Frustration, Fear, and Confusion

Jolie, BSN · Mar 30, 2006

Hi Karen,

I am truly sorry for the rough start you have had in your professional career. I fault the leadership of your LTC facility for not providing you with a thorough orientation, and your fellow staff for being unsupportive.

But I would also like you to consider another point. I am not trying to pile on, and hope you will take my suggestion in the positive light in which it is intended.

Your training thus far has been abysmal. But, as a licensed professional you must accept responsibility for own learning, as well. If important information has not been provided to you, it is your responsibility (to yourself, your patients and your profession) to seek it out, and refuse to accept responsibility for situations that you are not trained to safely handle.

Let me give an example: In a previous post you mentioned caring for a patient whose respiratory status was deteriorating. You mentioned that if she had coded it would have been someone else's responsibility to get the crash cart, which was a good thing, since you didn't know where the crash cart was. Of course, that is something you should have been shown by your preceptor or DON. But, knowing that you lacked this information, you went to work night after night. That is where your responsibility comes into play. You had a duty to request that information, and refuse to accept an assignment on your own without having that knowledge. To do otherwise places your license and patients at risk.

I sincerely hope that your new job is more satisfying and better suited to you. But working in a setting where you are likely to be the only nurse on duty at any given time makes it even more imperative that you challenge yourself to think independently, seek out knowledge, and have the confidence to take appropriate action.

Good luck!

Home Health Columnist / Guide · Mar 30, 2006

Ditto the above.

One night I came on duty in 1978 to find vent dependent patient on my floor + 25 other patients with me as LPN charge + 2 nursing assistants.

Didn't realize then I should NOT have accepted the assignment. As the panic bubbling up, thought what SHOULD I do to get resources I need.

Paged RT STAT to my unit (had great rapport with him over past year) and notified night supervisor. RT came and instructed/observed me suctioning via ET tube, hooking back up to vent and brief overview of alarms state he would be responsible for vent and check with me hourly. CCU RN contacted and reviewed with me clinical issues/concerns over phone.

Made it through the night. Asked in AM Head nurse WHY she accepted patient for unit when none of us were oriented step-down type patient---blindly followed Chief Medical Resident reasoning that she had "outstanding nurses who's patent's never coded". Decided if I was being placed in that position, I needed to signup for respiratory critical care course to protect myself and my patients. That pivotal night, made me fall in love with respiratory nursing.

You WILL find your niche and gain confidence. Don't assume someone is going to teach it all to you....that's not how healthcare works. Seek out resources, look things up online, sign up for inservices in topics that interest you, ask for a mentor here to support you.

All things ARE possible if you ask him to guide you---with a little of your own gumption thrown in. :)

SouthernLPN2RN, MSN, RN, APRN, NP · Mar 30, 2006

On the person who is desatting with a clear chest, could she possibly have fluid overload/chf? I had a pt over this past weekend who desatted and was sob, but her lungs were clear. It turned out to be chf (i'm thinking right sided b/c she had edema everywhere that had creeped up gradually) and fluid overload.

jillyk*rn · Mar 30, 2006

hi,

i'm sorry for the rough start that you have had (i don't really know the details). perhaps you need to leave ltc (don't know if you tried anywhere else). hospitals usually give lots of orientation.

hang in there and good luck!

kwagner_51 · Mar 30, 2006

Hi Karen,
But, knowing that you lacked this information, you went to work night after night. That is where your responsibility comes into play. You had a duty to request that information, and refuse to accept an assignment on your own without having that knowledge. To do otherwise places your license and patients at risk.
Therein lies the problem. The evening shift nurse NEVER said a word about the pt desating. NOT ONE WORD!! I went in, as routine, to do her SAT and found out ON MY OWN that she was at 78%!! Two hours AFTER I accepted responibility for the pts. On my own, I gave her breathing treatments, increased her O2, elevated the head of her bed, and tried to talk her into going to the hospital. When the charge nurse came on at 7AM, she apologized for the fact that I wasn't told about the pt. SHE was well aware that the pt was desating and told the evening nurse about it. The report I received was her BP was high 194/60
but that it had dropped to normal range.
When the charge nurse came in I asked where the crash cart was. Every night from then on, I asked about pts desating. This AM the pt with clear lungs was in the low 80's. No O2 in the room! Evevated the bed, had her deep breath, and the O2 came up to 91.
On my other pt. This AM her O2 was 86 with Bi-Pap on!! However, that is now in the accepted range for her. As far as educating myself, I came home and read all I could on desating with COPD.
It doesn't change the fact that I was there by myself, putting my lisence on the line, trying to help a pt. who needed someone with a LOT more experience than I had. The pt. no longer trusts me and insists on having another nurse check my work!!
Thanks for listening and for the great advice!!
______________________________________
In His Grace,
Karen
Failure is NOT an option!!