Getting worse with experience??

[KSU-SN]

So I just hit the year mark for working as an RN. I work on a busy med/surg unit at a large hospital. At my 6 month evaluation I got a great eval...the nursing director had nothing but good things to say and said she was impressed with how well I was doing and everyone she had talked to said I was doing a great job. A few months later it was time for my yearly review. Once again I got a great evaluation. The only thing that was marked needs improvement was keeping up with all the education requirements. Shortly after that review, maybe a week or so I made a big mistake and transfused a unit of blood on a patient who was only ordered to have blood typed and crossed. Cant explain why I did it, it was just a busy night and I saw the order and immediately thought that I had to give blood. So the nursing director was told about it of course and she did not write me up because she said we all make mistakes and she knew how bad I felt about it. Lately its felt like Ive been struggling to get things done on time and I dread giving report to the oncoming shift because Im afraid of what they will find that I didnt do or did wrong. Last night was especially busy....I had a patient with a BP of 60's over 30's and a patient who was going to surgery and they sent transport up over an hour early to get the patient and did not tell me so I had to fly around getting this patient ready for surgery and filling out the pre-op checklist, getting the consent signed, etc. I was getting 3 patients from surgery and 1 from the emergency room. And the charge nurse was trying to give me a 7th patient to primary! I said "there is no way I am going to take a 7th patient right now." And I left the nurse's station/ I heard the charge nurse say "she needs to knock it off right now." Then she came up to me a few minutes later and asked me if I was done throwing a temper tantrum. I said "im not throwing a temper tantrum, im not going to primary 7 patients when I have an extremely busy group of patients, its not safe." And she said "sometimes you just have to do it." And I said that "No i didnt HAVE to do anything, my license is more important than this job and taking 7 patients is not safe and I wont do it." Well she was crappy with me the rest of the night which just added to my anxiety because I absolutely hate confrontation and arguments.

So I finally get off work 3 hours past quitting time because of all the charting I had to do and I see the nursing supervisor talking to one of the nurses in a private conversation. The nurse was the one I had given all my patients to. They stopped talking when I walked by. So now Im thinking CRAP what did I do wrong??!! It had to be something pretty serious to get the nursing supervisor of the whole hospital involved. I have been thinking back over the whole night about what I could have done wrong. I had to give blood to a patient and because of my previous mistake I immediately thought it had to be something with that but I cant think of a single thing I did wrong. I dont even know for sure they were talking about me but I cant really think why else they would be talking privately at 2am unless it had something to do with one of the patients. Now I am scared to death to go back into work tonight....how am I getting worse over time instead of better? I get great evaluations over my first year as a nurse and after that it seems like I'm falling apart instead of getting better. Any thoughts on this???

[grandmawrinkle]

OK --

Where is the support on your unit?

What crazy person would give somebody 3 post-ops and an ER admission with another patient's B/P in the toilet?

I know you are second guessing yourself with that post, but seriously --- holy crap. The wards in my hospital have busy shifts but nothing like that.

I do charge about 50% of the time I work and would never dump all that into one assignment. That is just plain ugly. Don't take that as a reflection on your skills and it has absolutely nothing with you getting worse or transfusing that unit of blood when you shouldn't.

Wow, I'm really sorry, and really, what you described is pretty mind-boggling to me. Just, wow.

[imintrouble, BSN, RN]

Good for you for standing up and saying NO. No, I will not risk my license. No, I will not risk my pts. No, I will not risk my health.

But by saying no, you made an enemy. She may get over it and she may not. They were probably talking about you, but give yourself some credit. Maybe she was still mad because you called her out on a bad decision, not because you made a mistake.

[darren_callcareer18]

Well, I think the first thing that you should do is to put aside those thoughts that maybe you did something wrong coz it won't help you.

Try to relax yourself first especially you're going to have your shift tonight. Remember the more you think negative thoughts the more you'll loose your concentration and focus thus increasing the chance of committing mistakes.

Lemme share to you this, do you know that nurses here in our state has a ratio of 1 Nurse is to 30 patients per shift? hehe but we're being careful and alert all the time

Tonight is your chance to prove that you're a good nurse :)

god bless.

[tvccrn, ASN, RN]

Did lab not question you requesting the unit?

Do you not need to verify the order with a second person when starting the blood?

In my facility, you have to go through at least three checks before you can start a unit of blood. The unit manager (HUC) takes off the order and orders the T & C, the nurse goes to lab with a copy of the order to pick up the blood, and a second licensed personnel verifies the order along numerous other details before the unit is started.

It seems as if there are more issues at stake than you give blood without an order. The biggest is the expectations on the nurses for the patient load. I would have to think long and hard about staying at a place that expects that sort of thing on a daily basis.

[Monkeytoes]

KSU-SN...I really feel what your going through. I made a huge error my first year of being an RN, and it really shook my confidence. I began to regress because I always second-guessed myself. I remember the sleepless nights and anxiety that you are going through.

