Help! I'm sinking!!

wonderbee, BSN, RN · Aug 25, 2006

This was your third day? I mean think about it... just your third day. You won't spike the blood that way again. We learn. We get better.

I had one or two horrific days during my orientation. On one of those days, I was relieved of my patient care duties so that I could calm down, sit and chart. I was obviously shaken by my own ineptitude. It was a welcome intervention by my clinician and she was the one who stepped in for me. I wasn't sent home but this was pretty close to that.

It's 8 months later and I'm still on the unit. I got better. I'm learning. So will you.

Pediatric Critical Care Columnist · Aug 25, 2006

On my last day of orientation to the PICU I used to work in, I made a huge mistake that almost killed my 13 month old patient... I cut the ties on her trach without making sure the new ties were snug. The trach was dislodged, she desated to the 40s, had a bradycardic arrest and got two doses of epi, compressions and the whole nine yards. I was devastated that I had done something so awful. But I cowboyed up and filled out all the incident forms then spent an hour talking to the head nurse and the educator. Then I decided that I would learn from it and make darned sure I didn't do anything like that again. I didn't let it scare me out of the environment I KNEW I was meant to work in, and although I've done some pretty dumb things since then, none of them have been of that magnitude. No one held it against me either. Just as no one will hold it against you that the spike went into the blood bag sideways. These things happen. Your aplastic anemia patient most probably wasn't unduly compromised by waiting for the blood, but you were exposed to blood meant for someone else so I'm more concerned about YOU! Take a deep breath and cut yourself some slack. Humans are not perfect beings, but they are special!

New2ER · Aug 25, 2006

I've been working for 6 months (3 in ICU and 3 in ER). I understand being overwhelmed with all the drips. The monitor, the vent, and the 5-6 drips a patient can be on in ICU/ER was very intimidating but we all get used to it. We have to not be afraid to ask questions when we're in doubt (no matter how silly the question sounds to us) and be willing to triple check what we're doing. Always, always check. I've made plenty of mistake, but I've managed to learn from them and not repeat them. My favorite so far is when I gave myself a heparin bath. *grin* My patient was on a heparin drip and the bag needed to be changed because of the date and was half full. I hung the new bag and popped it open, went to pull the spike from the old bag but didn't consider the fact that if I didn't remove it from the hook it would drip. The second i pulled the spike I saw the fluid coming out head toward my patient, I redirected it to myself in the process of taking it down and ended up bathing myself in about 50 ccs of heparin. Not fun and I was extremely embarrased. Nobody saw it and my patient was not with it so there are no witnesses but I did tell my preceptor afterwards and we both laughed about it. Since then I've remembered to take the bag down *before* I take out the spike.

Pediatric Critical Care Columnist · Aug 25, 2006

my favorite so far is when i gave myself a heparin bath. *grin* my patient was on a heparin drip and the bag needed to be changed because of the date and was half full. i hung the new bag and popped it open, went to pull the spike from the old bag but didn't consider the fact that if i didn't remove it from the hook it would drip. the second i pulled the spike i saw the fluid coming out head toward my patient, i redirected it to myself in the process of taking it down and ended up bathing myself in about 50 ccs of heparin.

i've done that before! i don't remember what was in the bag, but i know i've done it at least once. and i've done it with heparinized ns on a pressure bag... whoops!!:trout: i'd hate to do it with tpn... the smell would kill me! it's not unusual for our patients to have more than a dozen drips running all at once. plus their antibiotics and magnesium boluses...

youngatheart · Aug 25, 2006

Janfrrn, Your words at times have been very comforting as I have seen your threads in othe posts. Whippet I feel like you do. I am a new grad (may 06) I work on a pulmonary/renal/med-surg/telemetry/overflow floor, I have had a total of 5 preceptors only 1 has really been good. I feel very unorganized and not that I need my hand held but could use some direction. I am really frustrated and wish I could fast forward one year already. I am currently orientating on days and eventually will be going to nights 7pm-7AM looking very forward to working those hours and less doctors, less orders, people not off the floor going for tests, less family members. I will go on to nights in October (count my blessings) hang in there we are all new and cannot be expected to know everything. One day at a time is my mantra now.

Pediatric Critical Care Columnist · Aug 25, 2006

youngatheart, thanks for the pat on the back.

