Had a bad day and must share

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Specializes in Critical Care, Pediatrics, Geriatrics.

I had a really bad clinical day and I just have to share my story and try to find humor in it....hope you enjoy!

I am the queen or procrastination! I had a LONG care plan due my last day of my clinical rotation and I had only half of it done. So I worked on it all night and ended up getting NO sleep the night before clinical. I literally printed of my careplan two minutes before I left the house, grabbed some starbucks, and went to the hospital.

When I showed up, I was lucky enough to have been given two pts for the FIRST time of all days, based on my previous performance. I checked the MAR for both pts and found I had to give about 50 meds that day, and only recognized about 5! Great. I frantically looked up as many as I could jotting down important things to remember; when to hold, side fx, and interactions. I took report from the night nurse, and low and behold, discovered conflicting info from what I had read in the chart.

My instructor and I clarified the info, and I went off to do my assessment. Pt 1 was Mrs. M.M. with pancreatitis and a terrible case of anxiety and panic attacks; the docs think the pancreatitis was med induced and this woman wanted every prn available. Pt 2 was Mrs.RR with CHF and a fecal impaction that brought her to the ED. She had about 10 diff IV meds to hang, which I had never done before. Both pts had DM and pt2 had a special sliding scale diff from hospital protocol. Pt1 was to be d/c that day, more paperwork-lucky me, and her daughter was hounding me b/c she had to be at the airport in a few hours to catch a flight. I did my assessment on the CHF pt first who seemed to be the worst of the two and this lady was so dear, I took my time and did a thorough check of all her systems. Then I went to 2 and they had a list of demands a mile long.

I started to get panicked by all that I had to do and time was zooming by while I seemed to be going in slow-mo. My instructor came to check on me and help me prepare some meds. I kept fumbling and stuttering and having a hard time keeping my pts straight due to the lack of sleep. I had a good grasp on who was who and who needed what but my mouth wouldn't effectively work with my brain and my instructor was getting frustrated with me which only made my anxiety go through the roof. I am surprised that she didn't yank a pt from me and give it to another student.

I gave my morning meds and was in and out of both rooms, running down the doc, ordering prn's from the pharmacy that had not been sent up, and trying to fill special requests for extra ice, blankets, and what have you. By 1100, my instructor came to check on me and pointed out that I had only jotted down my vitals and had not finished documenting the rest of my assessment in the nurses notes. I tried to explain that I had not had a chance to breath yet, but that I had done both full assessments and that I would be getting to it as soon as I gave pt2 a bath because she had just lost her bowels in the bed but my instructor was unsympathetic.

My classmates and I all have to leave for lunch at the same time from 11-12 so they had to wait on me while I did my charting and they were thoroughly p.o.'d. When we came back I finally got pt 1 d/c'd and finished her paperwork. Then I thought I was in the clear. I had to give pt1 Dig and my instructor was asking me about the med (we can't look at paperwork...we have to know all our meds by memory) She asked me what it was for and all I could remember was that it was for the heart and to hold if apical pulse was less than sixty. I was a zombie mind you, because I had now been up for more than 36hrs straight. She kept hounding me for the class and I couldn't remember it was an antiarrythmic, so finally I just said i didn't know and i would have to look it up.

At the end of the day, she said that I had caught a few med errors, charting errors, called the doctor on my own, ran the pump like a pro, but because I couldn't remember what dig was I got a needs improvement for med admin. I thought that was kind of harsh. I went home after clinical around 4p and slept until 5a to be reminded by another student that I had a major test in Human Growth that I had forgot to study for! Great! Here we go again :roll :roll

Moral of the story: I will never put off doing a care plan again! That was the stupidest thing I have ever done and not safe for my pts. I really could have made some serious mistakes in care. Not to mention my instructor seems to think I am an idiot, when actually I perform well with proper sleep. I will pass but my ego is shot right now. :sniff:

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Specializes in Staff nurse.

...yeah, it is difficult, glad you were appreciated by the one patient and have something positive to look back on. Some pt. families are so demanding. I have taken to saying, I will get that as soon as possible after my prioity duties. Do you not have an aide to help or do you do total care? We had a mixture of both in our clinicals, asking for assistance only if really needed ie, safety issue. hang in there. Bet you never forget DIG :)

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Specializes in Critical Care, Pediatrics, Geriatrics.
...yeah, it is difficult, glad you were appreciated by the one patient and have something positive to look back on. Some pt. families are so demanding. I have taken to saying, I will get that as soon as possible after my prioity duties. Do you not have an aide to help or do you do total care? We had a mixture of both in our clinicals, asking for assistance only if really needed ie, safety issue. hang in there. Bet you never forget DIG :)

LOL...yes I will remember what DIG is for, for the REST of my life!!! No we do not have aides, they are there for the nurses only, the students must perform total care for all pts.

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Even though things seemed pretty hectic, you did your best, and you and your patients made it through the day just fine. It's good to recognize the things that you need to improve upon, and you learned from this experience.

I'm a new grad in orientation now & a couple big things that I've learned is to chart as I go--even if I take those couple minutes I feel I don't really have (it seems to make a HUGE difference in my day), and to remember that I can only do one thing at a time. Take a deep breath during the day, regroup, and jot down your priorities if you have a list going in your head. Keep plugging away and it will all come together. Feeling calm & taking your time when you need is important & ensures safe care for your patients.

I wish you the best of luck.....somedays it does seem like one thing after the other!!

Take care....and make sure you get your rest :wink2:

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