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
) Anyway, under the circumstances, I think you did a good job. As far as giving pt info over the phone, maybe that wasn't the best thing to do. But here's the thing about that; under the same circumstances, I think a lot of people would have done the same thing that you did. I have been a nurse for a little under a year, but I was a medical asst for 8 yrs before that, so I have a very good understanding of HIPAA laws. But when I started working med-surg nights, I did the same thing a couple of times. I know I'm not supposed to give out pt info. But, I guess, being so new, overwhelmed, exhausted, ect..., that when the family member called, I just wanted to let them know the pt was doing okay. Afterwards I remember thinking that I probably shouldn't have said everything I said. But lucky for me, nothing bad came of it. There really weren't that many phones calls to and from family memebers on that shift, at least where I worked. No one really told me how to handle those calls. I know it should be common sense, but after a couple of 12hr shifts (which are more like 13 or 14 hrs!) there isn't a whole lot of common sense left in me. My point is, what you did wasn't bad enough that you should waste one more second feeling bad about it. 
UM Review RN, ASN, RN
1 Article; 5,163 Posts
Our whole unit needed instruction on the Flexi-Seal rectal tube, to the extent that at one point, someone hung a sign up: "45 ml of AIR works best for the Flexi-Seal. NO MORE THAN THAT."
I've only put two in. The first one, the patient hollered so much I was afraid I'd hurt them, which completely freaked me out, so I withdrew it and had someone else insert it. The second one (no difference in technique or struture of the rectum, mind you) the patient was thanking me a thousand times for saving him endless embarrassment in dealing with C. Diff.
Why did I tell you all that? Because, Shawna, there's a learning curve with everything. It takes time. It sounds like most of your coworkers are ok, except for that one snide little brat, who you need to ignore, because every unit has one :icon_roll. Comes with the territory.
I have two suggestions for you:
1. Don't quit. Please. It's important to have nurses like you who really want to do their best for all their patients.
2. Start a personal journal. When you get home, write down what you learned, what you missed, and how you'd do it differenly next time. Then...let it go. You'll really be amazed at how much you'll learn in one year. Plus you'll teach yourself how to leave work at work and you'll get a lot more sleep that way.