New Grad-Insulin

Triddin · Jun 7, 2018

We don't check for sc insulin, just infusions

Sour Lemon · Jun 7, 2018

Hi my fellow nurses :)
I am looking for advice. I am working on a brain injury floor as a new grad. Words cannot describe how happy it makes me to see patients progress, BUT it's my fourth shift training and I felt so incompetent today. The first couple of days I got a feel for the unit and the procedures. (I am explaining this as I have a few more questions). I have serious OCD and check all meds and procedures three times. Having said that, I have to give a patient insulin and I'm very nervous about it. My preceptor thought I was
overthinking it.
My questions are:
I thought insulin had to be signed off by two RN's? This hospital only requires one nurse. I've just not heard of that from any other RN friends I have.
Is it possible on my fourth day of training(my preceptor worked on other things "because she was bored") that I had a hard time getting everything done within a 12 hour period? . ALL meds, assessments, documenting, assisting with the nursing aides(gosh they are all blessings) AND make sure the unit is safe.
Maybe this profession isn't for me or I'm not smart enough. What has been everyone's expiernce witj insulin and training?
thanks all :)

My current employer requires a co-sign for insulin, but not all do. That doesn't mean you can't ask a co-worker to double check anything you're unsure of, though. Do you and your preceptor have the same set of patients? If so, that would explain why she's not very busy. I usually end up helping the CNAs when I have an orientee who's doing well. It keeps me busy, but available if needed.

NuGuyNurse2b · Jun 7, 2018

yup, different hospitals, different policies. Ours started to do that, then stopped, then started again. We half-jokingly said among ourselves "someone did something wrong" cause that type of knee-jerk reaction/policy change is most often a result of someone doing something that resulted in patient harm.

LisaStone · Jun 7, 2018

At my placement I never needed a nurse to sign off insulin. I know how you feel though, I used to check maybe 5 times..

psu_213, BSN, RN · Jun 7, 2018

I have worked places where you need someone to double check and cosign insulin, I have worked places you do not. Same goes for heparin and antiarrhythmic gtts (example, dilt). One of my places of employment required a cosigner for Coumadin! In other words, it varies, and there is no hard a fast rule.

Ilovenursing3 · Jun 7, 2018

Hi all :). Thank you all for getting back to me. I'm sorry it took a while. I thought about it and I feel bad for complaining. The fact that I was able to pass my boards and become an RN,is something I am thankful for everyday. I shouldn't have ANY complaints at all, but I'm human I suppose.

I look up to any and all nurses that have expierience. They are excellent resources so I hope I didn't come across as I know everything and I'm smarter than her. That's not the case AT ALL.

What bugs me is that I want to be ready in two weeks to take on a full patient load of 8 patients. It is a 8 patient unit and it is only allowed one nurse and one nursing aide. Nurses for this floor only get three weeks of training. Which I was told was unheard of.

Sorry that was long but feel free to put me in my place if im wrong about the following:

I gave out meds, did full head to toe assessments (which I haven't seen her do one, but documents she did it) helped the nursing aide with lifts and baths. I want to be consistent with my patients. Make sure they are getting the correct care they need. I tried to get it done all in the shift, but I THINK my preceptor could have helped a little more with patient care vs. sitting on the telephone complaining how "she doesn't want to work overtime as she doesn't want to be a slave to her job".

She conplains about one specfic technician which bothers me as it's unprofessional.

She said she hates nursing students.

Everything i did during the day she managed to say she did it all in report. I just kept my mouth shut. I'm not entitled to anything.

I started to become tired and by 4pm I just wanted a 15 mins break to go to the bathroom and at least eat. I was granted 30 mins. The last insulin draw I told her to watch me do it as mistakes can easily happen. I'm confident I can do insulin once I have at least a couple more shifts.

Okay, I'm done venting. Thanks for listening and to anyone that's replies. BTW-I LOVE nursing aides. They do so much work and are truly a blessing to us fellow nurses.

dream'n, BSN, RN · Jun 7, 2018

Seems like a high ratio with minimal training for a new graduate. When you say it's an 8 patient unit with one nurse, do you mean that you'll be the only nurse on duty? Is this a hospital with acute patients?

vanilla bean · Jun 7, 2018

I gave out meds, did full head to toe assessments (which I haven't seen her do one, but documents she did it) helped the nursing aide with lifts and baths. I want to be consistent with my patients. Make sure they are getting the correct care they need. I tried to get it done all in the shift, but I THINK my preceptor could have helped a little more with patient care vs. sitting on the telephone complaining how "she doesn't want to work overtime as she doesn't want to be a slave to her job".
She conplains about one specfic technician which bothers me as it's unprofessional.
She said she hates nursing students.
Everything i did during the day she managed to say she did it all in report. I just kept my mouth shut. I'm not entitled to anything.

OK, so as part of your orientation to the job you've also learned what kind of nurse you *don't* want to be. Learning experiences are not always positive; only you can decide to make the most of all of it.

Ilovenursing3 · Jun 7, 2018

Thank you for your response. It is a state hospital with three units. The first one is long term care, the second is resident that have to be on a higher level of care but will return back to long term care, and the unit I work on is a rehabilitation unit for anyone with a brain injury. There are 8 beds, but currently we have 5 patients. When I'm done training(if I make it) even if it the unit is full, only one nurse a nursing technician are staffed for the shift. It is a locked unit some of the patients that had a brain injury have psychiatric diagnosis. It is perfect for me as I understand-I've attempted suicide before. I can't say anything about any current patients or give an example. But this example is not anything like a current patient.

If someone who got into a car accident, survived but was paralyzed in the process would be in our unit. We give them PT,OT, and give them the best care to prepare them back to the community. It is so filling to see someone come in not being to walk, but then walk right on out. It's amazing to see. So, yes my preceptor basically said I don't have have time to spend twenty minutes comforting someone who doesn't have visitors. Well, she's right but that does suck.

TriciaJ, RN · Jun 7, 2018

I think you're on the right track. You do have a job in a place that's going to be very demanding. You have a preceptor who doesn't sound like that good a nurse. It's probably par for a state hospital; not everyone wants to work in one so they tolerate what other facilities might not.

The fact that you will be the only nurse on the unit when you are off orientation explains why there is no 2-RN insulin check. At the last hospital I worked in, many things, including insulin, were a 2-RN check. When I subsequently did some LTC through agency of course that was not the case. It felt strange to not have the double check system or bar coding, even though I'd spent most of my career without those things. But once you get used to them, you do feel vulnerable to errors without.

I say you are on the right track because you sound very careful and conscientious. Your biggest challenge (besides the demands of your workplace) will be to allow yourself to learn and grow without constantly second-guessing and beating yourself up.

Congratulations on your new job!

Ilovenursing3 · Jun 7, 2018

You are exactly right. I had to re-evaluate myself and what I needed to do on my own to help further my learning process. She does have things to do, and doesn't have time to explain everything to me. I know I should know it, but I went home and printed out any and all nursing care plans for each patient. I also tend to worry. After giving insulin, I always go back to make sure the patient is okay. She has three years of nursing expierience so she already knows the patient's and they are fine after giving it. Thanks so much for your input.