Had My First Night Off Orientation Tonight...Need a Little Support Please!

[al7139, ASN, RN]

Hi Everyone!

Tonight was my first night "on my own". I was very anxious as I went to work tonight, and my shift did not start out well.

I got to work and got my assignment (same pts as the last two evenings, just without the preceptor).

Found out in report that a pt I had last night bottomed out after I left (BP dropped to 60/30). YIKES! The reporting RN (who was also the Team Leader for day shift told me it was probably as a result of the fact that I gave her 2100 lasix and lopressor with a B/P of 97/65). The pt is OK, but I REALLY felt awful, especially because in hindsight, I know better than to give those meds with a low B/P. I felt so bad that I started crying at the nurses station. The TL and the other RN's there were very supportive and understanding of how I felt, and some had similar stories of things that happened as they were starting as new nurses. My preceptor even apologised to me, and said that she should have been paying more attention to what I was doing, but really, I take full responsibility for this, since as I said, I know better than to do that. I have been beating myself up over this ever since I found out, and am having a hard time forgiving myself for this. I just thank God that the pt is OK, and did not code.

I really started questioning whether I wanted to be a nurse anymore.

I will say that except for a few easily handled issues, my first official shift as an RN went well.

I will definitely use this as a learning experience.

I know I am not alone in this, and that other nurses have probably had similar experiences. Would you please share with me your stories and how you made sure that you did all you could to prevent it? My worst nightmare is having a pt die from something I did, because I am still new.

Also, is there a good resource besides the drug books to really help me know my heart meds?

Amy

[rn undisclosed name]

Don't beat yourself up. Yes that BP was a little low. Have I given BP meds to people with BPs like that? Of course. First of all it depends on the pt and how their BP runs and the dosages I'd be giving them. If I'm not comfortable I will run it by the doc first. If they tend to be that low it's one thing. This is where your critical thinking comes in. Depending on the patient I have also held bp meds and see how they're doing in a couple hours.

You will learn a lot and you have the right attitude. Use it as a learning experience and don't get mad when someone tells you about what happened.

I haven't given any heart meds to any patients that shouldn't have gotten them (at least not that I know of). When I was still on orientation I gave heparin to a patient with heparin induced thrombocytopenia and I just felt awful. Now that pt probably didn't receive much of the heparin because it was used for her dialysis permacath so when I realized it we withdrew what we could flushed the port and then used some other med in place of heparin. We also called the doc to explain what happened and they were ok with it. But it is definitely a horrible feeling when you feel like you made a mistake. It wouldn't be normal if it wasn't.

So, keep going forward and remember there will come a time when it is not so overwhelming. I didn't believe that time would ever come but it does.

Kelly

[BBFRN, BSN, PhD]

I agree- don't beat yourself up. We have cardiologists where I work that don't want Lopressor held unless the SBP is 90 or lower.

It is completely normal to question whether you want to be a nurse or not when you're new. The reality of the high level of responsibility that comes with the job has hit you. We have all gone through that, and it does get better.

Personally, I would be much more afraid of a new nurse who is too confident, than one who knows they need help every now and then. Heck, I've been doing this for over a decade, and I still need to bounce stuff off of other nurses.

[jmgrn65, RN]

Well I have worked cardiac many years, and I probably would not have had a 2nd thought about give the lopressor and lasix. that bp wasn't that low. Most likely if you would have asked a doctor they would have said give it. so don't beat yourself up over it. You are still learning and you will be, you don't get everything in nursing school. The most important thing you can do is, if your arent' sure than ASK. Nurses that have been around for ever still ask each other question, if nothing else just to validate what we were thinking. Good Luck you will be fine.

[Spatialized]

You'll have good days and bad days. I too would have given the Lopressor and Lasix, BP wasn't too low to start with. Many of our cards folks write to hold lopressor only for SBP>90, so I would have given both. Don't feel abad about it.

If in doubt, like others have said, ask. I joke I do my best thinking out loud.

Cheers,

Tom

[al7139, ASN, RN]

Thank you all so much for your replies, I feel much better. Th pt was ok, and went home with no problem. I have been off orientation for a few days now, and it's still overwhelming, but I find that after that incident, I am being much more careful, and "slowing down" when I pass meds. So far so good. I talked to another RN at work, and she said she probably would have given the meds too, since the pt trended low, and was taking the same meds at home prior to admission. We usually get parameters from the MDs, but she did not have any. Most of the time it's hold if

Anyway, I will let you know how I am doing soon.

Thanks again for your support

Amy