Heparin drip disaster

[Neuronurse88]

I made a mistake and it's eating me alive. Would like to vent about it/maybe get some insight from other nurses... before I tell you about the mistake, here's some background.

I'm a new nurse, I just got my license and started working in August 2022. 
I work on a neuro stepdown unit where we have 5-6 patients every day. 
I had five patients on Thursday and here is what my assignment looked like:

Patient 1 - (not a neuro patient) came into the ED with shortness of breath and chest pain. She had orders for intermediate care and we were the only step down unit with an open bed. 

Patient 2 - stroke patient with major deficits. Likes to jump out of the bed/chair to walk to the bathroom or for some other reason every five minutes even though this  patient is unsteady af. I'm in the room every five minutes because she has jumped up again  

Patient 3 - another stroke patient with major deficits. 

Patient 4 - fresh post OP spinal surgery from PACU

Patient 5 - patient had bone and lung cancer and it spread to the brain. Patient had multiple tumors on the brain. This was making him confused and aggressive. 
He kept getting out of bed also and he is not steady and he is a major risk for falls d/t brain tumors. Bed alarm keeps going off, and that makes him agitated. He would yell and hit things. Also, getting him back in bed was impossible.... 

So on Thursday, patient 1, who is on tele, randomly converts to AFIB with RVR. Heart rate went from 60s to sustaining 130s-170s

Drs paged, they ordered an amino drip and a heparin. I go to get those started. Her only IV has now infiltrated ? I start 3 IVs on her, so both the heparin and amino can have a dedicated line and then have a line open for other various medications she was getting. 

I start the two drips around 12:30, drew the APTT at 6:30pm. It didn't result by the I left so I told the night nurse in report that she should be on the look out for the result so she can titrate the drip accordingly. 

She didn't titrate the drip or draw labs all night. The Heparin drip was started at 12 units/kg/hour. I looked at the result from the APTT that I had sent down last night. It was 89. According to the order, the drip should have been titrated down. This was never done and labs were never collected  overnight. I asked why labs were not collected all night and she said the patient is a hard stick....

At this point we do an APTT and it results as 39. I assume the low result was because the night nurse said that she paused the drip a few times for the intermittent antibiotics the patient was receiving... I made sure the patient had three IVS before I left so that wouldn't happen.

Anyway, according to the order, we had to bolus heparin and then titrate the order from 12 units/kg/hr to 14. We did that at 9 am. So labs should have been done Q6 after the bolus. I start trying to get the lab around 2:30. I'm having no luck, patients veins are blowing, not giving any blood.

After asking two other people, we finally got a blue top sent to the lab. Lab rejects it. They rejected it because they said I mislabeled the tube. I labeled the tube with the routine APTT lab that was ordered but I also put in a STAT order so  lab would process it fast (they are ridiculously slow and this was an important lab)

I put the routine lab on the tube and just put the STAT label in the bag. Because of the STAT label in the bag, they said the sample was mislabeled and wouldn't accept it. I didn't know that was a thing, I have seen others do it and it was fine. 

Lab rejected that sample and put in for a re-draw. After two nurses trying, we got another blue top and sent it down. Lab calls and says that can't accept it due to insufficient quantity. That tube was full...

Lab puts in for another re-draw. At this point it's after 3:30. We are struggling to get blood off of her and the patient is tired of being stuck. Every time I came in the room she literally would say "please no more labs"

I put in for a STAT order for an IV nurse to come draw the labs with the ultrasound machine. When I left at 7 pm the IV nurse never came. Therefore the lab post bolus and titration was never done. I am now overthinking it and feel horrible. I don't want to cause harm to any of my patients.?

The drip was essentially running my entire shift without an updated lab result. I am sick to my stomach about this. 

Also I would like to add - when I got off Thursday, I went and spoke with the night shift charge nurse and asked her to please change my assignment for the next day. I told her I couldn't handle this group with 5 patients. 

