Just landed my 1st position as an RN and there are a few things that are weighing heavily on my mind in regards to patient safety. All of the following have happened during my orientation and I am seriously questioning whether I should stay at this facility. How would you have handled the folowing?
Night shift handed off two pts to me, one with a glucose of 388 and the other with a blood glucose of 279. Accucheck was done at 0600...neither pt was covered w/insulin
Night shift reported of on a pt who looked terrible. Orders were to have pt on 02 to sat at 94%. I assessed pt immediately...no 02 on pt, HR >200, SOB, sats @ 88..did what I could do and called rapid response
Received an admit without report or notice
Charge nurse reassigned one of my pts. to another nurse who at the end of the day stated "thats not my pt"
Asked preceptor multiple times for help and preceptor helped by siging off on my orders when I begged for help with pt care.
Received report that a pt was heplocked, only to discover that pt should have been rec. NS @80 ...and yes the order was signed off on by the reporting RN.
Given a pt with altered mental status, was known to be violent and had to call security. I felt like this was an inappropriate assignment for a new RN.
Received report in the am on a pt who during the night had a troponin II of 2.8 (MD was called), checked labs 1st thing, troponin III was 4.05..pt was having an acute MI and somehow nobody on the night shift noticed that the pts atrial pacer wasn't pacing....I noticed!
There's more but I think you get the idea. I have read that your orientation can make you or break you. Worried that I might not find another new nurse position, but more worried that I am not building a good foundation for my nursing career as well as being extremely concerened about my patients well being and safety.
Specializes in med/surg, telemetry, IV therapy, mgmt.
if they all happened on the same day--quit.
night shift handed off two pts to me, one with a glucose of 388 and the other with a blood glucose of 279. accucheck was done at 0600...neither pt was covered w/insulin
are you sure the insulin wasn't supposed to be given with the breakfast tray on your shift? that the fingerstick was only done at 0600 as a courtesy for your shift? if the night shift was supposed to give the insulin then write up an incident report on the nurses who failed to give the insulin. that is a medication error.
[*]night shift reported of on a pt who looked terrible. orders were to have pt on 02 to sat at 94%. i assessed pt immediately...no 02 on pt, hr >200, sob, sats @ 88..did what i could do and called rapid response
any nurse who leaves a patient knowlingly in a condition like that should be written up and disciplined. do it and report them to your manager.
[*]received an admit without report or notice
report this to your manager so she can follow this up with the er manager.
[*]charge nurse reassigned one of my pts. to another nurse who at the end of the day stated "thats not my pt"
are you saying that this patient never got any care? does the charge nurse know this?
[*]asked preceptor multiple times for help and preceptor helped by siging off on my orders when i begged for help with pt care.
report the preceptor to whoever is in charge of your orientation.
[*]received report that a pt was heplocked, only to discover that pt should have been rec. ns @80 ...and yes the order was signed off on by the reporting rn.
you need to be assertive and go to the person who gave you report and tell them about their mistake for starters. then, you can decide if you want to write it up as a medication error or not.
[*]given a pt with altered mental status, was known to be violent and had to call security. i felt like this was an inappropriate assignment for a new rn.
discuss with your preceptor.
[*]received report in the am on a pt who during the night had a troponin ii of 2.8 (md was called), checked labs 1st thing, troponin iii was 4.05..pt was having an acute mi and somehow nobody on the night shift noticed that the pts atrial pacer wasn't pacing....i noticed!
good for you.
nursing is about solving patient problems. that is why we are taught the nursing process. welcome to the world of rn nursing.
As long as these things didn't happen all in one shift it sounds typical. I've called Rapid Responses as soon as I walk into a pt's room before. Sometimes people just miss things. The IVF situation happens occasionally. Not too big of a deal but the MD should be notified.
A few of the situations you mentioned are unacceptable and should be discussed with your DON. If you don't feel like you are getting enough support from your preceptor you need to say something now. Either to her or to your DON. This is your only chance to get a good orientation.
[*]Night shift handed off two pts to me, one with a glucose of 388 and the other with a blood glucose of 279. Accucheck was done at 0600...neither pt was covered w/insulin.
Sometimes pts do have high blood sugar due to eating snacks they have squirreled away, healing process, etc. If it is a concern, you should talk to the doc when he/she came in about the high glucoses and see if they want to increase orals or provide coverage.
