looked like I was a dumb dumb.

So you took report from a nurse who was too busy to give an adequate one, and you gave report to a nurse who is a chronic fault-finder. You were sandwiched in the middle.

Blow it off. You have a work ethic and a desire to keep learning. Those will stand you in good stead. Other people's poor personalities don't have to be your problem.

[MunoRN, RN]

What you're describing is an introducer, often called a "sheath", which from your description sounds like it is in the groin. These are what are used to pass the various catheters that are used in an angiogram and are either venous or arterial. If you got a patient with one of these still in and aren't already familiar with them then it's not your fault, somebody above you failed, and pretty badly.

[gonzo1, ASN, RN]

I sent you a private message

[BeenThere2012, ASN, RN]

I understand the overwhelmed feelings she had and to look up so many details in that type of situation is unrealistic...especially if the references are not easy to find. Your points are all excellent as far as your knowledge of these lines. This is a class in itself.

As far as the nurse giving her such a hard time is unnecessary and rude, but we run into this a lot. RNexplorer...As others have said, sometimes you just have a bad night. In report, if you explain that you never got the information yourself and will try to get it before you leave, that can be very helpful to the off-going shift and for you the next time. I have done that and depending on your unit, is the best time to get the information, because after you have given report, you are free to concentrate and take your time looking things up. Having said that, when someone is stressed and rude, no matter what you do will please them, but at least you will have gotten the information for yourself and be better prepared the next time around.