(5 patients and four of them are Q4 neuro checks, two high fall risks that keep getting up, patient one had the heart changes and two drips were started. That same patient also kept having sugars from 400-500. When I left Thursday they were considering an insulin drip)

I couldn't handle it.... And the assignment was not changed. I went and talked to the charge nurse when I came in on Friday and noticed it wasn't changed. She said "look at the assignment you have an orientee, that's why I didn't change it. The orientee  can take patients"

The "orientee" was a travel nurse who could not take patients, didn't have access to anything, and was trying to learn about the unit, how we do things, our policies, etc. she would also go MIA for hours at a time. 

I had the same assignment from the day prior, with no real help when it came to patient care, and I was now tasked with teaching a new hire.

?

[ladedah1, BSN, RN]

Neuronurse88 said:

I had five patients on Thursday and here is what my assignment looked like:

patient 1 - (not a neuro patient) came into the ED with shortness of breath and chest pain. She had orders for intermediate care and we were the only step down unit with an open bed. 
 

patient 2 - stroke patient with major deficits. Likes to jump out of the bed/chair to walk to the bathroom or for some other reason every five minutes even though this  patient is unsteady af. I'm in the room every five minutes because she has jumped up again  

patient 3 - another stroke patient with major deficits. 

patient 4 - fresh post OP spinal surgery from PACU

Patient 5 - patient had bone and lung cancer and it spread to the brain. Patient had multiple tumors on the brain. This was making him confused and aggressive. 
He kept getting out of bed also and he is not steady and he is a major risk for falls d/t brain tumors. Bed alarm keeps going off, and that makes him agitated. He would yell and hit things. Also, getting him back in bed was impossible.... 
 

So on Thursday, patient 1, who is on tele, randomly converts to AFIB with RVR. Heart rate went from 60s to sustaining 130s-170s

Drs paged, they ordered an amino drip and a heparin. I go to get those started. Her only IV has now infiltrated ? I start 3 IVs on her, so both the heparin and amino can have a dedicated line and then have a line open for other various medications she was getting. 
 

I start the two drips around 12:30, drew the APTT at 6:30pm. It didn't result by the I left so I told the night nurse in report that she should be on the look out for the result so she can titrate the drip accordingly. 

Sounds like a busy day!

Neuronurse88 said:

It didn't result by the I left so I told the night nurse in report that she should be on the look out for the result so she can titrate the drip accordingly. 

She didn't titrate the drip or draw labs all night. The Heparin drip was started at 12 units/kg/hour. I looked at the result from the APTT that I had sent down last night. It was 89. According to the order, the drip should have been titrated down. This was never done and labs were never collected  overnight. I asked why labs were not collected all night and she said the patient is a hard stick....

Hospitals are a 24 hour operation.  It sounds like you did a lot to try to set the next shift up for success.  The fact that they dropped the ball is not your fault.

Neuronurse88 said:

Hello everybody,

I made a mistake and it's eating me alive. Would like to vent about it/maybe get some insight from other nurses.. 
 

Before I tell you about the mistake, here's some background.
 

I'm a new nurse, I just got my license and started working in August 2022. 
I work on a neuro stepdown unit where we have 5-6 patients every day. 

I had five patients on Thursday and here is what my assignment looked like:

patient 1 - (not a neuro patient) came into the ED with shortness of breath and chest pain. She had orders for intermediate care and we were the only step down unit with an open bed. 
 

patient 2 - stroke patient with major deficits. Likes to jump out of the bed/chair to walk to the bathroom or for some other reason every five minutes even though this  patient is unsteady af. I'm in the room every five minutes because she has jumped up again  

patient 3 - another stroke patient with major deficits. 

patient 4 - fresh post OP spinal surgery from PACU

Patient 5 - patient had bone and lung cancer and it spread to the brain. Patient had multiple tumors on the brain. This was making him confused and aggressive. 
He kept getting out of bed also and he is not steady and he is a major risk for falls d/t brain tumors. Bed alarm keeps going off, and that makes him agitated. He would yell and hit things. Also, getting him back in bed was impossible.... 
 