It's very unfortunate for you that you've had so many preceptors... or more correctly, "buddies". The only time that is a benefit is when you've had experience in the specialty and are orienting in a new unit. For someone just getting her feet wet, it's so much better to have that consistency that comes with only one or two at the most. They know exactly where you are and what you're doing and can plan experiences for you that will help you get comfortable. The more faces and personalities you throw into the mix, the less likely the orientee is to have the best possible orientation. Communication is harder too with more bodies involved. I hope when you go onto nights that you have some consistency. You will find the pace much slower and you'll probably learn more too. You might want to mention at your evaluation that having had so many preceptors made your orientation unnecessarily difficult and suggest that they try to limit how many the next crop will have. If you use the right words and the right tone, it will come across as constructive rather than whining (nobody wants to be considered a whiner!) and it might help those to follow. Good wishes.

truern · Aug 25, 2006

Paula, I feel your pain.

This week I had a pt w/prostate and bladder ca. He'd had a J tube placed and had a urostomy tube. Not only did he proceed to PULL OUT his J tube, but he managed to dehise his abdominal incision and had to go back to OR for repair of both. He's so thin the only place I can find to give his insulin is a tiny pocket of fat at the top of his thigh.

This week I also had a pt that has hidden breast ca from her family for over a year. She was "treating" it with antibacterial soap and dressing it with KLEENEX. She said that was the only way to "hide" the evidence because she could flush it. After spending time in the ED and ICU (she had pleural effusions and had almost a liter of fluid drained and a CT placed) and refusing to let anyone look, she finally agreed to let me remove her dressing and take a peek. I can't begin to describe what was hidden away. Bless her heart...I can't imagine what a toll this took on her mentally and spiritually

Mind you..this was only my third week of nursing since passing NCLEX:uhoh3:

It WILL get better, Paula. I have faith that it will, and you can, too :)

Dempather, RN · Aug 26, 2006

Paula,

It sounds like you've been activated at just the right moment. I'm so sorry that things have been a tough for you. But this is the stuff that makes your skin thicker (and we're not talking about scar tissue..). How much can anybody appreciate their accomplishments if they didn't have their share of struggles? If they didn't have to work at something and grow and thrive? I'm sure you've heard this tons of times, from people here on the posts, and on your unit... but that should make it all the more true. I've been repeatedly encouraged to look towards the more experienced nurses for help when I need it, but also for their experiences... because everybody starts somewhere and every day we grow a little more. Time helps us accept events like this, and maybe even laugh at them a little later on down the road (this can be your "the one thing during orientation I wish I hadn't done" story to contribute to the group). Keep your head up. Hope this makes you smile and reminds you that you're where you are because of your hard work and because you deserve to be there. Keep in touch and let us know how orientation continues to go.

Trauma Columnist · Aug 26, 2006

When I first started in the ICU, I did some pretty dumb (and now) terribly funny things. However, at the time, they were not funny to me.

You live and learn and don't repeat the mistakes.

And in a few years - you'll be that preceptor to that terrified new grad. And you know what? You'll be a great preceptor because of this bad experience.

grinnurse, RN · Aug 26, 2006

Paula-

Unfortunately-the first year is something we all have to get through:uhoh3: But like all the advice befor this post, the best thing is learn from your mistake and move on and know that there will be more to come no matter how prepared we are out of nursing school it's not anything like the real world of nursing.

I've been a nurse now just a little over a year and I finally feel like I have some kind of organization and that simply gets better with time. And I feel your pain on the pumps. When I first started in May of 05 I always was wrestling with the darn pumps, been soaked in saline more times than I care to think about during those first few weeks, and wondered for about 6 months why the heck I chose this profession with all the stress, etc. Then, my gut instinct kicked in and I caught a situation with another nurses pt that helped to save his life and realized, yeah-that's why I went to nursing school and am working here-to help people!! Stick with it, it will get better. Just have to give it time and go easy on yourself, ask tons of questions of your senior nurses. Good luck and keep us informed how it continues to go for you. We're here for you gf!!

healer27 · Aug 26, 2006

Hi Whippet!! I believe you posted on my post where I was asking for some encouragment because I too have been having a rough start to nursing. I'm currently working on a tele floor and I find myself frustrated ALOT b/c my preceptor will disappear and I'm in a grey area as far as knowing what to do; I try to figure things out but sometimes I simply just don't know and then I can't find my preceptor to show me, then I'm walking around in circles deciding what to do next so I don't waste time till she decides to appear again. I also have a problem with hanging iv's and stuff and it should be interesting when I start doing IV insertions.. Also another simple thing I sometimes have a problem with is getting a manual IV on someone with a weak pulse (this is particulary embarassing for me.) Sigh.... IN any case I'm sending you lots of positive thoughts and just know you're not alone!!!!

Also I said it in my post but I'll say it again here just thanks to everyone who has had kind words or shared experiences with people who are new.