I have worked in ICU for several months now. While I know I still have a lot to learn, I am beginning to feel confident in the more routine aspects of ICU work. Except....
I don't feel like I move fast enough in truly emergent situations.
I can think of two examples. The first had already coded on night shift (I took over care on day shift). He was already maxed on on several pressors, but I had to add several more. I had multiple teams of doctors (critical care, surgery, hematology, etc.) writing multiple orders for new meds, tests, IV boluses, etc. I took the patient to CT (made one of the critical care docs come too because the patient was so unstable). Multiple docs attempted to get an A-line, but all were unsuccessful. I was NEVER was able to pick up a blood pressure or an 02 sat on the monitor, so I had to check the BP manually with a Doppler every so often. I expressed to the other nurses (who helped me tremendously) that I did not feel that I was taking adequate care of the patient. They would reply, "Don't worry about it, you're doing all you can do, he's going to code again anyway." At the end of the day, the patient DID code again, and we were unable to recussitate. I looked back over my orders, and I found several medications I had not given, lab tests not ordered, and FFP that I had not given. (Side note: at that time we did not have a secretary to put in orders, so the RNs were responsible for faxing orders to pharmacy/entering their own labs)
The second patient came from surgery, and we coded her several minutes after she had arrived (very sick patient prior to surgery, prognosis not good, unable to get a BP or A-line access while in the OR). Similar story to the first--several new orders, pharmacy needing clarification for post-op orders, new labs and medications. There was a post-op antibiotic that needed clarification (I never clarified it, it was never given). The doc gave me a verbal order for a new medication (never wrote the order, never gave the med). We coded this patient several times throughout the day. I gave blood and FFP. Again, the BP monitor and sat monitor never picked up. Again, the patient coded at the end of the day and we were unable to recussitate her.
While I don't argue that both patients were very sick and as the other nurses said, "Going to code again anyway," I feel like if I hadn't missed the FFP on the first patient, or maybe given more FFP or PRBCs or the new medication to the second patient, I could have stabilized them and at least given them a chance for survival. I feel that I cared for the patient to the best of my ability, but I don't feel like I did a good or even adequate job. I know that I need to take care of these types of patients to gain experience for "the next time" I have one. However, I feel guilty because I feel like I am failing the patient and I should just ask a more experienced RN to take over. I feel like I am struggling just to maintain the patient, and I miss critical orders and medications.
Has anyone else experienced this as a new ICU RN? Any advice from experienced RNs?
It sounds like you did everything you could for your patients. I would have refused to go to CT--the patient sounded far too unstable (if I was only able to get a BP by manual doppler that patient is probably not going anywhere but the morgue). Even if they found something on the CT, what would the likelihood be that they would take that unstable of a patient to surgery? I also doubt a some FFP would have done anything for the patient.
RocktheBoat
19 Posts
It sounds like you did everything you could for your patients. I would have refused to go to CT--the patient sounded far too unstable (if I was only able to get a BP by manual doppler that patient is probably not going anywhere but the morgue). Even if they found something on the CT, what would the likelihood be that they would take that unstable of a patient to surgery? I also doubt a some FFP would have done anything for the patient.