So on Thursday, patient 1, who is on tele, randomly converts to AFIB with RVR. Heart rate went from 60s to sustaining 130s-170s

Drs paged, they ordered an amino drip and a heparin. I go to get those started. Her only IV has now infiltrated ? I start 3 IVs on her, so both the heparin and amino can have a dedicated line and then have a line open for other various medications she was getting. 
 

I start the two drips around 12:30, drew the APTT at 6:30pm. It didn't result by the I left so I told the night nurse in report that she should be on the look out for the result so she can titrate the drip accordingly. 

She didn't titrate the drip or draw labs all night. The Heparin drip was started at 12 units/kg/hour. I looked at the result from the APTT that I had sent down last night. It was 89. According to the order, the drip should have been titrated down. This was never done and labs were never collected  overnight. I asked why labs were not collected all night and she said the patient is a hard stick....

At this point we do an APTT and it results as 39. I assume the low result was because the night nurse said that she paused the drip a few times for the intermittent antibiotics the patient was receiving... I made sure the patient had three IVS before I left so that wouldn't happen.

anyway, according to the order, we had to bolus heparin and then titrate the order from 12 units/kg/hr to 14. We did that at 9 am. So labs should have been done Q6 after the bolus. I start trying to get the lab around 2:30. I'm having no luck, patients veins are blowing, not giving any blood.

after asking two other people, we finally got a blue top sent to the lab. Lab rejects it. They rejected it because they said I mislabeled the tube. I labeled the tube with the routine APTT lab that was ordered but I also put in a STAT order so  lab would process it fast (they are ridiculously slow and this was an important lab)

So I put the rountine lab on the tube and just put the STAT label in the bag. Because of the STAT label in the bag, they said the sample was mislabeled and wouldn't accept it. I didn't know that was a thing, I have seen others do it and it was fine. 
 

lab rejected that sample and put in for a re-draw. After two nurses trying, we got another blue top and sent it down. Lab calls and says that can't accept it due to insufficient quantity. That tube was full...

Lab puts in for another re-draw. At this point it's after 3:30. We are struggling to get blood off of her and the patient is tired of being stuck. Every time I came in the room she literally would say "please no more labs"

so I put in for a STAT order for an IV nurse to come draw the labs with the ultrasound machine. When I left at 7 pm the IV nurse never came. Therefore the lab post bolus and titration was never done. I am now overthinking it and feel horrible. I don't want to cause harm to any of my patients.
?

the drip was essentially running my entire shift without an updated lab result. I am sick to my stomach about this. 

This is the kind of situation that makes me grateful for the team-style set-up my hospital has.  Pharmacy manages heparin drip titrations, boluses, orders, schedules timed draws for anti-Xa and / or aptt, and monitors for results (of course, contacting us in a timely fashion if it's missing, too!).  Phlebotomy does our draws, but if they're a hard stick, we can call the specialist team.  If the drip rate needs to change, the pharmacist calls us directly to let us know.  If we're super busy, we have a free charge that we can delegate it to (though it is a double check).  As a result, heparin drips run very smoothly where I'm at.  While it sounds like you encountered quite a few issues, it also sounds like a system that could benefit from some process improvement.  It's so easy to blame ourselves when everything goes awry, but sometimes it can very well be the result of a flawed system that lacks useful safeguards and fails to take the full context of your daily duties into account.

Neuronurse88 said:

I went and spoke with the night shift charge nurse and asked her to please change my assignment for the next day. I told her I couldn't handle this group with 5 patients. 

(5 patients and four of them are Q4 neuro checks, two high fall risks that keep getting up, patient one had the heart changes and two drips were started. That same patient also kept having sugars from 400-500. When I left Thursday they were considering an insulin drip)

I couldn't handle it.... And the assignment was not changed. I went and talked to the charge nurse when I came in on Friday and noticed it wasn't changed. She said "look at the assignment you have an orientee, that's why I didn't change it. The orientee  can take patients"

the "orientee" was a travel nurse who could not take patients, didn't have access to anything, and was trying to learn about the unit, how we do things, our policies, etc. she would also go MIA for hours at a time. 

