I'm scared to go back to work

[ljgonz]

Sorry but this is gonna be long....

I just graduated in may and started working in a whole new state and new hospital at the end of aug. It's a PCU. I've never had a tele or cardiac rotation in school but thought this floor would be a great learning experience for me. So I started Orientation on the floor in september and already I'm on my own! I had my second day on the floor by myself last night. I felt extremely overwhelmed and scared during orientation, but my preceptors have told me that I'm doing well and I just need more confidence. So after just 6 weeks on the floor I've been let loose. I didn't feel ready to be on my own but I figured I just neeeded to suck it up and do it. So my first night alone was okay.... I only had 3 patients (4 is average and 5 is the max for nights on this floor). I got everything done and got out on time even though I was nervous. The second night I had the same 3 patients plus one more. Apparently two of the patients that I had had the previous night had some respiratory distress earlier but were doing ok now. Of course I checked them both out right away to make sure they weren't in distress and to see if I needed to call the doc's right away. They were fine, but I still felt pretty overwhelmed because there were a lot of changes and new orders from the previous night. We were short staffed and they tried to give me a 5th patient. Even during orientation I never had 5 patients! I refused and luckily another nurse volunteered to take the extra patient. So I was really busy all night, one patient was very confused and kept trying to pull out lines, o2, getting out of bed, (very unsafe) so I had to put her in restraints, another confused pt had a critical K level of 2.8 and refused oral K so I had to give it IV, he kept picking at his one good IV... I had to reorder K with lido... that took forever to get done. Another had a PCA and I had to check neuro Q2 hrs. Another had a low phos leve and I had to get that replaced.

The pt I had to restrain somehow got out, got her O2 off and was anxious and sob. I went in immedietly, put the o2 back on, checked her sats (which were 85 on RA but came back up to 95 with O2), calmed her down, restrained her again, and gave her prn xanax. After that she was resting comfortably. At 0645 I felt like I was almost home free. I still had charting to do but the day nurse who was taking my pts already had come in to get report. I gave report and felt like I actually was able to handle the night on my own when I get a call from the desk that the restrained and confused pt is in SVT with a HR in the 170's. The day nurse and I run in and luckily the other night nurses are already at work. Her HR jumped up to the 240's, they were pushing amioderone, cracking open the crash cart, putting the pads on her....... All the while I felt like a deer caught in headlights. I was just stunned and didn't know what to do or how to even help. This was MY patient for crying out loud and I didn't know the first thing to do. Someone else called rapid response, other people were taking all the vitals, and recording times for the amioderone. When rapid response came they were asking me all these questions I didn't know! I felt like I didnt even know my own name at that point! I ran and got the most recent labs, and all the meds she was on (I only knew the meds she had on my shift). They were asking who her cardiologist was and all I could say was "I don't know". She had come in with renal failure and decreased LOC so she didn't have a cardiologist. The other nurses were telling me to call the doc and tell him what was happening but again.... I was a deer caught in headlights. I was just frozen and couldnt move. I didn't even know what everyone was doing and exactly what they had given. There is an emergency standing orders class that I take in 6 months... so after that I'll have more of a clue but right then and there I was just ready to cry and felt helpless and useless. Luckily the day nurse I had given report to took over and called the doc and everything... But it wasn't even 0700 yet, what if she hadnt come in early? I dont even want to think of how I would have (or not) handled it.

The woman was stabelized and put on a cardizem drip. The day nurse asked me to write a narrative about everything that happened during the night with the patient. I wrote it and was trying to figure out if I had dome something wrong or had missed something and that's why she went into SVT. She had been a little hypertensive all night (bp in 140's 150's) but that wasn't unusual for her so I never called the doc about it. Her rhythm was NS with rare pvc's... again all normal for her.

I came home and cried for an hour after. Maybe I didn't miss anything and she would have gone into svt regardless... but I'm so upset and angry with myself for not knowing simple questions about her during the situation... like who were the consulting docs, her labs, her daily meds. I should have had a clue! And then I couldnt even call the doctor! I was just so scared. Thank G_D the people I work with came together and handled the situation, because I obviously couldnt. Anyway, I don't want to go back to work. I'm embarressed and scared. Maybe I should have started on a less acute floor. Maybe I should have listened to myself and stayed on orientation. Well I'm just venting over here. Any advice, tips, ect, would be appreciated. I think I need a new floor with a longer orientation. I want to call out of work because I just don't feel ready to go back.

