I feel dumb! - new grad med/surg

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I had my own 1 patient yesterday and I felt like I couldn't even handle even one! And now I'm thinking, how can I take care of a 6-8 patient load? I'm constantly asking my preceptor questions but her attitude is "figure it out on your own". I'm having trouble thinking of what to do next for my pt even though there is a "worklist" on the comp. system that I could follow. When is it appropriate to notify the MD? When you use an IV pump, what do you enter for rate & VTBI? how do you know what to enter? (can you give example?) Also, it takes me a long time to document... especially the progress notes. sigh... right now everything seem like little pieces to me and I'm trying to put it together and get the big picture. :crying2:

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Specializes in Hospital Education Coordinator.

well the rate should be ordered, or the MD will order volume/time and you do the math. The rest all sound like things you get with experience. With MD you want to notify of change in condition and anything that makes you think a new order would be appropriate (lab results for instance)

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Specializes in MED/SURG.

I agree with the last post. Contact the MD if there is a change in condition especially respiratory and cardiac related symptoms.Always make a full assessment(VS,breath sounds,etc) so you can have facts to present the Dr. as to why you are paging him or her.I often call dr.'s when a patients pain is not controlled by what they have ordered.If a pt is having chest pain don't wait... get help and take vitals.On my floor if a pt has chest pain we call a rapid response (time is critical). As for what to enter into the IV pump.The Dr. should state the rate.However if you have a pt with bad viens and has a peripheral line and you are about to give something like Vanco consider running it slower than what is prescribed to avoid infiltration.Occaisonally I will get meds in 30cc syringes where the instructions are to run over 30min or longer.In this case I either put it on a Bard machine or do a simple calculation to run it as a secondary. For example our pumps only run in mls/hr so I take the vol to be infused which is 30mls then X time 60min/hr divided by run time which the order states is 30min.So I would set the pump for 60mls/hour so basically this med will run a ml per minute.Also never hesitate to ask the pharmacist about meds they are a great resource.I also agree with the last post always keep the pts DX,labs,etc in mind for instance, question the order if a Dr. has ordered a potential nephrotoxic drug for a pt whose BUN and creatinine are high.Dr.s sometimes make mistakes too and we must all work to ensure pt safety. Hope that helps!:)

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I feel your pain. I am up to 3 pt's now on orientation and attempted to take a 4th last week. Bad idea on that day. One ended up coding and The charge nurse is asking who was responsible for this pt.etc. I was petrifried because I hadn;t even done my full assessment on them yet. Thank god i have an awesome preceptor who took over for me but let me be involved. I need to be able to take 5-6 on days before they move me to my night shift. Some days are good and some days i never want to be a nurse again. Then I remember all nurses started somewhere, they didn't come out of school knowing everything. As long as you are confident and safe and remeber to breathe when s*** goes down. We will all find our own individual ways to organize ourselves or what time to check labs etc. Or pass all your meds and then go back and assess. or assess while you are doing med pass..sorry so longwinded but i totally understand what you are feeling. Ask lots of questions???Good luck to you!

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rate is how much volume u want to infuse per hr. sometimes its going to be ordered by md. or sometimes if it is an antibiotic, it can be for 30 min, 1 hr or over 90mins etc. volume to be infused is how much fluids is in the bag.

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Specializes in oncology.

It sounds like your preceptor isnt very nurturing. I would request for a different one, because as a GN you should be asking questions even if theyr'e "dumb" questions. just remember as a GN there are no such things as 'dumb' questions because were not gonna know! I'm a GN too and im looking for a job. hospital didnt work out. You can always ask the other nurses or the charge too. But I highly recommend you changing preceptors if you can. the earlier you do it, the better, because it is what you need to grow as a nurse and learn to practice safely. and your not gonna be able to get the confidence if your preceptor keeps on saying... "go figure it out on your own"....its ok to be scared...everyone is scared, I get scared. your not alone out there.

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dont hesitate to ask whenever you are unsure than be sorry in the end, and blame yourself for not asking.

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Specializes in Med Surg: Pulmonary & Renal.

I agree you should ask for a new preceptor. It can be a mismatch in style, nothing personal. Orientation is when you ask the most specific how-to questions. If they are not answered now when else can you ask?

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