I don't know why everyone always seems to be under the misconception that having an orientee is somehow considered offering a nurse "extra help" and should therefore merit a more difficult assignment.  What it really is, is extra work (even if it's an experienced traveler and not a new nurse).  You may have two sets of hands, but it results in slower progress - not to mention all the time it actually takes for teaching about policies, routines, protocols, and the location of stuff (heaven forbid, they come from a place using different software!).  In the end, orienting someone with a difficult assignment creates a burden for both parties: you're both running around like chickens with your heads chopped off, you're both distracted, and the nurse your supposed to be teaching ends up with no meaningful or cohesive information.

Either way, I'm sorry that things went so crappy.  Nonetheless, what has happened has happened and cannot be changed; just breathe and try not to be so hard on yourself.  The only thing you can do is try to learn from any mistakes (like the lab sticker issue) and still aim to do your best.  Maybe you could even sign up for a process / quality / safety improvement team if you have one there?  Sounds like they could use some new ideas ?

Good luck!

[bunnynurse 69]

dearest new nurse. I was very lucky as years ago my mentor told me you can never be faulted if what you did was the safest thing for the patient. I also bet no one ever told you, you can refuse to accept an assignment , if you do not believe it to be safe. I can tell you . DO NOT let some one bully you into a situation like this again.  Politely excuse yourself  from report. politely go to charge nurse, house manger on up the chain. Do not become tearful or angry. explain just as you have so eloquently to whomever is you next level supervisor,  If no changes are made. Let the nurse giving you report you will not accept this assignment until you speak to the supervisor. If no solution can be resolved, Decline the assignment and leave! Document in your own nursing ledger and ask whoever you spoke to to sign it. If they refuse, again politely and respectfully document their  names and names of any witness and Leave. This is not abandonment as you have not accepted the assignment I had a similar issue happen to me many years ago. They will try and bargain with, guilt you and remind you of the lurch you are leaving your fellow nurses in.  This hospital, supervisor will not be sitting in the courtroom when you are asked if you felt this assignment was safe.  Personal nursing ledger? Whenever an incident occurs, good or bad, write down your honest recollections.  I left the night of my incident. I was called into HR and a letter of reprimand was placed in my file. until I read into the HR minutes exactly what had happened. It was later removed. I also heard the outright lies entered by the house supervisor. When the assignment was outside my expertice. Any employer will suck you dry if you allow them to. I don't know what state you live in, check all laws and practice acts. but there is not an administrator that will have your back when it come to the issue of negligence or loss of your license. And while I abhor committes, do ask to see the policy of having an orientee. Every nurse know if an orientee is to have any chance to learn something, you as the staff nurse should have fewer patients, not more. I leave this long winded answer with a "core" truism there is not a shortage of nurses. There are only nurses who find they are unwilling to be treated like disposable chattel anymore and working someplace else. signed 30+ years in nursing

[brissygal, BSN, RN]

Neuronurse 88 - you did a magnificent job under difficult circumstances. You have received very good advice from those who have responded to this post.

The only comment I would like to make is, next time alert the Team Leader or in charge RN of your difficulties early in the shift. But don't beat yourself up. You're a fine nurse - and the proof is the steps you took to do the job. Nursing is 24 hours - you did everything in your power to get the job done - the concern I have is with the oncoming nurse for that shift - I don't believe she fulfilled her nursing job for that shift. 

[LovingLife123]

With a patient being on 2 gtts and frequent labs, and being a difficult stick, I would have asked for a PICC line.  
You did the best you could.  Also, your lab is ridiculous and I would have been escalating things to get my labs run.  

[Lust4life, BSN]

Neuronurse88 said:

Hello everybody,

I made a mistake and it's eating me alive. Would like to vent about it/maybe get some insight from other nurses.. 

Before I tell you about the mistake, here's some background.

I'm a new nurse, I just got my license and started working in August 2022. 
I work on a neuro stepdown unit where we have 5-6 patients every day. 
I had five patients on Thursday and here is what my assignment looked like:

Patient 1 - (not a neuro patient) came into the ED with shortness of breath and chest pain. She had orders for intermediate care and we were the only step down unit with an open bed. 