[*]Night shift reported of on a pt who looked terrible. Orders were to have pt on 02 to sat at 94%. I assessed pt immediately...no 02 on pt, HR >200, SOB, sats @ 88..did what I could do and called rapid response
Was the patient a rapid decompensator? Possible that the patient pulled off own O2, and desatted. What were the other vitals? was the HR per the computer or your manual assessment? I would have put on the 02, and called that rapid response...but sometimes this happens..that's why you go try to see everyone asap first thing in the shift.
[*]Received an admit without report or notice
NOT ok....but it happens. The ER's talked to charge, gotten the bed, and brought the patient. States "the charts with the papers" That's nice, but it doesn't help you prepare. Or the other units bring patient and say, I'll send tape when I get back. NOT ok! report this to your NM.
[*]Charge nurse reassigned one of my pts. to another nurse who at the end of the day stated "thats not my pt"
Did you report off to said nurse? If the charge reassigned, and told you so, you're responsibility ends. It sucks, but it happens. If you were concerned, you could have just asked a quick "hey do you need to know anything about so and so?"
[*]Asked preceptor multiple times for help and preceptor helped by siging off on my orders when I begged for help with pt care.
What patient care did you ask for help with? what was preceptor's response? Sounds like you may need a new one?
[*]Received report that a pt was heplocked, only to discover that pt should have been rec. NS @80 ...and yes the order was signed off on by the reporting RN.
Sometimes it happens. I received in report that a patient was on fluids, had been back from CT since 10AM, and the am nurse did not hook the patient back up. when you do discover this, use judgement and get em back on.
[*]Given a pt with altered mental status, was known to be violent and had to call security. I felt like this was an inappropriate assignment for a new RN.
Everyone will get patients like this. You have to get used to dealing with them. This is why security is there, and hopefully your coworkers would rush in and help.
[*]Received report in the am on a pt who during the night had a troponin II of 2.8 (MD was called), checked labs 1st thing, troponin III was 4.05..pt was having an acute MI and somehow nobody on the night shift noticed that the pts atrial pacer wasn't pacing....I noticed!
Not a cardiac nurse, so I can't comment.
The upshot is that mistakes happen, but all you can do is what you can do while you're there. You seem to have a idea that nursing is perfect...but you have to catch/fix what you can when you can. don't worry about the rest.
When it comes to orders, we had too many orders not getting caught on days. The hospital went to a system of cosigning 12 hr chart checks at shift change. This has helped us not lose orders or order things early in the night shift versus 11PM....maybe you could suggest this?
I agree that the patients you are talking about sound like typical patients on a tele unit. I will say that the ER or whoever dumping a patient and not providing care and the other nurse not taking over care of your patient is a problem. Did you report off to that nurse? I mean, in my head it wouldve had to go like this-day shift, 3 hours in, the charge decides to change room assignments for whatever reason, the nurse recieving your patient gets report from you, and then takes over care. IF that last step didn't happen, you were still responsible for the patient. The ER thing and that situation sound like a busy unit day communication problem that needs to be addressed in staff meetings and safety huddles to better handle these situations, IE go to your nurse manager with your preceptor and report it. But the other stuff is explainable by many other factors.
Nursing is a 24 hour profession. We'd all like to fix our patients problems on our shift, have them all cozy in their bed, correct meds given an hour early, blood sugars normal, all off labs covered with meds or addressed otherwise and in a beautiful sinus ryhthm rate of 68. But reality is the patient, the families, the MDs and basically everyone else in the medical care team including YOU conspire against this lofty goal. You just do the best you can with the time you are there and the resources you have.
Good luck to you and work to be part of the solution, not just a complainer. I'm not saying you are now, but be active on your unit in identifying areas for improvement. You are a new grad and you are learning and I think its great that you are at least noticing deficiencies-use those experiences to improve your patients outcomes.