I really admire you for sticking up for yourself! It is important to be honest with your capabilities when patient safety is at stake. Let the dust settle. If this confrontation with the CN only happened yesterday, move forward knowing that you got overwhelmed and expressed your genuine concern. Sometimes you need to speak your mind and you won't be able to please everyone.

Hang in there.

[Doinmybest]

Quote from Darren Callcareer18:

Lemme share to you this, do you know that nurses here in our state has a ratio of 1 Nurse is to 30 patients per shift? hehe but we're being careful and alert all the time

...

What type of environment are you working in? And what state is that? I used to have 40 patients at a long term care facility, but with multiple HTs under my delegation.

The 30:1 ratio you described wouldn't work on a med/surg floor of a hospital. So I'm just wondering, so you can specify and not freak the girl out as to why she can't handle 30 patients at once.

Six is our MAX on my busy med/surg floor.

[Doinmybest]

I feel for you honey. I've had nights as bad, and it is absolutely ridiculous. Sounds like you've been with them for over a year, it's time to move on. It sounds like you're a great nurse, mistakes happen especially in that kind of a work environment. Don't let it bother you any more!

I recently gave my two weeks notice on a floor just like yours. In fact, part of me is wondering if you work in the same hospital!! I you do, let me just tell you there are some sour grapes, and don't you listen to them!

I would love to talk with you more, I'm worried about you because I know how awful it can make your life, and how unstable you can feel. I'm new to this site, is there a way to send personal messages? Because I will be there for you to talk to about this ok? Seriously, if you need someone to talk to PM me!

[lrobinson5]

I may not be a nurse yet, but my only advice to you is relax as much as possible. It is very plausible that you didn't do anything wrong. Sometimes a conversation is private from anyone not involved. If it was about you, try not to worry about it, because what's done is done. Try to live your life without regrets. Also, I commend you for doing the responsible thing and sticking up for the well being of your patients. It was the safe and right thing for you to do.

[Scarlette Wings]

ok --

where is the support on your unit?

what crazy person would give somebody 3 post-ops and an er admission with another patient's b/p in the toilet?

i know you are second guessing yourself with that post, but seriously --- holy crap. the wards in my hospital have busy shifts but nothing like that.

i do charge about 50% of the time i work and would never dump all that into one assignment. that is just plain ugly. don't take that as a reflection on your skills and it has absolutely nothing with you getting worse or transfusing that unit of blood when you shouldn't.

wow, i'm really sorry, and really, what you described is pretty mind-boggling to me. just, wow.

sadly the op's entry could be the identical twin to the hospital i work at, at least it would be on the med/surg floor 3 out of 5 days... and from what i read on here a great deal of the time, it is a pretty routine shift in most places.

it is not right or safe, but seems to be the reason most floor nurses are overwhelmed and burned out. specially the one's who really do "care." to them it does matter when things do not get done as they should. the nurses who "could care less" seem to let things roll off them like water on a ducks back and they are the ones who are left when all the caring and burned out nurses resign, get run off, or just finally give up.

[OCNRN63, RN]

How did BB wind up releasing the blood if the order was only for a T&C? If you didn't have an actual order to transfuse, they shouldn't have released the blood. Yes, you made a mistake, but you weren't the only one involved in it.

As far as your other situation, I think it was unrealistic for you to be expected to accept another patient. Perhaps you could have stated your case better, but I know that in the heat of the moment when you're stressed, it's hard to always say the right thing. You were right to speak up and say you felt it was an unsafe situation. It won't be the last time, so get used to it.

Try not to stress over whether you made a mistake. Who knows what the nurse and the supervisor were talking about? You don't know for sure they were talking about you. For all you know the nurse could have been relating something personal to the supervisor and didn't want you to overhear. Try not to personalize everything or you will drive yourself crazy. Easier said than done.

You're going to find that you will have ups and downs throughout your career. Even seasoned nurses go through spells when they think, "Geez, how did I even manage to get a license?" I know I've had them. Give yourself a break.

[nrsjo60]

Well

What a night.

I remember those nights some time ago I have been a nurse for 30 years. So I have seen and done alot.

I have had nights like that flong time ago where I thought the only thing I could accomplish was to cry in the closet....Some nights are really bad, others good...

I would suggest that on the bad nights.. ASK FOR HELP.. sometimes we think it is bad if we need help...Its about keeping safe for the patients, that includes asking the charge nurse for assistance. THen keep an anecdotal notebook of your own and write down when and what time you ask for help and the reply...THis kind of antecdotal note an safe you if lu get called to your bosses office, and in court also...

You are not alone...I am a case manager now, and I see our nulrses doing the same thing and feeling the same...They stick together though....No nurse should talk to you like that...its bullying. THis is forbidden now in the workplace and there are new nurse practice acts to protect you...Document Document Document...

You are having some growing pains. You will do ok, learn form the pressures, but ask for help,..If the staff or the charge nurse cannot assist you then you have proof that the unit is too busy,,.