[ukstudent]

Take a deep breath and lets look at all the positives. You work on a floor that supports each other (that's huge). Other nurses would not have known her cardiologist either. Yes you froze a bit but you have just gotten off orientation and have not taken the class yet. You did manage to get her labs and her med sheet. I bet you are being harder on yourself than any of your co-workers. When you go back to work, if the day nurse is there , ask her what you could have done differently. Ask someone to show you the code sheet, ask someone to open up the crash cart so you can see what is in it. The first time is always the worst.

[lesrn2005]

I say "take a deep breath and go back to work", you have not gone to the class yet, so cut yourself a break! Talk to your charge about your feelings!

[suzy253, RN]

Just reading your post, sounds like you did everything exactly right. I work a cardiac floor and it still freaks me out when a pt codes or near-codes and i had that deer in headlights look. As far as the narrative, when one of my pt goes sour, I immediately start a narrative of my own and just record everything, what meds they got that night, BP checks, etc. etc. and also what is being done during the code. It's normal to feel a bit stunned about it because you haven't had the experience in it but take it all in, observe and listen. It does get better although codes are never really 'easy'.

Also, grab the patient's chart because the response team/MD are going to want to look at it.

Chin up...you did great!

[deeDawntee, RN]

It's OK, we have all been there... our first emergency situations are always a memorable time and then you really find out what it is like and how to respond. I think what happened to you is pretty typical when you are new. How could know until you've been through it?

I always take report and find info on my patient as if I need to report during a code (or emergency) situation. What will the code Docs or others responding want to know? Why is the patient there. Past medical history. Pertinent labs. Etc. It is OK not to know everything, because you can find out, for instance, you may not know who all has been consulted for the pt, but you can say, I will find out.... you don't need to know EVERYTHING on your patient, just know the essentials, because during those emergencies, you are the "expert" on the patient.

There is NO WAY you could have prevented or predicted SVT. It is OK. It will happen again. Remember that you are NEVER alone, you always have people around to help you. It will take years before you are able to respond like the nurses you see around you responding in an emergency situation with precision and expertise. That is OK. You will feel better after you take ACLS. No one expects you to be able to act like an experienced nurse when you are new...please don't compare yourself, it will come with time. I promise.

You need to REALLY acknowledge yourself for how awesome you are doing as a new nurse on that unit. You will grow to love it. It is OK not to know, remember that too. Especially at this point in you career. Just relax and let yourself take one shift at a time. You can do it!!

:yeah:

[ljgonz]

Thanks to everyone for the support and advice! I feel a lot better now it's been a few days after that night. I also talked to my old preceptor about what happened and found out that the patient was discharged and was fine. I still have a lot to learn but every experience I have (good, bad, and terriable) will just make the next easier to handle. Thanks to all who responded, your words and encouragement have really helped :)

[psalm, RN]

Sounds also like you are on a floor that helps...displays team work. Someday YOU will be the one aiding a co-worker. It is scary, and we feel your stress. God bless and hugs to you.

[Virgo_RN, BSN, RN]

I am an LPN on a cardiac floor. I had ten shifts of orientation. I know exactly how it feels to be so new and so inexperienced and so overwhelmed by the degree of responsibility that I have for these patients. I am thankful every day that I am "only" an LPN and that if the poop hits the fan, I am not expected to be able to handle it single handedly. About the most I can do that falls within my scope of practice is initiate CPR and call for help.

I think the great thing about your experience is how the nurses all came together and acted as a team. Just remember that every single one of them was once new and inexperienced too! You did just fine. You're probably being too hard on yourself.

Sometimes we can see a patient heading for an arrhythmia and head it off before it gets to that point. Other times, we cannot. Don't beat yourself up. The situation was handled, the patient is safe, and you have the good fortune of working in a place where teamwork is the rule, not the exception! I'm sure you learned a lot from the experience and will do better next time. That's how experience happens.