Help me stop obsessing over my shortcomings

[RNcDreams]

Hello

I'm open to any suggestions ....

I'm almost finished with my first year in nursing. Some days I feel excellent about my performance, but more often than not I get totally fixated on what I have done wrong.

Recently, I realized after I gave report on a patient that I had been running blood too slow.... (the pt. was at a HUGE risk for fluid overload and had major ascites...and it was running at the slower rate for less than an hour, but still....) and had the ICU nurse not pointed it out, the patient would have had to have the remainder of that unit of blood discarded. Ugh. I know better. I didn't stop and think.

Recently, I could not recall off the top of my head if prednisone was to be taken with food or not.... BASIC INFORMATION. I had to double check and look it up. I should know this.

Also, in conversation the other day I could not remember the maximum daily dose of Tylenol for an adult....couldn't remember if it was 2G or 4G... I had to double check it in a book.

I'm starting to feel like I am a moron and that I will never, ever be good at this.

SoOooo.... what's the best way for me to move forward??

[nightmare, RN]

Best way,treat all these things as a positive learning experience.Write them down,reflect on what you could have done differently then...move on.No one knows everything.If you know where to get the info then that is good.I've been at this a long time and still use the drug books to double check if I am not sure.First year of nursing?Give yourself a break ,you're still learning and sounds like you're making a good job of it too!

[Flare, ASN, BSN]

Don't beat yourself up. I have been a nurse for quite a few years now and I still consult the drug books regularly. Even if i am sure, i will often double check as complacency often leads to tragedy. Take the things you have learned, and the things you wish you did differently and learn from them. You are not the first nurse to have to waste blood and you certainly won't be the last.

[Beary-nice]

You are beating yourself up way too much and will be heading down a path of self destruction. Briefly reflect on what didn't go right, briefly think about what you could or could not have done differently in the situation and move on.

I have been a nurse for almost 19 years now and have never had a day when I haven't had to look something up even if I thought it was something very simple that I should have been able to come up with the info. I would rather have a nurse and a coworker who was willing to look things up than assume.

Take care and be gentle.

[kmoonshine, RN]

No one can remember everything. Good nurses are the ones who realize that they are unsure about something, and therefore look up the answer or ask someone for help. I'm also in the ED, and there are so many medications we use; some often, some rarely. It's impossible to recall everything. Also, medication information is continuously changing and it's good to look things up to verify accuracy.

I hope you don't mind, but I do have some suggestions that may help you. Perhaps invest in a PDA? I have one with Davis's Drug Guide, and its awesome. I'm able to quickly look up different meds along with route, dosage, administration (IV push/infusion rate), compatibility, and nursing intervention/assessment regarding a medication. It is great and I can't work without having it in my pocket. I'm able to connect my PDA to my computer and update Davis's Drug Guide with the latest medication information. I am also able to type information on my computer and upload it to my PDA (for example I typed the hospital's policy for PRBC infusion rate and uploaded it to my PDA for easy access). There have been many times when a patient would ask me something about a medication and I feel good saying "You know, I don't know the answer to your question off the top of my head - but let me look it up"; 15 seconds later, the patient has their question answered and I've suddenly become the "smartest" nurse to them.

Secondly, call the hospital's pharmacist to verify info as needed - they are a good source of knowledge and are generally happy to help out!

And finally: for time-sensitive medications (including blood products) and high-risk medications, perhaps have another nurse double-check pump settings?

Please don't take these suggestions as criticism - they are just some of the tools that I have found that help me. Its ok to feel the way that you do, since emergency nursing can be very thankless (and the things you do well never seem to get recognized, while the little things seem like such a big deal). For things that don't go well: look at what the problem was, what you did well, and what you could do differently in the future to prevent the situation from recurring.

I also subscribe to free email alerts from the FDA for discontinued medications, drug shortages, pulled meds, medication contamination, etc. It gives me the "edge", and I've actually caught ED docs prescribing discontinued medications for patients ready for discharge. Its a good feeling to say "Hey, Tigan PR is no longer available; wanna give them something else instead?" You can subscribe to the updates at https://service.govdelivery.com/service/subscribe.html?code=USFDA_48

Nowadays they seem to be pushing new grads too hard and overloading them with too many patients. Just think, you have only been doing this for a year; and while management may expect you to function at 110%, you need to realize that you're not a machine. Look back on your first week in the ED; how much have you grown since then?

:cheers:

PM me if you need anything else.

[AuntieRN]

My first year was rough too RNcDreams. It does get easier. But dont be so hard on yourself. Noone can know or remember everything about every drug, every procedure. Theres just too much to know and everything changes on a regular basis. Its better to ask questions and look things up then to do something and harm a patient. I still look up the basic drugs that I give on a regular basis just to make sure I havent forgotten anything. Good luck to you sweetie and dont be so hard on yourself.....

[jessiern, BSN, RN]

I read at least twice that you didn't know and "looked it up".

That's shows great common sense to me. And that you are trying your best to protect your patients. I know a lot of nurses that wouldn't have taken the time to look it up. Never feel bad about looking something up.

Also, to me running to blood slow shows critical thinking skills because you were concerned about fluid overload. Do you know how many times I have come on shift and had to immediately called the MD because the previous nurse was running blood in too fast, and the patient was going down the tubes when I got there? Don't beat yourself up, and like me, you are still learning. That is a great thing!