Med Surge/Tele

[pepinokc]

Hi, 

I have been a nurse for over 2 years now working night shift. I don't know if anybody else goes through this issue but Im having trouble retrieving information that I already knew and feel foggy all the time. I believe that  at this point my critical thinking and skills should have improved. Im having a hard time connecting the dots ( Is almost as if I was book smart but not "hands-on" smart) my IV skills have not really improved that much. There was a particular pt who was confused all day and at night when I got him, although the previous night he had been cooperative. He was an HD pt who got dialisys that day, HF, anemic H&H 7.8/24 or so.... nothign was done during day shift..became tachypneic later on during the shift. I shouldve asked the MD to draw labs earlier and make sure I had a second IV available in case we had to trasnfuse and give him IVF/send to ICU ..(I had established a 2nd IV access  on my first night but for whatever reason I didn't do it that night smh!) the charge was not happy, and she asked to paged the MD...asked for VBG and lactate. I asked for ammonia levels but was told not necesary and scolded for giving trazodone earlier...after 2 draws lactate finally came back elevated...the next night pt was trasnferre to ICU. 

I love nursing and there is nothing else I rather do! Love being on the floor and connecting with my patients... I enjoy handling emergencies such as rapid responces or codes and my heart is on the right place... but Im afraid that Im neglecting being able to anticipate what could go wrong. Nursing is already my second degree, otherwise I would switch just because I feel like I will never be good enough. I feel at unease at work (afraid of asking for help at this point due to some interpersonal issues with some colleagues) and inadequate, and currently handling other things outside of work (but who isn't?) Somehow the only thing that is a little encouraging to me is that the "newer" nurses ask for my help (although I feel like I don't have much to pass on). 

I've lost all confidence and I don't know where to go from here.

[Been there,done that, ASN, RN]

Dialysis patients are complicated. ..but  treat the symptoms .  "I shouldve asked the MD to draw labs" No... if any patient  has new onset tachypnea.. call for the doctor to assess and then order the labs THEY want.