Help! I think I'm going to accidently hurt or kill someone

Mulan · Feb 17, 2015

There must be a manual of some kind at your workplace that has the hypertensive emergency protocol in it. If not, that's another problem.

Become familiar with all the policy and procedure manuals. They are probably in your computer system.

Make yourself a copy of that protocol and other protocols, such as the hypoglycemia protocol, and keep it on your person or your clipboard so that you have ready access to it.

Mulan · Feb 17, 2015

Are you still on orientation and do you have a preceptor?

Did you have any kind of classroom orientation that would have covered protocols and where to find them?

Susie2310 · Feb 17, 2015

New nurses today often do not receive sufficient training in nursing school to be able to practice safely at the level of the novice nurse without lengthy internships, and facilities often do not provide this kind of training. This means that new nurses may often be in situations that risk both their patients safety and their own licenses.

Without knowing more about your orientation/preceptorship, it is not possible to comment on the training/support you are receiving in your job as a new nurse. However, you should have been introduced to policies and procedures in regard to care of patients on your unit. I would expect there to be a policy for the care of post-operative patients.

brownbook · Feb 17, 2015

I could have written your post 30 years ago. TAKE A DEEP BREATH AND TRY TO RELAX.....take your own pulse!

We need to know the rest of the story? Did the patient survive? What happened?

I can't see anything you did wrong?

Hypertension is a NORMAL response to pain. If, that is a big if, the patient's blood pressure dropped really, really, low due to pain meds and blood pressure medication being given at the same time well...patients don't just suddenly die from "only

their blood pressure dropping.

If nothing else was wrong with the patient...he had not suddenly lost 4 pints of blood, his heart hadn't suddenly stopped beating, etc. his body, sympathetic nervous system, etc., would, will, (did?) kick in and he was fine?

A hypertensive emergency protocol would be for someone who had completely unexplained hypertension over a certain amount of time. (A patient with no obvious issues, no pain, saying "I feel fine....I don't know why my blood pressure is 210/110?) Not a patient with one or even two "high" readings over 10 - 20 minutes when they were in pain.

Please believe me....it is REALLY, REALLY, hard to hurt or kill a patient.

You seem like a really good, sensitive, caring, concerned, nurse. Remind yourself your worrying just shows you really care.....don't let your worries destroy you.

AJJKRN · Feb 18, 2015

My curiosity wants to know what the BP and HR recheck was an hour later and if the patients pain was controlled better after the pain meds were given. A few things, breathe!, acute pain can cause elevated BP's and HR's, I would try the patients scheduled normal BP med first (with consideration/relation to their HR), and if it didn't work in about an hour I would be looking at BP prn meds to give plus looking again at if the patients pain was under reasonable control or not...could have just been the pain causing the elevated BP. Remember with surgical patients that it is nice to keep their BP under control when able to to protect the surgical anastomoses healing process. Lean on your more trusted seasoned staff during these situations as well but ALWAYS use your own judgement! Stay humble and remember that it takes time and experience to grow and learn how to deal with new situations that you will later be able to apply to other new or familiar situations.

Rbeck911, BSN, RN · Feb 18, 2015

Okay, first thing you need to do is calm down. Every new nurse goes through this to some extent. 2nd, do some self reflection and be honest with yourself. Do you really think you are going to kill someone? 3rd, take steps to prevent it. There are nursing measures and standing orders. You can't memorize the P&P, so always have it handy. Learn your standing orders, and if the problem your facing doesn't apply, call the MD. Learn your parameters.

Esme12, ASN, BSN, RN · Feb 18, 2015

BREATHE!

IMHO you started off just right. I would have medicated the patient for pain and give the beta blocker (if ordered) I would have gone back and checked the B/P in about 15 mins. If better I would wait another 15 mins and see what the B/P was and if the pain was below a 5.

If not then I would call the MD with the B/P and better pain control. I would be cautious to give the emergency B/P control (unless they were a craniotomy and an aneurysm clipping) until the pain was better controlled because if you lower the B/P then fix the pain you will probably over shoot the mark and make the B/P too low....and the patient remains in pain. Now you can't medicate them for pain until their pressure is higher.

