I Have Poor Judgment As A New Nurse - Not Sure How To Improve

[uniteddemclub, BSN, RN]

I have worked in a SNF for a couple months now and it’s my first job. One of the residents recently complained to me of severe pain in her thigh that was “killing her” as she was sitting up in bed. I lowered the head of her bed and gave her Tylenol and notified the doctor.

I sent the doctor vital signs that included a temperature reading of 91.2. I knew that was abnormal, but I was getting 91-92 temperature readings on everyone due to my equipment not working. Her systolic BP was also 190. The doctor immediately responded “send to er stat” and so I had her sent over but they found nothing wrong with her and sent her back to our facility with no new orders.

I was told by another nurse that I need to use my nursing judgment and just give the Tylenol and her blood pressure meds and wait a few hours before I told the doctor.

The next day when I came to work the resident was back from the hospital and I was berated by the nurse there. She said my vital signs were unacceptable but even said that I need to stop recording a respiratory rate of 13 or 14 breaths per minute. I told her I was taught in nursing school that 13-14 breaths per minute is in the normal range and she told me it’s not and that she’s been a nurse for 42 years so she knows. She told me that resident who was sent to the hospital was at her baseline and always has her BP up before her medication, that I wasted thousands of dollars, and that even the LVNs in our facility know better than me, that I’m an RN and have worse judgment than the LVNs.

I am so utterly disappointed in myself and I only messaged the doctor because the resident asked me to do so and I was really overwhelmed with all the work I had to do to really think about it before messaging the doctor what I did.

I would like to a better nurse and I can’t seem to be, maybe because I’m not as intelligent or well trained as the nurses who are better at their jobs. I have Twitter where I advertise that I’m a nurse and I’m often told that I shouldn’t be a nurse and that I’m a sick individual because of certain beliefs and opinions that I hold about a variety of controversial political issues. They also have dug up old tweets from earlier this year where I talked up flunking NCLEX and they take screenshots of those old tweets to claim that I’m lying about being a nurse and probably still studying for my failed nursing exam. It really affects my confidence and I can’t stop thinking about the negativity. If they knew about what happened at work with the patient who went to the hospital then it would be another story for them to attack me for.

Yes, I failed NCLEX 3x and I took 6 1/2 years to complete a BSN and it would have been 6 years but I was kicked out of clinical in my first semester of nursing school and that held me back 1 semester. But now I’m a nurse and so why should I have to feel like I shouldn’t be a nurse or am not a real nurse because I didn’t get straight As all through nursing school and pass NCLEX first try in 75 questions.

No one is perfect and no one knows everything.

I understand that I have a lot of opinions that others may not understand or agree with, but so does literally every nurse. I had professors in nursing school with political posters in their offices, professors who told us to vote for Trump or to vote straight Republican on our ballots, professors who made comments to me that I felt were untrue and even bigoted. So every nurse and every human is entitled to their own opinion about anything. I just had to vent here because I’m really tired of being judged and attacked for being an imperfect person like everyone else. 

[spaulson1, BSN, RN]

I would not be so hard on yourself. Nursing has a steep learning curve. But letting negative feedback get to you doesn't do you any good either. I know when you're stressed out it can be hard to sit back and think. But remember the nursing process ADPIE. Always start with assessment. Did you look at her thigh when she reported the pain was killing her? Could it have been a DVT? What was her main diagnosis, labs, what medications was she taking? And if your vital machine is not working, look for another or take it manually. Whenever I have an outrageous vital sign I will take it manually to confirm. And yes. After giving her blood pressure medication and pain medication always reassess after. Did it work? If not there may be a more serious issue. Regarding the respiratory rate. Everyone has a different baseline. But 13 to 14 is still within normal range. It helps to look at the patients vitals over time and compare whenever this is in question. Do not be afraid to contact the doctor if you're concerned though at any time. You are the advocate here.  

 

When it comes to political affiliation. That's not what I would worry about here. I would worry more about my own response to criticism and stress. And I would stress slowing down and thinking more about what you are doing. You got this. Critical thinking is where it is at. 

[Ruby Vee, BSN]

On 12/13/2022 at 11:17 AM, uniteddemclub said:

I have worked in a snf for a couple months now and it’s my first job. One of the residents recently complained to me of severe pain in her thigh that was “killing her” as she was sitting up in bed. I lowered the head of her bed and gave her Tylenol and notified the doctor, however I sent the doctor vital signs that included a temperature reading of 91.2. I knew that was abnormal, but I was getting 91-92 temperature readings on everyone due to my equipment not working. Her systolic BP was also 190.