Patient 2 - stroke patient with major deficits. Likes to jump out of the bed/chair to walk to the bathroom or for some other reason every five minutes even though this  patient is unsteady af. I'm in the room every five minutes because she has jumped up again  

Patient 3 - another stroke patient with major deficits. 

Patient 4 - fresh post OP spinal surgery from PACU

Patient 5 - patient had bone and lung cancer and it spread to the brain. Patient had multiple tumors on the brain. This was making him confused and aggressive. 
He kept getting out of bed also and he is not steady and he is a major risk for falls d/t brain tumors. Bed alarm keeps going off, and that makes him agitated. He would yell and hit things. Also, getting him back in bed was impossible.... 

So on Thursday, patient 1, who is on tele, randomly converts to AFIB with RVR. Heart rate went from 60s to sustaining 130s-170s

Drs paged, they ordered an amino drip and a heparin. I go to get those started. Her only IV has now infiltrated ? I start 3 IVs on her, so both the heparin and amino can have a dedicated line and then have a line open for other various medications she was getting. 

I start the two drips around 12:30, drew the APTT at 6:30pm. It didn't result by the I left so I told the night nurse in report that she should be on the look out for the result so she can titrate the drip accordingly. 

She didn't titrate the drip or draw labs all night. The Heparin drip was started at 12 units/kg/hour. I looked at the result from the APTT that I had sent down last night. It was 89. According to the order, the drip should have been titrated down. This was never done and labs were never collected  overnight. I asked why labs were not collected all night and she said the patient is a hard stick....

At this point we do an APTT and it results as 39. I assume the low result was because the night nurse said that she paused the drip a few times for the intermittent antibiotics the patient was receiving... I made sure the patient had three IVS before I left so that wouldn't happen.

Anyway, according to the order, we had to bolus heparin and then titrate the order from 12 units/kg/hr to 14. We did that at 9 am. So labs should have been done Q6 after the bolus. I start trying to get the lab around 2:30. I'm having no luck, patients veins are blowing, not giving any blood.

After asking two other people, we finally got a blue top sent to the lab. Lab rejects it. They rejected it because they said I mislabeled the tube. I labeled the tube with the routine APTT lab that was ordered but I also put in a STAT order so  lab would process it fast (they are ridiculously slow and this was an important lab)

I put the routine lab on the tube and just put the STAT label in the bag. Because of the STAT label in the bag, they said the sample was mislabeled and wouldn't accept it. I didn't know that was a thing, I have seen others do it and it was fine. 

Lab rejected that sample and put in for a re-draw. After two nurses trying, we got another blue top and sent it down. Lab calls and says that can't accept it due to insufficient quantity. That tube was full...

Lab puts in for another re-draw. At this point it's after 3:30. We are struggling to get blood off of her and the patient is tired of being stuck. Every time I came in the room she literally would say "please no more labs"

I put in for a STAT order for an IV nurse to come draw the labs with the ultrasound machine. When I left at 7 pm the IV nurse never came. Therefore the lab post bolus and titration was never done. I am now overthinking it and feel horrible. I don't want to cause harm to any of my patients.?

The drip was essentially running my entire shift without an updated lab result. I am sick to my stomach about this. 

Also I would like to add - when I got off Thursday, I went and spoke with the night shift charge nurse and asked her to please change my assignment for the next day. I told her I couldn't handle this group with 5 patients. 

(5 patients and four of them are Q4 neuro checks, two high fall risks that keep getting up, patient one had the heart changes and two drips were started. That same patient also kept having sugars from 400-500. When I left Thursday they were considering an insulin drip)

I couldn't handle it.... And the assignment was not changed. I went and talked to the charge nurse when I came in on Friday and noticed it wasn't changed. She said "look at the assignment you have an orientee, that's why I didn't change it. The orientee  can take patients"

The "orientee" was a travel nurse who could not take patients, didn't have access to anything, and was trying to learn about the unit, how we do things, our policies, etc. she would also go MIA for hours at a time. 

I had the same assignment from the day prior, with no real help when it came to patient care, and I was now tasked with teaching a new hire.

?

???

