Waking up at night to worry about patients

[missninaRN]

Apparently I'm not worrying enough during the day. Now I'm waking up at night to obsess over whether I did anything to harm my patients. (I'm working as nurse tech while going to nursing school.)

I had an elderly lady last week that needed to be changed into a clean gown just before the end of shift, which involved clamping the IV line and disconnecting it to thread it through the arm of the clean gown (she had normal saline running). I know that I reconnected the line, but I woke two nights later, up in the middle of the night, worrying that I hadn't unclamped the IV line-I simply can't remember if I did or didn't.

If I didn't unclamp it, I'm wondering how long it would take for someone else to notice. Surely the pump would start to alarm, right? Surely, if something had gone wrong and it was my fault, I would have heard about it by now (6 days later)?

My instructor says I tend to obsess when I go home from clinicals/shifts, and I know that she's right. She says it's not necessarily a bad thing, that it will cause me to be more careful (I'm definitely checking that IV clamp from now on), but I can't help but think that waking up and lying there, worrying for hours, is not a good thing.

So, would leaving an IV line clamped cause serious harm to a patient before it is discovered?

[starae]

You sound so much like me that I could have written this exact post a couple of years ago. It started in nursing school when I also worked as a tech, and the feeling did not go away as a new nurse. I jumped straight into critical care out of school and weekends off were torture for me often times because I would be so obsessive about what I did or did not do on my last shift. It was almost like I would replay the day in my mind looking for something to worry about. Now I'm not talking about mistakes I made that I was failing to report, please don't assume that. I'm talking mostly about doubting myself and my actions. Like, did I restart that tube feed (when I know I did but would convince myself that possibly I hadn't) or did I chart all the VAP care I did?

I'm a type A personality and a perfectionist. Also, I was scared to death when I first started working on my own. I can tell you, however, that those reactions started to decrease as months went by and I felt more comfortable with what I was doing. Hopefully you will experience the same. Just hang in there and don't let your fear or caution paralize you. Start each day as a new day and give the best patient care you can. Be a careful nurse/tech, don't become complacent, and trust yourself because you know that you follow safe nursing standards.

As far as the clamped IV, was it on a pump? If it was the pump should have alarmed letting someone know there was a problem. Also, since it was the change of shift the expectation that the oncoming nurse would assess the IV and hopefully quickly catch any problems.

Good luck! :nuke:

[GingerSue]

just curious, aren't they teaching anymore that the IV is held and passed through the sleeve of the gown (it's not disconnected in order to put on a gown)?

{pass IV bag through sleeve first, then hand goes through sleeve as usual, then other arm goes through other sleeve}

[TraumaICURN]

just curious, aren't they teaching anymore that the IV is held and passed through the sleeve of the gown (it's not disconnected in order to put on a gown)?

{pass IV bag through sleeve first, then hand goes through sleeve as usual, then other arm goes through other sleeve}

Even if you passed the bag through the sleeve first, if it was on a pump, you would still have to take it off the pump before being able to pass it through the sleeve.

If the NS was on a pump, and you left it clamped, the pump should beep with a downstream occlusion. I don't think you could have caused much harm at all.

[muffie, RN]

20 years later, still worrying :trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout:

[Young Woman]

Hey dont worry so much about it i am sure your a great nurse you really sound like your a caring person who really cares about her patients

if your worried go and drop by and see them when your off

or asked the management how your going if you did something wrong i am sure you would here bout it if your still worried talk to some of your collegues that u do trust and tell them,

[PickyRN]

just curious, aren't they teaching anymore that the IV is held and passed through the sleeve of the gown (it's not disconnected in order to put on a gown)?

Yes, they are still teaching that, at least they did in my nursing school (graduated 2005). That's fine for a IV running to gravity, but for one going through a pump, it takes ten times as long to disconnect all the IV tubing from the pump, pass it through the gown, reconnect it, remove the old gown, etc.

Easier and faster to disconnect the IV from the patient, secure the IV distal end with a sterile port cover, change gowns, and then reconnect the IV after swabbing the IV port with alcohol.

