Had a bad night.

[Morainey, BSN, RN]

So I worked last night, I had three demanding patients (I don't want to get into specifics but one was a fresh post-op, one was getting 2 units of blood, and one was NOT HAPPY with the previous shift nurse).

Lots of things happened. And I was only there for four hours! But here is the basic rundown:

Saw the unhappy patient first, turns out they were fine, basically a customer service issue, whatever. Then I got report on the fresh post-op (assignment changed three times, grrrr) and went to see them, they were having a little bit of pain so I assessed them and then medicated them. Unit of blood person comes back from DI, so I went to go see them.

Was getting the 1st unit of blood ready for the blood patient, before I hooked them up to the IV pump and walked away (all the checks were already done) I decided to flush the IV to make sure it was ok because it was saline locked. Well it leaked all over the place. I was like, oh NO. I am so-so with starting IVs, but if you don't use the unit of blood within a certain amount of time you have to send it back. Luckily (and this is why I love my coworkers) someone came to see if I needed help with anything. So she got the IV started, the blood got going fine. Good, great, whew, because all I could think about was Oh my gosh I am about to waste a whole unit of blood.

So I started doing some charting, and while I was going through VS for the fresh post-op I noticed that hey their last O2 sat (about half an hour before) was 89% and coincidentally this same anesthesiologist who did this pt was sitting next to me at the charting area, she was saying to someone else that she sent the CNA to recheck VS. She was kinda standing around, so I said oh I'll go check them. I felt like a jerk because I didn't know my patients' O2 sat was that low - it comes up in a big nasty read box on our screen so it's hard to miss, but honestly I had been busy with blood pt so I hadn't looked at it yet.

I went to the pt's room, no CNA to be found. So I grabbed a computer and did the VS myself, the O2 was 87% and BP was crappy - 70s/40s. I called down and said the doctor in here please. She came in, I said, I'm not sure if this BP is real, let me go find a BP cuff so I can check it myself. The pt was kinda yucky looking, pale and sleepy, mentating ok though. They had vomited 2x and gotten Zofran. Long story short is, I couldn't find a BP cuff. The MD was more concerned with the O2 sat however, and said I could give them a fluid bolus if I wanted. I said I would feel more comfortable giving a fluid bolus with a BP like that. She said fine.

Then this is the part I keep replaying in my head. She started showing me their recovery room orders, where it says O2 prn, etc etc, the standing order kind of stuff. So I just stand there going oh, okay. Like OBVIOUSLY I know to put O2 on if needed, you know? But I just said yes, oh okay, like this is alllll new to me. So she says it looks bad in the computer that the O2 was 89 and you didn't do anything. I didn't want to say, I didn't know, because I felt like that was a copout.

However, when you get a VS that is out of normal range, a big nasty box comes up in the computer saying "high" or "low", notify RN. And the person taking VS never notified me!!! I didn't say anything, because I didn't want to throw this person under the bus, you know, and go "oh, but so-and-so never TOLD me". I felt like that was a cop-out. Majorly.

So anyway. The patient had their O2 on at that point, sats were in low 90's, encouraged incentive spirometer, and seemed better. After their bolus, their BP popped right back up to 110/70.

I'm just frustrated and venting. The anesthesiologist was nice, it's not like I got screamed at in the hallway or anything. But I just... didn't say anything. I didn't put the blame on anyone. I'm scared I made myself look negligent or something. Or stupid. Obviously, if I knew the patient had an O2 sat that low, I would have intervened, but I wasn't aware. But I feel like it was a major cop-out to say, but I didn't know.

I was really aggravated with the CNA, and I told them, you need to make me aware of VS like this. She was like oh sorry. I don't think she was assigned to my patient, she was just taking their VS for whatever reason, but I mean really? I KNOW the computer prompts you to notify the RN of any weird set of VS!!!

Okay, done venting. Just disappointed in myself. No harm came to my patient (or any of my patients) but I just left feeling, like, arrrrrrrgh. I could have handled that much, much better, but I didn't want to be a defensive nurse who blames everyone else - you know the kind I'm talking about.

bummed out today.

[Armygirl7]

Don't beat yourself up! Seriously - i feel like the big dragon of the first year after licensure is negative self talk. The little train that "shoulda, woulda, coulda!"

Yes, you "should have" already had the O2 on per post-op orders or whatever - but you didn't and you corrected it when you saw it- you involved the team (MD), you can nicely ask the PCA to please please be sure to inform you of VS outside normal limits, and you can work on a system for checking for those nasty red boxes more frequently. Lessons learned!

I spent months beating myself up for every stinkin mistake I've made and finally my preceptor said - "Knock it off- when you are leaving shift start framing it like this "Tonight I learned....XYZ." Instead of "Tonight I f** up XYZ!" If you think it doesn't make a difference I'm begging you try it - it makes a huge difference in your confidence and it ensures that you are learning which is what nursing is all about.

I also have a strategy for when people correct me (like more expert RNs, MDs, PCAs, URs) ESPECIALLY when it is something so OBVIOUS that I am cringing inside and all I want to do is defend defend defend because honestly I KNOW it!! I've found it is simply not at all helpful or good for my reputation to be defensive - when I see it in other new nurses I see how ugly it is and how it actually shuts them down to collegiality and respect - so in those cringe moments now I just say "Copy that!" and "Thank you!" And I learn and I move on!

Good luck! Remember you are a newbie making newbie mistakes - right where you're supposed to be - safety first and move on!

Peace!