Esme12, ASN, BSN, RN · Feb 18, 2015

Are you still on orientation and do you have a preceptor?
Did you have any kind of classroom orientation that would have covered protocols and where to find them?

I would also think there would be an order for "B/P as per protocol"

HouTx, BSN, MSN, EdD · Feb 18, 2015

Heck, you're only 5 weeks in and you are able to consistently identify patient problems?? That's actually really good. Learning how to apply your "book" knowledge - and recognize patient symptoms is a huge, very big deal!! With experience, you'll learn how to manage patient problems & prioritize your interventions. It's a normal progression toward clinical competence. Eventually, you will be able to anticipate the likelihood of problems arising and adjust your interventions to account for them - that's the hallmark of expertise.

Don't be so hard on yourself. You're on your way.

HollySue061566 · Feb 18, 2015

Hi All,

Yes, I am still in orientation and have a preceptor who has been a nurse for 25 years. She is great and I am learning a lot from her, but I am not learning it fast enough to feel competent as a beginning nurse. (Ironically, the nurse who yelled at me about the blood pressure is the one I want to train me now....she tells it how it is with no kid gloves).

I also feel that checking my charting is often more important than actual teaching or patient safety (I'm pretty good at this, so maybe my preceptor has overestimated my abilities in other areas). Because of training in admissions, discharges, and computer use, I have been on the floor for a total of nine, 12 hour days.....to me that is not a lot of time to obtain experience.

I took everyone's advice and went into work yesterday and started printing off some of the more pertinent Policy and Procedures from our online site (this is the only way we can access them). I want to review them before I am in a situation where I need them in an emergency. Plus, I still need to learn how to anticipate which ones I might need.

The patient lived....it took them three hours to bring down his blood pressure, but he is doing fine. His pain control is still an issue...unbeknownst to us he was taking Norco 10/325 at home on a pretty regular basis...tolerance?

Thank you everyone!

I feel better, but I am still scared.

Holly

JimmyDurham9 · Feb 18, 2015

Give yourself a break. You'd be a real danger to your patients if you didn't have this fear you might make a mistake. It's when we think we know and have seen it all that we become seriously dangerous. It's going to lessen with time and experience, but the concern that harm might come to the patient due to your action or inaction should NEVER go away; it just shouldn't torment you.

I've been where you are, feeling like I wasn't learning enough as quickly as I should, and I'm gonna tell you what my preceptor told me: "You're only human boy. It took the Romans 1,000 years to build that place."

You're on the right track with printing out policies and procedures. While its not feasible to memorize every detail of every one, with time you will come to know them. And you should always be able to utilize your team as a resource as well - the charge nurse, your fellow nurses, definitely your preceptor.

Have you read your state's nurse practice act? How about ANA's Scope and Standards of Practice? Highly recommend reading each and just be familiar with them. Your best resources will be your states nurse practice act, ANA's Scope and Standards of Practice, and your facilities policies and protocols. They contain the information to guide you in carrying out prudent nursing care.

You can talk to your preceptor and other nurses and ask about some of the things they've encountered. Also you can use the critical thinking skills nursing school taught you - what kind of floor do you work on? what kinds of patients are there? Then you anticipate potential problems/complications. Personally, no matter what unit I work I familiarize myself with the cardiac, stroke protocols and procedures as well as codes. My surgical unit did huddle each morning and assigned code roles that way if one occurred there would be no scramble or confusion as to who's doing what. You'll learn the kinds of problems to anticipate based on your unit and the patient population. It'll come. I promise; just be patient and don't get frustrated with yourself. Ask for help if you need it.

You'll feel boggled down by the charting at first. That too will pass. Now, as for the nurse who yelled at you - that is unacceptable and unprofessional behavior. If your facility hasn't adopted one already, the day is coming for zero tolerance policies across the board on behaviors like that. It's inexcusable behavior.

Good luck with the rest of your orientation! You sound like you're on the right track to finding your nursing legs :)