New nurse critical care- am I getting it?

[learning2Bnurse]

I graduated in May, boards in July (5 days before we had our 3rd boy). Started on a step down unit in the hospital I've worked at for 5 yrs in Feb. I am off of orientation by about 3 weeks. Two nights ago I had a pt on a vapotherm that went into respiratory distress r/t anxiety. She bounced around so I was trying to give her a minute to recover on her own. Another RN walked in and was like "do this do that."when all was said and done I felt two things: a) did I not react quick enough and did I fail and b) I have to be coached still on so much is this normal or am I failing at this critical care stuff? I feel so stressed out, as I mentioned I have a new baby a new job and I feel so lost. On top of that they have made change where I work and put a heavier load on the RNs and less on our NA's. I also blew a perioheral IV giving D50 to a pt. I feel so dumb.

[jadelpn, LPN, EMT-B]

Lots of things overwhelming at once. Seems like if you were waiting a moment to see if pt recovered on own, that would be the preferable thing, as opposed to getting her all worked up even more by immedietely intervening. Other than perhaps changing her position, being sure that her O2 was positioned properly, that type of thing.

And when the other nurse came in, I would say something along the lines of what you did, and what your plan is. Sometimes hard when someone comes in full bore and starts ordering you around. However, I would not take it to heart. Soak it in, so that you know what the next steps would be. This is your patient, who you know her information, and if the distress was r/t anxiety, IV ativan? Morphine? What did she have for her anxiety? I would task a nurse coming to help with obtaining that for the patient. You will get more confident as time goes on, and with anxiety patients, you did the right thing in not getting all worked up. Orientation is for fine tuning your practice. And to think of it in the positive--you know that a nurse on your shift has your back and IS going to come in and help (even if it is not in the most calm way)--as respitory distress is something you should not be put in the weeds for alone, and after that moment to let the patient try and recover, then you would need help to put into play plan B. So thankfully, you have backup.

And the IV thing---it happens, they infiltrate, just be sure you get a really good blood return and the line flushes before putting anything through it. And always good practice to be sure when you do your shift assessment that you have a working IV.

You got this. Truly.

[learning2Bnurse]

Thanks! The pt was getting 1mg Dilaudid q4hrs and oxycodone for break through pain. I made sure to keep them on time so she was getting meds every 2 hours. She had no orders for anxiety but I fixed that after this episode! I guess I feel like I ask entirely too many questions. I hope I do get confident. Thanks again for your input!

[tswim]

hey learning2b,

Great advice from jadelpn. What you're experiencing is completely normal for a new nurse. Nursing is stressful, and taking care of unstable patients makes for a special kind of challenge. If there's something u don't know ask someone about it or look it up.

In 6 months or so you'll begin to feel comfortable, and by a year you'll feel like a pro- just recognize that that wont actually b one, and always seek help when you're unsure.

About the blown line - D50 has a very high osmolality and a low pH (~3), so it should b given through a central line when possible or with running IV fluids. Don't know if your patient was awake, but - for future situations- if they are awake enough to eat/ drink, start with milk, PB, graham crackers; juices (simple sugars) bring glucose up rapidly but also stimulate insulin production... check your protocol. Best