LONG - Incompetent, me? Nah - just inept

EmmaG, RN · Feb 3, 2008

Well, I'm gonna tell you anywho.

Don't be so hard on yourself.

I feel incredibly inept... I put a patient in danger.

No you didn't. You recognized a problem (which many might have missed) and fixed it. You should be proud of yourself.

EmmaG, RN · Feb 3, 2008

BTW, that daughter needs to be told to stop making so many calls as it is interfering with the care you have to provide to all of your patients, including her mother. Tell her she can call for an update once near the end of the shift, and otherwise you will notify her if there are any significant changes in her mom's condition. If you aren't able to take the call, she is to leave a number and you'll get back to her; she is also to be able to provide a passcode before receiving any information about this patient.

The daughter already lodged a complaint against me.

She's got a hell of a lotta nerve, eh?

lorabel · Feb 3, 2008

I feel so badly for you! I felt the same on my former job. I was to the point that I dreaded going in to work. My coworkers were NOT supportive...just snitches! I ended up quitting. When i left I told them i knew there was a place for me in nursing, it just wasnt on this unit! dont let one job experience chase you from the profession. i'm still looking for a new job and even applied for a job in the same hospital on a different floor!!!!!!!! Only applied yesterday online...but that was a MAJOR step for me! Maybe you need a position with a little slower paced environment...I did. Its tough being off orientation...thats when you need the support of your coworkers the most! There is soooo much we aren't taught in school! It is a major reality check isn't it? I guess the main thing to remember is that you are still learning and to ASK questions and as many as needed and also ask for help! Patient safety is priority........if you need help...ASK!

jojotoo, RN · Feb 3, 2008

You're being way too hard on yourself. Was everybody alive at the end of your shift? (And if someone wasn't, was it because of something you did or didn't do?)

Two things will come to you as you get more experience. Organizational skills and the abilitiy to set boundaries. Boundaries for your patients, for their families, and in some cases, for your fellow staff members. "Maybe next time you'll pay attention." What kind of smartass remark is that? I'm not sure that you did anything wrong with the PEG, but if you did, that type of remark is not condusive to a learning environment. And you are still learning, and will be for a long time - in fact, I hope you learn something new everyday of your career.

So give yourself a break, eat, go to bed, and go back and do the best job that you can tonight. Good luck.

(And I've been an RN for seventeen years and never used a rectal tube, so I would need some instruction too.)

ltmja · Feb 3, 2008

wow, sounds like my typical day at work. i just got off orientation myself and since i work night there is always an admit. i won't be halfway through my night meds before er wants to call report. we are new, that's all there is to it. we did not learn EVERYTHING in nursing school so this is going to be expected. the hospital is also very hard. i know a lot of my friends who were to nursing homes. hang in there, you're not alone

lorabel · Feb 3, 2008

jojotoo, Thank you so much for the post. I'm not the original poster but you said things I needed to hear!!!!!!!! I posted above and I ended up quitting my job because of toxic work environment, etc. But, i was told when i was hired that organizational and prioritizing skills come with time. I left after only 4 months. I feel that while we are still so new and have so much to learn we need extra positive encouragement. We need to be told that organization comes with time. I got written up for organization. My director told me i needed help with organization and i agreed. so, the next day she called me into her office and had a plan written up...I was ok at that point.....after we went over it, she then said, oh and you need to sign this! she wrote me up!!!!!!! I feel that is totally unfair. There was no patient harm done. I feel like when we are so new they should come to us and ask if we need help with anything...like..are you ok with organization or need help? or are you ok when you get a new admission or do you need to go over the forms again, etc. Instead, where I worked, the suppport disappeared after my first week off orientation. From that point on, the nurses ran to the director and told them every little flaw they saw. I think we shouldnt be written up until after our 6 month probation period. I think in the meantime they should focus on helping us get to where we need to be. I openly acknowledged my lack of skills and organization, etc. I was told it wasnt a problem! They would come in time and staff would be there to help me and nurture me along. I saw no nurtuing after week one. I couldnt take the nasty nurses any longer and finally broke so I quit after 4 months. We as new nurses do feel incompetent and we are in some aspect. We need to gain confidence in our skills and ourselves as a new nurse and it takes time. so thank you for understanding how we newbies feel and letting us know its normal. I was told that my first week but never after that. Maybe it took me or was taking me longer to get to where they needed me to be? I just know I couldnt learn in that hostile environment.

yellow finch, BSN, RN · Feb 3, 2008

First .... take a nice, long, deep breath of air. Fill your lungs up and slowly expel. How does that feel? :)

You sound like a typical, caring nurse. This is a shocking yet realistic day in the life of a nurse. What's amazing is how few patients and families that recognize this. They treat you like a cockroach and expect world class service in response. I've actually come to tell some patients that they shouldn't peeve off the person who holds the key to their pain meds. I'm also a little krazy.