My two cents....run from that job asap!! It doesn't seem like a safe hospital for anyone...not even patients!!

It sounds like you did all you could and you gave report. After report is given and you leave...it becomes the responsibility of that nurse coming on shift. At that point I would have called the Dr and said this patient needs a central line, if only for the fact that she is REFUSING any further blood draws. Document it all. Monitor the patient closely, as long as she's okay... find out why the heparin was indicated.  Is it necessary? You've then did your part.

As for that charge nurse...she isn't practicing safely as being charge she needs to consider her responsibility as well. I don't understand the whole orientee (which makes an assignment harder, they can't legally help) becoming a travel nurse (making probably at least 1,000 a week) not being able to have an assignment?! Travel RN will tell you that you have to be prepared when u travel, there's no orientation. And...she didn't help u either!? My mind is blown. 

Seriously, you can, and should refuse a patient that you can't safely care for ( this counts because of the circumstances...not because of your skill)! I know it's tough as a new nurse but you have to do it. After hearing your story....the mistake you made was not refusing, not going over the charges head with your pt safety concern, and not resigning from there asap (imo). (That is my way of being sarcastic. I don't think you made any "mistakes "). 

Hope all ended up okay! 

 

[Lust4life, BSN]

Neuronurse88 said:

Hello everybody,

I made a mistake and it's eating me alive. Would like to vent about it/maybe get some insight from other nurses.. 

Before I tell you about the mistake, here's some background.

I'm a new nurse, I just got my license and started working in August 2022. 
I work on a neuro stepdown unit where we have 5-6 patients every day. 
I had five patients on Thursday and here is what my assignment looked like:

Patient 1 - (not a neuro patient) came into the ED with shortness of breath and chest pain. She had orders for intermediate care and we were the only step down unit with an open bed. 

Patient 2 - stroke patient with major deficits. Likes to jump out of the bed/chair to walk to the bathroom or for some other reason every five minutes even though this  patient is unsteady af. I'm in the room every five minutes because she has jumped up again  

Patient 3 - another stroke patient with major deficits. 

Patient 4 - fresh post OP spinal surgery from PACU

Patient 5 - patient had bone and lung cancer and it spread to the brain. Patient had multiple tumors on the brain. This was making him confused and aggressive. 
He kept getting out of bed also and he is not steady and he is a major risk for falls d/t brain tumors. Bed alarm keeps going off, and that makes him agitated. He would yell and hit things. Also, getting him back in bed was impossible.... 

So on Thursday, patient 1, who is on tele, randomly converts to AFIB with RVR. Heart rate went from 60s to sustaining 130s-170s

Drs paged, they ordered an amino drip and a heparin. I go to get those started. Her only IV has now infiltrated ? I start 3 IVs on her, so both the heparin and amino can have a dedicated line and then have a line open for other various medications she was getting. 

I start the two drips around 12:30, drew the APTT at 6:30pm. It didn't result by the I left so I told the night nurse in report that she should be on the look out for the result so she can titrate the drip accordingly. 

She didn't titrate the drip or draw labs all night. The Heparin drip was started at 12 units/kg/hour. I looked at the result from the APTT that I had sent down last night. It was 89. According to the order, the drip should have been titrated down. This was never done and labs were never collected  overnight. I asked why labs were not collected all night and she said the patient is a hard stick....

At this point we do an APTT and it results as 39. I assume the low result was because the night nurse said that she paused the drip a few times for the intermittent antibiotics the patient was receiving... I made sure the patient had three IVS before I left so that wouldn't happen.

Anyway, according to the order, we had to bolus heparin and then titrate the order from 12 units/kg/hr to 14. We did that at 9 am. So labs should have been done Q6 after the bolus. I start trying to get the lab around 2:30. I'm having no luck, patients veins are blowing, not giving any blood.

After asking two other people, we finally got a blue top sent to the lab. Lab rejects it. They rejected it because they said I mislabeled the tube. I labeled the tube with the routine APTT lab that was ordered but I also put in a STAT order so  lab would process it fast (they are ridiculously slow and this was an important lab)

I put the routine lab on the tube and just put the STAT label in the bag. Because of the STAT label in the bag, they said the sample was mislabeled and wouldn't accept it. I didn't know that was a thing, I have seen others do it and it was fine. 

