Needing encouragement and guidance

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Specializes in ED.

Hi everyone,

I'm just reaching my 1 year mark of nursing and I feel so lost. I currently work in an ER in a rural area. I just recently got off orientation and all the staff have been so helpful but I feel like I'm annoying the physicians and some of my co-workers with some of my questions and concerns.

When it comes to BP I get so worked up because I don't quite understand when to worry about BP and when to be okay with the pt being discharged, so I ask the MD. But each time I feel like I'm bothering them. I'm still uncomfortable with giving certain medications (specifically IM injections). I feel like I should be getting this stuff and understanding everything by now but I still feel so confused a lot of the time. I know everyone says you won't start feeling comfortable until after 2+ years but I'm just really starting to doubt my abilities.

I guess I'm just looking for some encouragement and any advice you may have to offer.

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Specializes in Critical Care, Education.

When it comes to BP, make sure you are focusing on the patient rather than just looking at the numbers. What is the patient's norm? Is she feeling & acting OK? Keep in mind that patient variables such as lack of vessel elasticity due to aging or chronic disease can 'raise the bar' for pressure needed to adequately perfuse vital organs.

You DO need to contact the doc and obtain an order for DC if there's anything out of whack in relation to normal DC criteria...so keep on calling those docs. Physician grumpiness factor tends to increase if they feel you're "wasting their (super-valuable) time". Are you using SBAR for physician communication? If not, you may want to make sure you do. By using SBAR, your communications will be much more precise.

Injections are like other skills - confidence comes with practice & feedback. There's no need to second-guess yourself feedback indicates that you're doing OK - you should believe them.

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Specializes in ED.

Thank you for your response. I'm just having one of those weeks where I feel like everything I do is wrong. Hopefully after a few days off I'll feel a bit more refreshed and relaxed. Thank you for the encouragement. :)

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Specializes in L&D, infusion, urology.

I agree with HouTX about looking at the patient's baseline. I was working in an outpatient urology clinic, but my patients would have these crazy, sky-high BPs where I was panicky about sending them home! The doc was so nonchalant about it. I did send a few messages to primary docs just as an FYI, and I would tell people they needed to follow up with their primary doctor, or I'd review the s/s of stroke (and almost have one of my own as they walked out!). One of my guys would have a SBP around 200 BASELINE if he forgot to take his meds that morning. This happened ALL THE TIME. I would always get the MD to give the OK before sending him home, because I just didn't want that on ME. But he never had a stroke in the time I was caring for him, and I saw him monthly.

For procedures, can you practice on coworkers? Giving injections takes practice. What about them is hard? Is it placement of the injection, touching the patient, keeping the syringe steady? You can even ask people for tips for making them go smoothly, and ask to watch how they do it, because you'll learn something new from everyone you see.

Trust your judgment, know your protocols, and write down criteria for meds that make you anxious, like TPN. If the patient meets the criteria, they meet the criteria, and you can give the medication with a clear conscience. If they don't, then question the doc! Don't be afraid to CYA AND to advocate for the patient.

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