Prior to being an NP I was an ICU/CVICU nurse for 6 years and felt I was good at it. I went into ER and have worked 5 shifts so far.... I love it so much but I made a mistake and got yelled at already... I feel so so stupid and don't know what to do now!! I need some advice please...
Condensed story....I had a patient that needed admitted for IV clindamycin for a periodontal abcess that was crazy....So I went to the dr and told him all her symptoms and my plan.... He said "is there trismus" and I said "excuse me" and he said it again.... And stupid me said "no... She has" blah blah and said all her symptoms again. Then he said "do you know what trismus means" and I said "no but I'm going to look it up" and he said wasn't happy. He said "never ever answer a question without being 100% sure of the answer, this makes me not want to trust you". I mean I was wrong, I don't know why I even said no, I panicked and was nervous. Now I'm so worried to work with him again.
It really depends on the expectation. For our ICU if you are going to be there alone at night our orientation is eight to nine months. If you come out of a critical care post grad program its two months. For EM there are a couple of ways of doing it. You can do long orientations or you can do progressive orientation which seems to be more common. Start with relatively easy patients ESI 4 and 5. Then add ESI three until people are comfortable then take ESI 1 and 2. For new grads thats probably six months to a year. I would expect someone experienced to be up to speed within a month. Someone with experience but not in EM 2-6 months.[/quote']
I guess that sorta like what I'm doing now....
I can do any 4 and 5... If i do take a 3 the doc "gives" it to me and I go back and talk to him about it. It's not an official orientation, but I'm learning a ton.
Needless to say, I'll never make the mistake I made again. I just hope I can redeem myself...
I can do any 4 and 5... If i do take a 3 the doc "gives" it to me and I go back and talk to him about it. It's not an official orientation, but I'm learning a ton.
Needless to say, I'll never make the mistake I made again. I just hope I can redeem myself...
Sounds like this one would misclassified. Most tooth abscesses rate ESI 2 with the severe pain/high risk. Some places would classify it as an ESI 3 because of resources but I would wait and downgrade it once I assess it. All it takes is a Ludwig's Angina to get sent to fast track to solidify concern over a "tooth abscess".
Sounds like this one would misclassified. Most tooth abscesses rate ESI 2 with the severe pain/high risk. Some places would classify it as an ESI 3 because of resources but I would wait and downgrade it once I assess it. All it takes is a Ludwig's Angina to get sent to fast track to solidify concern over a "tooth abscess".
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Sounds like this one would misclassified. Most tooth abscesses rate ESI 2 with the severe pain/high risk. Some places would classify it as an ESI 3 because of resources but I would wait and downgrade it once I assess it. All it takes is a Ludwig's Angina to get sent to fast track to solidify concern over a "tooth abscess".
This was a return for IV antibiotics and depending of the severity initially, the patient presentation and what does this was... if nothing changed as evaluated by triage...ESI of 3 is acceptable.
ps...OP, I think the MD was baiting you just a little as they bait many other new ED members.
Like most of the others I say, move on it was a mistake. Learn from it and keeping it moving forward. We are not perfect, "not even doctors" because believe me he has had his share of mistakes too.
I had a similar experience... I was presenting a peds neuro patient to an attending and I was asked if I saw venous pulsations. I said no. Then she asked me if venous pulsations are normal and I said... "Uh.... no?"
Except in that case the attending said that she was never going to accept a case presentation from an NP student ever again.
I had a similar experience... I was presenting a peds neuro patient to an attending and I was asked if I saw venous pulsations. I said no. Then she asked me if venous pulsations are normal and I said... "Uh.... no?"
Except in that case the attending said that she was never going to accept a case presentation from an NP student ever again.
You know, I'm always so annoyed by physicians that paint a whole group by one incident. You answered one question incorrectly so now she wants to hear from no NP studwnt ever again? If a med student made the same error would all med students then suddenly be undeserving of her time?
NP education in the clinical environment is done so differently than medical education. I think as we precept NP students we need to be mindful of this. I was really glad I spent a semester of clinicals with MDs, because the way they taught was so different. I think we generally don't push students and put them on the spot and we are too quick to jump to a diagnosis, before really considering all of the potential DDs. Then we start our new NP jobs nod get grilled on our patients by our attending and asked what other differentials we have for our patients and feel like complete idiots when we can't answer. This seems like a very common scenario.
I wouldn't worry too much about this one instance. Just learn from it and move on. But expect to have many questions like this in the future. Just get used to saying "I don't know." My medical director told me when I interviewed for this job that she doesn't expect anyone new to know anything, not even her fellows. But after a year, if you still don't know anything then she's gonna start wondering what's wrong, lol.
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jamiejo05
24 Posts