Lab rejected that sample and put in for a re-draw. After two nurses trying, we got another blue top and sent it down. Lab calls and says that can't accept it due to insufficient quantity. That tube was full...

Lab puts in for another re-draw. At this point it's after 3:30. We are struggling to get blood off of her and the patient is tired of being stuck. Every time I came in the room she literally would say "please no more labs"

I put in for a STAT order for an IV nurse to come draw the labs with the ultrasound machine. When I left at 7 pm the IV nurse never came. Therefore the lab post bolus and titration was never done. I am now overthinking it and feel horrible. I don't want to cause harm to any of my patients.?

The drip was essentially running my entire shift without an updated lab result. I am sick to my stomach about this. 

Also I would like to add - when I got off Thursday, I went and spoke with the night shift charge nurse and asked her to please change my assignment for the next day. I told her I couldn't handle this group with 5 patients. 

(5 patients and four of them are Q4 neuro checks, two high fall risks that keep getting up, patient one had the heart changes and two drips were started. That same patient also kept having sugars from 400-500. When I left Thursday they were considering an insulin drip)

I couldn't handle it.... And the assignment was not changed. I went and talked to the charge nurse when I came in on Friday and noticed it wasn't changed. She said "look at the assignment you have an orientee, that's why I didn't change it. The orientee  can take patients"

The "orientee" was a travel nurse who could not take patients, didn't have access to anything, and was trying to learn about the unit, how we do things, our policies, etc. she would also go MIA for hours at a time. 

I had the same assignment from the day prior, with no real help when it came to patient care, and I was now tasked with teaching a new hire.

?

I'd also like to add that travel nurses are not "new hires" they are nurses who pick up contracts with staffing agencies. The hospital works with the agency because they are understaffed and the agency sends out a nurse to fill that void. Travel rns need 2 yrs of experience before they can work as a travel RN and they make ? MONEY money....especially since covid times, it's starting to get lowered but last I looked 2 days ago most contracts were offered for at least $1995.00 A WEEK. So, they were playing games with you or something else going on, cause it's not making sense. 

You should look into traveling after u have 2 yrs! LOL

[0.9%NormalSarah, BSN, RN]

Holy crap, what a cluster. 
1. Night RN couldn't get a lab draw in 12 hours and didn't bother to attempt to titrate the drip? Big problem, and was not caused by you.

2. Lab was a little crazy on this one, they could totally have sent you back that bag and asked you to place that sticker on the tube, as long as there were correct patient identifiers and it's the right tube, they should have worked with you on that one, especially given this was a hard stick patient who was getting uncomfortable with so many lab draws. Hard sticks are not your fault either. You tried your best to get that lab done. 
3. As a charge RN, if someone asks for a change in assignment, I try to do so. We have to have tough assignments sometimes, and this one sounds like a tough one! But we also need to try and spread that love a little so people don't burn out. They could have at least broken up the group of people jumping out of bed.  And yeah, orientees do nothing to help with productivity. And that's not really the way we should be thinking about them, they need a nurse that isn't so crazy busy so they can have time to learn the unit and systems.

As far as the drip is concerned, write an incident report. That can help your administration identify places to improve, like with lab processes and early line placement in patients like her. You can be part of the solution by bringing the situation up in the professionally accepted way. 

[RheatherN, ASN, RN, EMT-P]

First I want to apologize that the traveler did this to you, as a traveler for several years this give the rest of us a bad rep! shame on that person!! 

also, I agree with other post, stick up for yourself and don't accept assignment. you know what you can handle day in and day out, sometime we do just need to say NO and let that person be upset with you. you control your license not them and people don't always look at it as such. 

as long as you charted all the things, you are cya and doing everything you can for the pt, you are amazing! always know as long as you do all you can with everyone, everytime, you are great! keep telling yourself that! you got this! I would also have written an incident report or at minimum use your chain of command if you are not comfortable writing a report right away- even though they may have you complete one.