did i miss something??? vent from a new grad in ER!! need words of hope!

[clairebearrn]

Hi. I am finally off orientation in a busy level 1 er in la! I only got 5 weeks of orientation and I feel like am learning as I'm going along! Today I was just floating around in the ER and just triaging the ambulace pts coming, which are back to back...we are a super busy ER.

I got a pt who came in for N/V. The EMT took the vitals, vital signs were stable, the pulse was reading 191 on the vital sign machine, so I decided to check the radial pulse, which was 100 and then 94. I notified the MD ansd charge nurse and they sent the pt to the front waiting area to be completely triaged, instead of placing the pt on a bed inside the 23. the . Thirty minutes later the pt came back to the ER because her pulse was actualy 200! Now I feel so bad and stupid! How did I get a radial pulse of 94 and 100??? I keep thinking back, that I missed this...

And I feel that everyday I might have missed something...I've been on my own now for a month and I'm trying my best, but were so busy...the pt turnaround is high!!! I'm running around like a chicken with its head cut off...I love the ER, but I just don't know how to do deal with the feeling like I missed something on a patient or the feeling of being new and that the MDs might think am slow...my preceptor and other nurses say am good and mature and that I just need to be more confident and get used to the high pace... any hope for me???Sorry for the long post, just need some words of of encouragement...thanks!!!!

[love-d-OR]

What's up with the

Claire? Anyway, If I were you I would not be so hard on myself. His heart rate could have easily gone down when you were counting it. I had a pt with SBP in the 70's, called resident to give fluid bolus. As I was getting it, the resident walked into the room and the pt BP went back up to 90's. The resident left and the BP went back down. We went through this about three times. The guy must have had some kind of white coat fear. Ayway, my point is that vital signs vary. It could have also been that his HR was too fast and you probably did not count every beat. Was he symptomatic? You are human and you will forget or overlook things, the important thing is making sure we pay attention to the bigger picture and learn from our mistakes. Good luck! And props to you for taking on county, that ER is BUSY!