Floater to ms/tele needs advice after a disastrous shift!

[heartsgal, ADN, RN]

I've worked on the acute care rehab unit for 4 months and was cleared to float after 3 months per policy. Our censuses has been low the past several weeks, so I've floated 4 or 5 times and it hasn't been pretty but I've learned a lot. Last week though was nothing short of a complete and utter disaster. 3 of my 6 IV's infiltrated leaving me extremely backed up and finishing the 9am med pass at 12:30. Being so far behind made me a wreck trying to so hard (and unsuccessfully) to catch up, while my pocket phone rang incessantly. I am not afraid to ask for help and asked questions several times, but everyone else was slammed also and even the charge nurse was harried. After lunch I finally got help with the IV's and 2 discharges, one to an inpatient hospice care facility as she was quickly deteriorating. There were several situations that came up that I had no idea how to handle, because I haven't had exposure to those specific things on my unit. As usual I was there 2 hrs after shift to do charting I had no time to do all day. The next morning I received a call from the unit supervisor with some questions on a few things I didn't do correctly. The most important of these being her following up on my 91 y/o patient who crashed during the am hours and had to be transferred to ccu. After coming back from a procedure there was an order for her to be placed on tele that the pacu nurse didn't give me in report. I also missed the order after acknowledging 20+ orders before she was transferred back to me, that to my knowledge all pertained to the pacu since they all had "pacu" at the beginng of the order. I was very upset to hear my patient had a code save called for her, for something I know was largely my mistake because I should have caught it when she was transferred back, even if I didn't get it in report. Thankfully she was stabilized and did not go into full arrest. I told the supervisor that I take full responsibility for my mistake, especially since I did not document the report from the pacu nurse (a mistake I will never make again). I was so terribly overwhelmed that day trying to get to everything and have learned a valuable lesson the hard way due to an incident report with my name on it now. I do begin my day with reading orders and the latest h&p doctors's progress notes on my pts after report, but I can't seem to do it quickly and was behind before I even began my day. What can I do in the future to help stay on track with a 1000 things happening all at once? How do I not get overwhelmed when I see I'm getting so far behind on my meds and other tasks? I love being a nurse I really do, but some days lately I ask myself why I went to nursing school in my late 40's to be so exhausted and overwhelmed.

[montinurse, BSN]

My advice is to not be so hard on yourself! You sound like you did everything you could to keep your head above water. Being a nurse is so demanding, and we are notorious at feeling responsible for a 91 year old coding. I hope the nurse manager that called you was not trying to point fingers. That's what's so frustrating about hospital nursing. So much we're expected to take care of, and being blamed when something doesn't go right. Chin up!

[BonnieSc]

Well, hopefully the point of the incident report will be to check into things on the unit. I've had days like that on very well-run units... sometimes it just happens... but I've also had every day like that on a poorly run unit, which means some changes need to be made. Definitely don't be so hard on yourself, but do read your post in a few days and see what lessons you can find for yourself in it. Only you can really answer that question, but is it possible you want to rethink your priorities? (Maybe, maybe not--not making judgments here.) Did all of the IVs need to be dealt with right away? Was there anyone else you could have asked for help, or could you have asked in a different way? The nurse managers are always telling us that they're "there for us" during the day if we're getting overwhelmed and they can at least be an extra set of hands. The charge nurse was harried, but would s/he perhaps have been willing to hold your phone for you and answer some of the calls, even if s/he couldn't provide hands-on help? Is there a nurse educator you might have been able to call for help with a couple of those procedures? (I've called a few times and also flagged them down in the halls even just for random help.)

The patient didn't have a "code save" called "because of your mistake". It was called because the patient was ill. Telemetry is just a tool. Sure, she should have been wearing it, but it's not like it was going to save her on its own, and in my experience it's very likely either no one would have noticed any signs that she was going downhill (if there even were any), and even if someone did, would any interventions have happened more quickly? Very likely, no.

[heartsgal, ADN, RN]

Update: My unit mgr tod me today the after investigation it was revealed that the anesthesiologist accidentally canceled his own order for tele in surgery so the pacu rn wasn't at fault either. Since I was so overwhelmed I just presumed I had missed it. I have still learned a valuable lesson though as far as documenting when a patient returns to me after surgery or any procedure to be sure and document the full report from the transferring unit :)