SO! You will eventually learn what is right and not in your department. On the whole, no true information should be given out over the phone and it's not unreasonable to tell the person exactly why. I emphasize this to folks who call (or vice versa) so that they understand my position and why I'm not giving them any details unless in person. It's all about "patient privacy"... they tend to understand if you let them know this and that you would do it for anybody to protect them.

As for being written up... this may or may not have been a reasonable reason. Just remember that it will always be the mediocre nurses who are looking to get someone else into trouble. Granted, there will always be a valid backing to write someone up, but you will eventually notice the troublemakers and slower nurses looking for a pawn to deflect their own lack of ability onto. I had one early in my career and managed to make friends with her. Sometimes it's easier to catch your RNs with sugar than with vinegar.

Keep us posted on your successes... they will soon come. Just do the best you can and watch yourself. CYA with reasonable and direct documentations.

*hugs*

danissa, LPN, LVN · Feb 3, 2008

Shawna, you sound like you did extremely well in handling that workload, and getting done what you did, even with the interruptions from the phone calls!

That's quite a workload to have, stop beating yourself up, IMHO...you did GREAT babe! (I know, thats not much of a consolation, when an ungrateful person has complained about you!)

Are there any other areas of nursing you might consider, where you are not worked to the ground like this? Take Care of yourself, your own health and mental wellbeing is important!:icon_hug:

karma78 · Feb 4, 2008

OMG I feel as if you are reading my mind! I have just arrived home in tears after my fourth day on the floor. I am still in training, and not even on my own yet!

I feel like I will never be able to keep all of the patient information straight. I feel like I never say the right things to patients or families, or things just don't come out the right way. I feel like the only thing I learned in nursing school was how to assess a patient, and I don't even have the time or assistance to assess them as thoroughly as I would like to (i.e looking at skin on every patient!). I feel like I am not meeting certain nurses expectations. I feel like I ask too many questions. I feel like it is taking me too long to become comfortable with the computer system and basic eqipment ( IV pumps). An on-coming nurse was so rude to me during my report; I feel like she was purposely trying to make me feel inadequate.

I am just hoping and praying that it gets better because i want so badly to be an exceptional nurse. I hope I have what it takes.

RiverNurse · Feb 4, 2008

Yes, I had that happen once, too, during my orientation. A more experienced nurse (one young enough to be my daughter) gave me attitude. I was feeling physically awful (found out later my blood sugar contributed to that) and could not think clearly to save my life. All my efforts went into caring for the patients - no time to write things down during shift on my report sheet - and the previous nurse didn't have much info to give on these patients, either...

So, when this hip young thing gave me lip about me not having documentation on a patient's labs and that it wasn't "HbA1C", it was "HgA1C", I accepted what she said with humility and said, "You know, you're right. I can't give you the report you need. I'll just go out and get my preceptor and have her give you report so that you'll have all the information you need." I walked away to get my preceptor. The girl said, "No! Wait, it's okay." I said, "Oh, no... you need a decent report and I am going to make sure I get that for you."

My preceptor gave her report. I got in trouble for it and was told later that I didn't need to be so frustrated and needed to make sure I wrote everything down for report. I didn't bother to explain.

Oh, I found out later that the morning shift is routinely given copies of all the patients' labs for the day.

Hang in there - it's going to all work out for the best.

