I am a second year RN (i.e. this is my second year out of uni) who has just started in ICU in Feb. I've just finished a night shift. I had the only tubed patient in our little six-bed unit. All was going well, I had everything done and decided to draw up extra syringes for the infusions of levophed and Actrapid insulin.
I had finished checking my patient at 0600 - did the obs, checked her soft restraints were in place and were not too tight and checked that she was comfortable. I stepped out of her cubicle and asked the charge nurse to check my drugs. He was sitting at the station, not six feet from where I stood. I went over to him and he signed my drugs; as he was doing that, the ICU tech said "Oh, she's got her tube out". Sure enough, she'd self-extubated. It turned out OK, no need to reintubate; she is doing well on non-invasive ventilation (BiPAP).
The point is, I feel like this is my fault. I shouldn't have turned my back on her, no matter how well she was restrained or how good she was at 0600.
Add that to the recent mistake I made, when I gave 15mg diazepam IV instead of PO due to a miscommunication about the order, and the additional knowledge deficit I had that almost made me miss someone going in to APO, and I feel like an idiot.
I really like ICU nursing, it's my 'thing'. I don't know if I should be doing it, though; the mistakes I am making are such boneheaded things and could easily KILL someone. I am trying so hard to learn everything I can - I know I will never know everything, but I just want to avoid making these dumb errors. I try to remind myself that I am new to ICU nursing and that no one has died yet due to my idiocy, but I really struggle with the potential consequences of my actions (or inaction). I know experience will help, but I wish I didn't have to do these stupid things while getting experience!
Does it get better? Do you think this is normal for a new ICU RN (both the mistakes and the fear)?
I just can't see how with close supervision (intubated patient at 1:1 nursing) you need to restrain people so often.
Unfortunately, who gets 1:1 just because of the vent? The only thing we 1:1 is CVVH and Arctic Sun. Just be happy when you're not taking care of three, I guess. ANd, yes, like a PP sometimes we do that with vents, too. Sometimes it' easiest to take three when you have vents, but yes, you'll need the extrta security of the restraints.
Unfortunately, who gets 1:1 just because of the vent? The only thing we 1:1 is CVVH and Arctic Sun. Just be happy when you're not taking care of three, I guess. ANd, yes, like a PP sometimes we do that with vents, too. Sometimes it' easiest to take three when you have vents, but yes, you'll need the extrta security of the restraints.
All of our vented patients are 1:1. If they aren't vented, they're 2:1. We never have higher ratios than that in ICU (thank goodness!). I
Thanks to everyone for your responses. After a couple of days, I am feeling better about it. I know what I could have done differently and I am starting to accept that even the Platonic ideal of a nurse might not have been able to stop this lady!
Im sorry, but I actually found some humor in this. Im sure that you did nothing wrong and if this is the worst you can find you criticize youself with then pat yourself on the back. I worked as a Respiratory Therapist for 7 years before I went on to CVICU as an RN. I was VERY aware of the risk of self extubation and took pride in the fact that it hadnt happened to me EVER. I was sitting in front of a room watching a lady who had been deeply sedated for about a week. I had checked and just retied her hands after turning her. Her hands were pretty tight and there was no risk of her reaching the ET Tube. When I turned around to speak to a physician, she woke up, wiggled down sideways in bed (on diprivan) and since she coudlnt get her hand to her head, she got her head down to her hands all without making any noise or the vent alarming. She grabbed the Vent tubing near the Y and pulled the tube and half of the tube tamer off. I couldnt believe it. She did great off of the vent. My point is, things happen..........and most likely this isnt even close to the worst that you will do. Dont let it bother you. It has literally happened to EVERY person I have worked with. Good luck.
Our vents are never 1:1 unless they happen to have an IABP, be on CVVH, or be on hypothermia protocol (arctic sun). But a sick pt doesn't warrant 1:1 nursing just because of a vent. Its not uncommon in our unit to have two vented pts as our assignment. And we don't usually go to restraints unless the pt has shown us that they are a risk for self-extubation. I have had completely awake pts who never once reach for the tube and I have had the "sedated on propofol" pt who has pulled the tube out.
Im sorry, but I actually found some humor in this. Im sure that you did nothing wrong and if this is the worst you can find you criticize youself with then pat yourself on the back. My point is, things happen..........and most likely this isnt even close to the worst that you will do. Dont let it bother you. It has literally happened to EVERY person I have worked with. Good luck.
Aw, I think it's great you found humour in this! It tells me that this isn't the end of the world.
Argh, I don't know how I'll cope when I do do the 'worst' thing if this is how I feel with this mistake...
You will grow a little with each mistake or near-miss. Anything you miss the first time, next time you'll be on guard for it and begin to be the nurse who picks up on critical surprises before they happen. It takes time.
Also, I'm having "off day brain" and would dearly like to know what APO is.
Wow, I feel sorry for you guys. I've always had 1:1 for ventilated patients, unless they were longterm, stable ventilated patients who were 2:1.
We try to avoid triples, but it isn't at all unheard of to have three vents. I don't think I've ever seen a 1:1. I'm jealous. Worst triple I had was two vents and an alcohol withdrawal, all three of which were pooping like maniacs. I was one month off orientation and the only nurse tripled. It was supposed to be an easy triple, but bowels weren't cooperating.
I had a little old lady extubate herself twice in one day. Very very determined. The first time, she scooted down in the bed until she could reach it. We tried keeping her off the vent, but she needed it. The second time, three hours later, her son came to visit and felt sorry for her and loosened up her restraints. Thirty seconds after he left, she'd done it again. She extubated herself 5 times in that stay, ended up trached in long-term acute care. It drives me crazy when the family will not follow the patient's wishes, but if the family says do everything, we do everything. Very sad.
.thumb.gif.11fa0ddb3aacfb1b3953bc671abcfb7e.gif){kind=avatar}
Annony RN
94 Posts
Unfortunately, who gets 1:1 just because of the vent? The only thing we 1:1 is CVVH and Arctic Sun. Just be happy when you're not taking care of three, I guess. ANd, yes, like a PP sometimes we do that with vents, too. Sometimes it' easiest to take three when you have vents, but yes, you'll need the extrta security of the restraints.