Getting worse with experience??

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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???

Specializes in Med/Surg.

Thank you everyone for the support! There are some wonderful people on this forum :) I had a much better night tonight, got out on time and everything. I also found out that the nurse that was talking with the nursing supervisor was actually discussing a patient who wanted to leave AMA because she did not want an NG tube. So, no mistakes were made on my part.

Also, in response to the questions about the blood....here is how it happens at our facility. The doctor orders to type and cross 2 units of PRBC....the unit assistant or the nurse enters in the computer to type and cross 2 units of PRBC and it gets sent to the blood bank. They see it and prepare the order and it waits in the blood bank until it is needed. Even if there is an order to type and cross blood AND transfuse it, the blood bank only gets the part about typing and crossing. When the blood is needed we fill out a blood slip and it can be picked up from blood bank. The blood bank never sees the original order from the doc. Then the blood is checked by 2 RNs and checked against the patients ID band.....but it was never policy to check the order with both RNs as well. It is now though thanks to my mistake.

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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

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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.

Well, to tell you honestly I already did that in a busy med/surg floor.

to clarify things I meant no harm to the girl i'm just trying to help her by easing her anxiety.

believe it or not:)

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Specializes in Oncology; medical specialty website.

Well, look at your "mistake" as something that brought about an improvement in what was a systems breakdown. It's unfortunate that it came at your expense, but now patient care will be safer. Really, BB should be looking for the order to transfuse as well. Where I work, they won't release the blood if there is no order.

And see, not every side conversation means you screwed up. Relax.

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Specializes in icu, cvicu, case management.

Long Term care has a totally different type of nursing ratios. THe also have more CNA, who do mostof the care ADL's etc. The nurses role is more med passing, obs behavior, monitoring psychotropic drugs, maintaining wts, ..the focus is different, In acute care, the problems are acute, so the ratio is different. and regs. are different. If anyone has 30 patients in and acute center without a team approach...you are working in the wrong states...SOme states also allow CNA s to adm meds...that is how oour profession looses its value. Those states also pay the RNs a very small wage...So it matters what what the regs are in each states, and how the work is distributed. I work in Illinois, we would never give our professional workload away to unlicensed personnel..it would make the demise of our profession...and devalue the RN

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