The doctor immediately responded “send to er stat” and so I had her sent over but they found nothing wrong with her and sent her back to our facility with no new orders. I was told by another nurse that I need to use my nursing judgment and just give the Tylenol and her blood pressure meds and wait a few hours before I told the doctor. The next day when I came to work the resident was back from the hospital and I was berated by the nurse there. She said my vital signs were unacceptable but even said that I need to stop recording a respiratory rate of 13 or 14 breaths per minute. I told her I was taught in nursing school that 13-14 breaths per minute is in the normal range and she told me it’s not and that she’s been a nurse for 42 years so she knows. She told me that resident who was sent to the hospital was at her baseline and always has her BP up before her medication, that I wasted thousands of dollars, and that even the LVNs in our facility know better than me, that I’m an RN and have worse judgment than the LVNs. I am so utterly disappointed in myself and I only messaged the doctor because the resident asked me to do so and I was really overwhelmed with all the work I had to do to really think about it before messaging the doctor what I did. I would like to a better nurse and I can’t seem to be, maybe because I’m not as intelligent or well trained as the nurses who are better at their jobs. I have Twitter where I advertise that I’m a nurse and I’m often told that I shouldn’t be a nurse and that I’m a sick individual because of certain beliefs and opinions that I hold about a variety of controversial political issues. They also have dug up old tweets from earlier this year where I talked up flunking NCLEX and they take screenshots of those old tweets to claim that I’m lying about being a nurse and probably still studying for my failed nursing exam. It really affects my confidence and I can’t stop thinking about the negativity. If they knew about what happened at work with the patient who went to the hospital then it would be another story for them to attack me for. Yes, I failed ncled 3x and I took 6 1/2 years to complete a BSN and it would have been 6 years but I was kicked out of clinical in my first semester of nursing school and that held me back 1 semester. But now I’m a nurse and so why should I have to feel like I shouldn’t be a nurse or am not a real nurse because I didn’t get straight As all through nursing school and pass NCLEX first try in 75 questions. No one is perfect and no one knows everything. I understand that I have a lot of opinions that others may not understand or agree with, but so does literally every nurse. I had professors in nursing school with political posters in their offices, professors who told us to vote for Trump or to vote straight Republican on our ballots, professors who made comments to me that I felt were untrue and even bigoted. So every nurse and every human is entitled to their own opinion about anything. I just had to vent here because I’m really tired of being judged and attacked for being an imperfect person like everyone else. 

You've packed a lot into one post.

First, you called the physician without adequate vital signs, and you knew your equipment was faulty.  You don't really know what her temperature was.  You don't report vital signs unless you know (or have reason to believe) they're accurate.  As far as the respiratory rate -- did you actually COUNT respirations?  Or did you just write down 13-14 on every single patient because "that's the normal"?  If you're not counting, you don't know the respiratory rate and you are falsifying medical records if you say that you do.  

Did you look to see if the patient was due anti-hypertensive medication?  A reasonable thing to do would be to have checked that.  You could even have asked the physician if you could give the dose early.  

Did you wait to see if pain medication had any effect before calling the physician or sending the patient to the ER.  Did you assess for redness, warmth, swelling, bruising, hematomas, etc.?  Had the patient fallen?  Was there an injury?

From the assessment that you've put here, the physician may have felt he had no choice but to send the patient to the ER to get a proper assessment.  

So you've made some errors in judgement.  We've all made errors in judgement -- sometimes some whopping errors in judgement.  But you're new and you have much to learn.  An RN license is a license to learn.  You know you have much to learn.  But instead of focusing on learning, you seem to be focusing on how others are mean to you, whether it's the experienced RN berating you or online trolls.  All of that said, the experienced RN had no business berating you unless she's tried over and over to educate you without success . . . and even then no. business. berating. you.  no one is perfect, and no one knows everything.  As far as nursing goes, if you're not learning something new every day, you're doing it wrong.  And I say that as a nurse since 1978.  

Your political beliefs and opinions are no one's business, but you've put it out there.  Big mistake.  But that isn't the focus of this board, so perhaps those complaints are better made elsewhere.  

 

[allnurses Admin Team]

Admin note:

Several off topic posts have been removed. Those wishing to discuss politics may do so in the Breakroom Politics Club.

[vintagegal, BSN, DNP, RN, NP]

Information is currency, and you just gave large stones for your enemies to throw at you. Do not share your opinions, keep a low profile, stay off social media. Now everyone knows every flaw you have ever had. Shut it all down, get a different job, focus on your career.

[CommunityRNBSN, BSN, RN]

While you are still learning, and learning to develop good judgement- do you have anyone else that you can consult with before you make decisions?  For example, if I were one of your co-workers, and you had laid everything out for me and asked me "Should I call the doctor?"  I would have said: "Wait a minute.  You said your thermometer is faulty-- do we have a way to get an accurate temperature on her?  And you gave her Tylenol; let's wait a little bit and see if it helps her."  Etc.  It sounds like you get overwhelmed and maybe jump to decisions too quickly.  Even if something is "an emergency," it usually doesn't have to be solved within three or four minutes. In most cases, there is enough time to step out, take a deep breath, and maybe check with another nurse.

[Daisy4RN]

I think you are being too hard on yourself at this point. You need to slow down and think about what you are doing. You have only been a nurse for 2 months and it takes time to obtain experience and feel comfortable in the role. When you are not sure what to do ask your supervisor or a trusted fellow employee (it may take awhile to know who to trust). You learn from experience and now know (from previous posters) what you should have done in this situation. Focus on learning all you can and for Pete’s sake get off social media and stop worrying about what others say and think. Many people just like to cause hurt/drama and you need to be able to discern between helpful and not helpful and shut off the non helpful altogether. When at work keep a low profile which includes, but is not limited to, political views. In the past this wasn’t such a big deal but it certainly is now. You will learn and grow in your nursing skills, just have patience!!