New nurse here who keeps getting bad advice....help!

[chatty-cathy]

First of all I love this site and read topics on here constantly because as a new nurse I am hungry for all the information that I can get my hands on. And right now I need to get things off of my chest and seek advice on how to appropriately handle this situation of being misinformed constantly.

Long story short I am a new grad working in a small community ER, but we have our fair share of critical patients so I am learning something new every shift. I have prior ER experience as a tech at a Level 1 hospital so I have a lot of exposure to highly acute patients. But I am humbly aware that I have a lot to learn as an RN, especially when it comes to giving meds.

First of all where I work on nights, it is constant practice to take vitals every 1-2 hours if your lucky. I feel differently and do q30 vitals with my patients, because after all it is an ER and conditions can change. It's a good thing I did because my patient had a hypotensive incident where the Doc ended up placing a central line and I started a Levophed drip. My frequent assessments and vitals prevented this patient from having a more serious situation occur, thank goodness!

While the drip began to infuse I was monitoring the patient closely with q5m vitals because I was titrating to the pt's needs. My charge nurse told me that it was inappropriate to do that and that I needed to do q15 vitals "because the blood needs to have time to circulate through the patients' arm." ...I completely disagreed and have been reading material all day about safe practice with this drip and everything I read says monitoring should include q2-3m vitals for at least the first 15 minutes of the infusion.

So I'm not sure what to say the next time she gives me bad advice where she won't be offended and then stop giving me advice all together, because she can be very helpful at times.

Now that is just an example that happened last night. There are plenty others, but I don't know how to continue to do what I feel is right and appropriate for the safe care of my patients without ruffling any feathers. I like my charge nurse and she is a very nice woman who is full of knowledge and I can learn a lot from her. So I'm not sure how to proceed because I am open to critiques and constructive criticism because I want to be a good nurse, but it's hard when I get both good and bad advice from the same person.

It's even more frustrating when I can't admit my patient onto the tele monitor because she doesn't like the noises that it makes, and she will discharge the patient off of the monitor if the machine beeps too much or if the patient was disconnected and went to the bathroom. Never mind if there actually is a cardiac episode or if there is a need to see what actually happened.

Also, I feel like she keeps giving me more patients at a time than the other nurses on the shift, and it would be nice if she could spread the wealth so to speak. It is very tiresome to be dealing with 1 ICU patient with a 2nd patient who is in pain, and a new admit who is puking on the floor while other nurses are sleeping at the nurses station or on their facebook. Every time I say something the response I keep getting is that 'your fine.' I feel like because I am a hard worker and the new girl they feel it's ok to give me the more acute patients so the others can get assigned to 'toe pain.' I want to be a team player but as the new nurse on the block I don't know what to do to even out the playing field.

Sorry for the long rant and thank you for even reading my post, I appreciate any and all feedback! :)

[RNperdiem, RN]

First thing to do: locate your hosptial's policy and procedure manual.

Use this as your starting point for advise.

Think of the top few issues you feel you are getting bad or conflicting advise on and look up these topics in the policy manual. These are the standards you are going to be held to.

[GonnaBSN]

A key skill in nursing is being able to voice when you need help. And as a new nurse, we are eager to please. But remember that you can't do it all, and when you stop asking questions, and never ask for help -- these are symptoms of a problem!

[sourapril]

Follow your company's policies and procedures. You are ultimately responsible for your license. It doesn't matter what other people do.

[chatty-cathy]

I was really frustrated the other day and needed to vent and ask for some help and I really appreciate you guys for taking the time to post some great advice, thank you. I really appreciate it. Sometimes in the middle of the moment it is hard to focus on the obvious, like checking the protocols of the unit lol. :)

[ChristineN, BSN, RN]

I echo the others, your hospital should have a policy for monitoring of pts on cardiac gtts. I work ER and always place unstable pts or those on gtts on the cardiac monitor and set the BP to cycle, typically Q5min. My ER is also a smaller one, and we don't get a ton of critical pts, but none of my coworkers or superiors have ever questioned me. In fact, I would expect to be called out if I did not do these things. Remember it is always your license on the line, and not your charge nurses or anyone else's.

If your charge nurse is d/c'ing pts of your from the monitor just because she doesn't like the beeping that is a very serious concern that I would speak to your manager about.

Sounds like you may also want to speak to your unit educator about having an in service for staff for appropriate care of critically ill pts in the ER