feeling down :(

[OreoCookie3]

Yesterday was a rough day for me...I'm a new nurse and have only been on my own for a few weeks. Yesterday was the first day I had 5 patients. I felt like I couldn't balance everything. It was going alright until I got the last patient, and then I felt even more overwhelmed for the rest of the day. The patient originally came in with a low bp, and when I received the patient, the bp was normal. When the CNA checked vs in the afternoon around 4:15, the bp was elevated around 179/75. When I saw the vs in the computer I asked the CNA if we could recheck it in a little while. I rechecked it myself and it was still high. I noticed that one of the PA's was on the floor, and told her about the pt's bp. She wanted one of the patient's PO bp meds given early since it wasn't scheduled until nighttime and had originally been held with the low bp. I gave it around 6:25. I called the doctor before I left to see if they wanted anything else done, and they said to give one of the other po bp meds early. I passed this on to night shift, and I stayed late to finish charting. I asked the night nurse how the pt was doing and he said the pt's bp was up to 215/100 at around 9:15, but that he was not worried and would take care of it, but I was still worried and scared that the patient could have a stroke or something. Did I act fast enough? Was I wrong to wait and recheck the blood pressure?

The doctor also told me that he wanted an MRI of the patient's brain. I know that he wrote other orders for the patient, but I am not sure if he wrote this in the chart. I wrote it down on my sheet and I think I forgot to write it in the chart. I passed on to night shift that he wanted an MRI of the brain done but now I don't think I ever wrote it or if night shift would remember to check. I don't know what to do and I feel like the worst nurse ever. I feel like I forgot to pass on so many things to the night nurses even if they will see them in the chart, and I couldn't finish everything. I really don't want to give up but I feel like the patients aren't getting good care because of me...I had a tough assignment the previous day and the charge nurses said I was doing well and the director said she had heard that I was doing well but I still can't believe that...and after yesterday and me feeling like I missed everything I feel worse. Did I mess up horribly? I feel like a terrible nurse and person. Please help . Thank you.

[onepowerfullady, LPN]

I sure hope that I am as good as you when I land my first job. If it's any consolation...please get some rest and don't be too hard on yourself! Good luck, honey!

[KelRN215, BSN, RN]

The MRI thing seems like an example of a broken system. Our administrative assistants have NOTHING to do with entering orders. Orders need to be written by MDs/NPs (written as in ordered via our electronic system-we do not use paper charts for orders) and taken off/reviewed by RNs and RN/pharmacy if it is a medication. We can only accept verbal orders in an emergency and, even then, the doctor is supposed to enter it into the computer ASAP.

Our radiology department will not perform an MRI unless an MD/NP has written the order AND called to speak with them about why the patient needs an MRI.

[carolmaccas66, BSN, RN]

Carol- Sorry again for the confusion lol! When we write phone orders or the doctors write orders in the chart, the chart is placed up on a rack at the front desk for the unit clerk to put in the computer. we use the electronic system epic at the hospital. I'm sure the doctor eventually wrote in the progress notes that part of the plan was to do an MRI, but I did forget to write that order in the chart. I did chart the abnormal blood pressures and abnormal rechecks, and let the charge nurse know after I got the order from the PA. The physician's assistant from the patient's cardiology group was on the floor so I told her what was going on and told her I would recheck the pressure again and come back and let her know if it was still high, and since it was, she wrote the order to give the bp meds early. I use a separate sheet for each patient, but I know I need to be more organized with that. I called the PA on call who was a different PA than the one I spoke with in person earlier, right after I had given the bp meds, and she gave me the order to give the patient's other bp meds early, which nightshift gave. Thank you for your advice!!!

Beenthere- We have EPIC, so if a doctor is on the floor and writes orders, he puts the chart up front for the clerk to enter the orders. If he gives us telephone orders, then we would still have to write them in the chart to give to the clerk, which was my situation. Thank you, I was worried that it seemed to be getting higher and that the bp meds i had given on my shift weren't working. She did take several and they were pretty high doses. I think it will take some getting used to for me to realize I can't get everything under control on my shift and that nursing is 24 hours.

Thank you again for your advice, it is always appreciated :hug:! I hope everyone is having a happy new year!

OK thanx 4 the clarification. But who's actual job is it 2 book the MRI? I don't really understand why this has to be re-written in the notes by yourself. And why aren't the doctors booking the MRI?

Now, you say u use a separate sheet for patients. Stop doing this. Get ONE cheat sheet, with names on the side, times up the top in hours for all hours of ur shift. Make sure u start a system for abbreviations 2 put on ur cheat sheet, ie: VS for vital signs. I put meds in red, green for IV drugs, blue for other orders to be done. You can develop ur own system. Anything urgent or that HAS to be done I ALWAYS highlight with stars.

I think having 2 cheat sheets is too confusing. I used 2 do this, & I was always flicking from one sheet to another and forgetting things.

It sounds like ur doing the right things. And as another poster said, it takes a while 2 get used 2 a job. Studies show to feel comfortable in a job, it takes at least 18 months to even get used to doing one job.

You are doing OK!!! But that double charting the MRI worries me, I think u need a better system for that.

[anotherone, BSN, RN]

I still don't get this. We have EMR -the provider puts in ALL ORDERS unless he/she is in a situtaion where he/she does not have access to the EMR ( taking call at home, in the OR operating, etc). If that were to happen than I would put in a telephone order in the EMR right away. so much easier than passing a ton of paper around..