New ICU nurse

[lizdimi54873]

Hello,

I’ve posted a few times and gotten such great support! This time I’m just looking for some advice about work, positivity, and anything that would help! 
I just got off orientation and had 3 shifts this week, in the ICU. My first two days went well. My third, things got shaky. I had two floor patients, basically, no drips or vents. They were pretty manageable and comparable to patients I had med surg.

Everything went well, until I had a bed side procedure for one patient. I haven’t really experienced many procedures yet that I’ve had to be present and a part of. So the team was in there, felt like 50 people, they got everything ready and then the attending came in. I had my ketamine that was a one time order, small dose, on hand in a Syringe that had a larger dose then was needed. The attending came in and asked how much was ordered, I told him and he questioned it to his residents. He did ask if I had more than I needed and I said yes.

Then he went and ordered dilauded and I got that in hand to. Then they went to start the procedure, I wasted my ketamine so I only had what I needed and we started. When he told me to push it, I did, and then they did a few more things. The patient started to get uncomfortable so he asked me to push more. I didn’t have any and then realized my mistake. I ran to get more tubed up from pharmacy. It was a whole fiasco, I started to get super nervous and flustered. Then I finally got it, pushed a little more, verbal order. Then he wanted the dilaudid, so I pushed a verbal dose, was shaking at this point, I still had some left but it wasted onto the floor when I was shakily trying to administer meds. He wanted another so I had to run to the pixus, have a nurse help me override to get more.

Then my resource who was also my preceptor saw me in my slight panic and came and helped. She was amazing so calm and collected, got everything in order. But she was very upset that they had started this without adequate pain meds + knowing I was new/teaching hospital, it should have been more clear. She talked with the attending after and gave him a “talking to”. After all my nursing coworkers reassured me it was okay and not to beat myself up. Also, I’m aware of the fact that I needed to have the meds on standby and not to waste in the future until it’s complete. I haven’t really been in that situation before so I just didn’t understand how it worked.

long story short I’m just having a hard time not overthinking it. I also want the doctors to be able to trust me and feel like I’m a competent nurse. I just feel like I blew it my first week. I really didn’t think I’d lose my cool this early and on something that shouldn’t be too stressful..

Thanks for any advice ! 

[CalicoKitty, BSN, MSN, RN]

Doing procedures and pushing multiple "verbal order" medications can be stressful. You need to be able to keep track of what you pushed if it weren't being scanned in. Bedside procedures are kinda like little OR trips, but you're not a trained OR nurse (that training can take up to a year). You'll eventually get used to procedures and what to expect, and get to know your providers and their different wants/needs for procedures.  You did not blow it. You finished the case. Congratulations. ?