Plus, most hospitals have gowns that snap for people with IVF's.

[kenzy]

YOUR NOT ALONE! When I was in nursing school and yet 2 years later (tonight) I get up in the middle of the night thinking about my pts. Maybe thats why its 2:39am and i'm up right now. We had a hectic day, and were short handed like you usually are so you tend to think about all the what ifs, but to reassure myself I try to think thats really just what it is what if? I couldn't tell you how many times in nursing school I got up in the middle of the night sweating or on my way home from clinical would think of something and would have to call the hospital to reassure myself. Of course they would just laugh and tell me they all went through it, that it would eventually get better as I felt more comfortable with increased knowledge and time in the practice and it does. However i'm pretty sure for myself that it will not ever go away completly and thats ok too. I would rather be that nurse who cares enough to worry about my pts. safetly. then one who does something then never thinks about it again. Don't get me wrong its not that I dont trust myself, but I am human. So knowing this about myself I try to take measures during the day to eliminate my fears such as alsways doing the checks and rechecks before doing a procedure then following up on it. These are meassures that should be taken anyways, but are sometimes forgotten in the hussle and bussle of the busy day. So I guess what I would say to you is believe in yourself, believe in what and how your learning there is a method to this madness, when they enforce in school things such as checks for giving meds etc. its done for the purpose of eliminating errors, so if you do everything to the best of your ablity you can leave work knowing that if something did happen by no means was it intentional. And never be affraid to follow up on something you feel you may have done wrong or even missed, its just a phone call and could save someones life, also take it for what its worth its an opportunity to learn. I've learned alot by doing extra research at 2:00am on what could happen If I did do something wrong on a procedure I woke up thinking about. LOL! So know that it does get better. You sound like a very caring person who will make a great nurse.

[nursemary9, BSN, RN]

20 years later, still worrying :trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout: :trout:

Ditto, except, make it 40 years!!!

Don't worry; the pump would have alarmed VERY shortly after if you had not unclamped it!!

[locolorenzo22, BSN, RN]

Wow, I guess I'm in the minority around here! I do worry about a few things off and on, but generally, I go in, put in my 12 hours and go home, sleep a few, and go on through the day. I figure if there's something major enough, someone will call me or I'll hear about the next time I go in to work. I worry more about a pt being left incontinent, or more work then usual left for the next shifter, as I'll get it back on my next handoff.

Overall, I don't worry that someone is going to have died from something I did. If there is going to be a reaction, it's kind of quick.

I do work as a hospital tech here while schooling, and I see the difference between school/clinical/and work. It is tough to put the day behind you. You always think about one more thing you could have done to reassure yourself. The thing you must remember is to RELAX! If something is majorly wrong, then you would have caught it, or someone will catch it quickly. Pumps beep, IV's resolve, pts calm down here and there.....although some nights you're just crazy until 2-3AM. With clinicals the only advice I can give is be confident in your care, KNOW everything you are going to do/give all day, and meet your patients needs. I always tell myself that my FIRST responsibility is to make sure ALL my patients are happy/satisfied to the best of my ability before I walk out of a room. and usually, they have that last minute request that takes 30 secs in the room, and 15 minutes if you have to go back in.

BTW, if you are worrying about patients two days after a shift, you might want to talk to someone about some anti-anxiety options. You being awake for hours is NOT a good thing, we all need sleep (as much as possible-please!! Although cruising allnurses is one more thing to keep a body awake!). Good luck honey, keep the faith, being a tech adds so much more to being a nurse(mainly because I learn how NOT to treat a tech!)....

[TrudyRN]

You would have heard by now, I believe, if there was a problem.

I do the same thing - worrying, that is. I've been an RN for 30+ years and am still very obsessive-compulsive about my work. It has kept me out of trouble this long, so why change?

It is better, BTW, to not interrupt the tubing, although it is more convenient.

[TrudyRN]

Ditto, except, make it 40 years!!!

Don't worry; the pump would have alarmed VERY shortly after if you had not unclamped it!!

assuming the alarm was on and working;