many good responses in here. sometimes i get a reality check on an--"oh. this kind of thing happens to other people too" just a few things i'll add:
[*]night shift handed off two pts to me, one with a glucose of 388 and the other with a blood glucose of 279. accucheck was done at 0600...neither pt was covered w/insulin
like others said, maybe waiting for insulin coverage. i'd be more worried about the fact that the blood sugar got that high in the first place and make sure the doc knew about it (especially if it was unusual for that pt)--maybe they're not getting enough insulin, or some other issue is brewing. if they're consistently that high, well, you may as well start treating their infection now (save the hassle of the discharge and re-admission paperwork). while nurses need to be vigilant in treating their diabetics, i think the issue tends to lie more in mismanagement by the whole team. of course, if the blood sugar was >400 or
[*]night shift reported of on a pt who looked terrible. orders were to have pt on 02 to sat at 94%. i assessed pt immediately...no 02 on pt, hr >200, sob, sats @ 88..did what i could do and called rapid response
once i left a "stable" pt on the floor for 5 minutes. during that time she flashed. the moment i returned, nurses on my unit quickly and adeptly picked me up, and as soon as that bus came 'round the corner, gave me a toss without blinking an eye. one of many lessons i learned from this experience was--pt's may decompensate fast, always give the rn the benefit of the doubt.
[*]received an admit without report or notice
have not had this experience. i would refuse the assignment on my floor. i'm not in the ed, and our patients are acute--i need to have the opportunity to ask questions.
[*]charge nurse reassigned one of my pts. to another nurse who at the end of the day stated "thats not my pt"
not okay, hopefully a once in a lifetime accident that you just happened to experience
[*]asked preceptor multiple times for help and preceptor helped by siging off on my orders when i begged for help with pt care.
not okay, not safe
[*]received report that a pt was heplocked, only to discover that pt should have been rec. ns @80 ...and yes the order was signed off on by the reporting rn.
could be serious, depending on the pt. how were i/o's documented? age? condition? etc. i've actually seen this happen a few times, usually not my greatest concern
[*]given a pt with altered mental status, was known to be violent and had to call security. i felt like this was an inappropriate assignment for a new rn.
if you have the right support, i think this is actually not a bad assignment (as long as you're not so new that you don't even know where the staff bathroom is).
[*]received report in the am on a pt who during the night had a troponin ii of 2.8 (md was called), checked labs 1st thing, troponin iii was 4.05..pt was having an acute mi and somehow nobody on the night shift noticed that the pts atrial pacer wasn't pacing....i noticed!
nice work on your part! while i've also started a shift caring for a pt with suspicious troponin elevation, where i work the mds tend to follow cardiac enzymes closely. while the md should have been paged or consulted, if the pt wasn't grasping his/her chest, the pt's outcome was probably not affected by the slight delay. often i'll call a doc, and they'll say "troponin leak" or "demand ischemia"--which honestly doesn't comfort me a whole lot, though i feel generally assured that there is time to treat the pt (ie, they're not crashing). whenyou say the atrial pacer wasn't pacing--do you mean an artificial pacemaker? or the sinus node? was it heart block or afib or something? were they brady? just curious (i like cardiac, but not a cardiac nurse)
Great responses by all..thank you so much. It has really been helpful to see so many perspectives that it has in fact helped me to put all of this in the proper perspective. So much has been said about what is to expected "the norm" and what I need to address as being unacceptable> I truly seek your opinions and advice to help build a solid foundation to become the nurse I envision myself being. Yes, as a new nurse I still live in the "ivory tower" of nursing but do not expect it to be perfect and that my own personal deal with perfectionistic tendencies tend to complicate things. When I was a student my parameters were so well defined and I always knew where I stood that this may in fact be a new learning curve for me and one that I will have to learn to adapt to.
Daytonite, BSN, RN
1 Article; 14,604 Posts
if they all happened on the same day--quit.
[*]night shift reported of on a pt who looked terrible. orders were to have pt on 02 to sat at 94%. i assessed pt immediately...no 02 on pt, hr >200, sob, sats @ 88..did what i could do and called rapid response
[*]received an admit without report or notice
[*]charge nurse reassigned one of my pts. to another nurse who at the end of the day stated "thats not my pt"
[*]asked preceptor multiple times for help and preceptor helped by siging off on my orders when i begged for help with pt care.
[*]received report that a pt was heplocked, only to discover that pt should have been rec. ns @80 ...and yes the order was signed off on by the reporting rn.
[*]given a pt with altered mental status, was known to be violent and had to call security. i felt like this was an inappropriate assignment for a new rn.
[*]received report in the am on a pt who during the night had a troponin ii of 2.8 (md was called), checked labs 1st thing, troponin iii was 4.05..pt was having an acute mi and somehow nobody on the night shift noticed that the pts atrial pacer wasn't pacing....i noticed!
nursing is about solving patient problems. that is why we are taught the nursing process. welcome to the world of rn nursing.