I made a stupid error in judgment when working the night shift a few nights ago. I was caring for an 89 yr old man who was in poor condition with multiple health issues. His main issues involved diabetes, CHF, ARF and c.difficle. He had taken a turn for the worse several days prior with episodes of nausea and vomiting and decreasing urine output.
The pt's output had been only 100cc on the previous night. His blood pressure was around 96/55 and hR 65. On days he had an iv started of NS, he had been bolused 1000cc around 1400 and then the order was to run the IV at 100cc/hr for the next 12 hours. I started the night shift and was told by the rn going off that he wasn't doing well. He had only put out 75cc that shift. He was a DNR.
I was told we'd be working the shift short an rn. I was to be in charge (which always scares me because I have only been an rn for 1 year). That left me and 1 other rn on the floor. I began the shift caring for 8 pts and would pick up an extra 4 at 2300. When I did my assessment of this pt I found him much the same way he had been on days, vitals were similar and output was minimal. Per the dr`s orders I stoped the IV 12 hours after it had started. I assumed the reason for this was because the pt had chf. The pt had very little output still. I wasn`t sure what the next step was. It was the middle of the night. I DIDN`T CALL THE DOCTOR. I don`t know what I was thinking. when the day shift started the first thing the rn coming on said to me was why didn`t you call the doctor to address the low output.
I feel awful. I don`t think I am a good nurse. As much as I want to be good at this profession, maybe I am just not made of the right stuff!
I once bolused a patient in ARF till the cows came home (per the doc's order, mind you). That day I learned what flash pulmonary edema looked like.
Low U/O does not necessarily = decreased fluid volume. The patho involved with ARF and CHF is very complex, and in the moment it is sometimes difficult to assess which is the "chicken" and which is the "egg"--doctors have a tough time deciding how to treat it, much less nurses. IMO you were treating a patient who did not seem to respond favorably OR poorly to an intervention (IVF bolus). The patient was stable, didn't show signs of decompensating while you cared for him. You did the right thing--pass it on. Sometimes it's not possible to successfully diagnose and treat during the course of one shift--do not own that responsibility (I think both me and the doc in my example felt the onus was on us to fix that patient. we were both new. i'm sure neither of us will make that particular mistake again. the patient lived, btw. and peed plenty the next day)
Of course not, it may just mean pump failure. This is where lines and numbers would be helpful (sorry, can't help it, I'm an ICU nurse!).
I agree that the OP may not have made any mistake at all - what stands out to me is that none of this thinking occurred though. She didn't NOT call the doctor because she thought critically about the situation and decided not to. It didn't occur to her that it might be needed.
I hope my previous post was not too harsh though - trust me, I am sure I made a hundred mistakes a day as a new grad, as did all my contemporaries. It is a stressful job and it's made more stressful when you're given tasks that are beyond what you should be expected to handle. You can't always assume more experienced nurses know more than you, either. The important thing is to know why you're doing what you're doing.
Be kind to yourself, and learn from this experience, so next time, you can remember this stuff and think "Hm.. do I need to call anyone?" - and decide either to or not to, and be able to defend your decision to the next shift.
ghillbert, MSN, NP
3,796 Posts
Of course not, it may just mean pump failure. This is where lines and numbers would be helpful (sorry, can't help it, I'm an ICU nurse!).
I agree that the OP may not have made any mistake at all - what stands out to me is that none of this thinking occurred though. She didn't NOT call the doctor because she thought critically about the situation and decided not to. It didn't occur to her that it might be needed.
I hope my previous post was not too harsh though - trust me, I am sure I made a hundred mistakes a day as a new grad, as did all my contemporaries. It is a stressful job and it's made more stressful when you're given tasks that are beyond what you should be expected to handle. You can't always assume more experienced nurses know more than you, either. The important thing is to know why you're doing what you're doing.
Be kind to yourself, and learn from this experience, so next time, you can remember this stuff and think "Hm.. do I need to call anyone?" - and decide either to or not to, and be able to defend your decision to the next shift.