Shawna

solucky2beanurse · Feb 4, 2008

Hi all,
I need to vent - and hope that's okay. This is pretty much a brain dump of the past few days - my first few days out of orientation - and on my own.
I feel totally incompetent. This is the third day on my own, out of orientation. I work in telemetry/med-surg, 42 bed floor with the patient to nurse ratio of 8:1. I work 7 p - 7 a. The nurse manager told me that I will be assigned six patients for the next two months.
Two nights ago, I nearly lost it and almost bit everyone's heads off. I began the night with 7 patients and made sure that I only took six. I had 2 isolations, one of my patients was an inpatient hospice pt, the other had restraints and one had a family member that would eventually complain about the quality of care I offered to her relative.
Here's how that particular evening went down:
Good until 11 p when the shift change occurred. I lost a patient and "inherited" two patients. One of the patients had a rectal tube and continually cried out for help - that she needed to defecate. I tried explaining to her that she had a tube in place to help her with that - and she seemed appeased at that time - then she would call again. This was my first experience with a rectal tube - ever. Then, as I was trying to reconcile my MARS, I needed to go check on the patient with restraints - who protested vehemently... but complied. Right next door was my hospice patient who had copious secretions, requiring suctioning much of the time. I heard him coughing so I went into his room. Now, this patient had a PEG tube with feeding running - but the tubing from the feeding and the port on the PEG tube was taped together so that the tubing couldn't be disconnected from the PEG tube without removing the tape. Then... I noticed that the smaller port on the PEG had popped open, leaking out a puddle of Fibersource. So - I needed to clean that up. One of my co workers said, "Maybe next time you'll pay attention." Then helped me clean up the mess.
I returned to my MARS - finished them up, checked on all my patients and began my morning meds pass. Before I could get started with that, though, the CNA called me into another patient's room. This patient is the one with the doting family member - the one that was calling at 1 am, 3 am, 5 am to find out what her mother's BP was, BS, etc. I walked into the room to find that this patient's rectal tube had been expelled... ejected... dislodged... my first experience with this "device".
The CNA is asking what should be done with this - she asked if I wanted to put it back in. It was full and covered... but intact and on the bed. My first response was - throw that thing away - I'll get another one. We cleaned her up and I went on my way to dispense meds and to order a rectal tube - and to have another nurse accompany me while I did the insertion of the new one. I then found out that I should have re-used the existing rectal tube - that a new one was costly... Great... another mistake. In the meantime, the daughter called... again.
I passed meds without a hitch - then got to this patient again. When I checked on her, she was sleeping... too soundly... I roused her, she took her meds but then fell back to sleep... a little too quickly. I grabbed the glucose meter - her BS was 37! So, I did what I was taught... if the patient is conscious and can do so, administer juice such as orange juice, then follow up with some substantial protein. It worked and her BS rose to 102 and stabilized. Uh... but... this patient is a renal patient - on dialyis... and orange juice? Where in the world was my brain??????
I feel incredibly inept... I put a patient in danger.
Finally I finish most of my work - half of my meds have not been passed and it is nearly time to give report - but wait! I get to insert a rectal tube... So, I do. Then I called the daughter (who had called twice during all of this). I told her about the rectal tube and her mother's blood sugar issues. She was glad to hear that.
I finished charting and got home at 10 am.
When I went back into work yesterday, the charge nurse pulled me aside and told me that I shouldn't be giving out that type of information over the phone - that I do not know who was on the other end... I called the contact phone number that the family member provided - I was returning her call... No matter, I was wrong again.
In addition, b/c of the above, I didn't administer this patient's abx on time. The day nurse administered it - but - too late. The daughter already lodged a complaint against me.
Bottom line today - and this could change in the day - after I've had some sleep... I do not have the aptitude to do this work. I am not smart enough nor do I possess enough common sense to make this work for me - and this doesn't even begin to touch on the "flow" of the workplace - orders, consults and all those other things they really don't teach you in school...
This is my whine - and I deserve it - I am ready to leave the nursing profession and not look back. I'd rather flip burgers than to have to sustain embarrassment after embarrassment - that's what youth is for.
I always wanted make a difference - but I didn't want to make "this kind" of difference... I've evidently lost my smile as well. Don't look happy and appear mad most of the time (in reality - it's the deer in the headlights sensation).
Anyway, thanks for letting me vent. I don't have other nurses I feel comfortable discussing this with - so I decided to put this on the net for the whole world to see.... LOL...
Shawna
P.S. If anyone tells me to let it go, it won't do any good - I'm too exhausted and on OCD/fixation mode - LOL

Sweetie don't feel bad at all, me myself I'm a new nurse working in a nursing home for 3 months in michigan. Don't give up you've worked so hard maybe u should look for a position in a nursing home it's a lot less critical patients as far as you're med pass you go at your own pace. There's a lot of dementia patients,but u get attached to them and the majority of them keep a smile on your face throughout your shift. Just something 2 think about