feeling down :(

Nurses Safety

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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.

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I spoke to the charge nurse to tell her that I thought I had forgotten to write the MRI order and she said she would put it in the chart. Oh boy, I still feel like an idiot and the worst nurse ever though :(

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You need some rest and you need to stop second guessing yourself and beating up on yourself. When the supervisors tell you that you are doing a good job, believe them and move on. Make a conscious effort to check your note sheet at the end of your shift to see if there are any loose threads to tie, that would have been the time to catch the MRI situation. Keep on trying to improve a little each day and take time to relax. That will help the blood flow to your brain during the shift!

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Thank you Caliotter, I truly appreciate your response and advice. I know I'm new and will make mistakes, I guess I just have a hard time letting go when I make them. I feel better that I called and made sure that it would get done. I just hope the patient's bp is better. It's a great responsibility nurses carry, to be responsible for so many lives. I worry even after I've gone home if the patients are okay, if anything I've done or lack thereof has caused them harm...It is difficult for me to realize that nursing is 24 hours and to stop wondering if I should have done things differently. I will try harder to not make the same mistakes. I am sure that I will make new ones, I just hope I don't make the same ones and that I learn from them. I usually have a separate report sheet for each patient, and make boxes to check off. Maybe things were getting too cluttered I think I will start carrying a notebook so that I can write orders as I get them and can cross things out when I know that they've definitely been done. I am also going to try harder to work on time management...being a new nurse on a stepdown unit with so many patients is challening!!! I appreciate your kind words and will try and move on from this and do better next time. Happy new year :heartbeat

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Specializes in Pedi.

Why would you have to write for the MRI in the patient's chart? If the physician wants to order an MRI, it is his/her responsibility to write the order. In my facility, an MRI order must be entered by a physician and then they must call MRI to explain why it is needed so the radiologist can prioritize.

If VS are out of range, I always re-check them myself. The majority of the time when I get a "fever" reported to me, it's not a fever but an error with a tympanic thermometer that was inappropriately used on an infant or on a patient who's just had neurosurgery. In this case, I would expect the CNA to report the high blood pressure to me, not to have to find it in the computer myself. Not that that doesn't happen all the time, but if VS are out of range, the CNA should come find you to tell you.

My only advice to you would be to not be afraid to ask for help. If you feel like you can't balance everything, there's nothing wrong with asking your charge nurse or peers for help. They should want to help you since you're just off orientation.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

oh sweetie....:hug:. it takes a long time to feel like you're able to tread water. even after years of working you will have those days when you get home and think "oh crap!" and have to call back in....it will take at least a year to feel that you aren't drowning. it will get better, experience will help. don't be afraid to ask for help and never be afraid you may have made a mistake or forgot something. get a routine down. organize your report sheet and don"t be so hard on yourself!!!

student clinical report sheet for one patient

critical thinking flow sheet for nursing students

a beloved member daytonite(rip) came up with these sheets for students but they may help to keep you organized and have one for each patient.

now allow yourself to feel better and forgive yourself...you'll do fine!

happy new year!!!

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kelRN215: Sorry I forgot to mention in my original post! I had called the doctor after he already left the floor and had written the other orders, because the patient pulled out her iv's and I was wondering if maybe he wanted her to have a sitter as she was confused and had a history of dementia. I did not want her to hurt herself. He didn't want a sitter but wanted to order the MRI and gave me the telephone order. I got sidetracked and forgot to write the order in the chart. I had to call today to tell the charge nurse and she said the doctor was making rounds. I realize I forgot to tell her that he wanted it without contrast :( but I believe she would have had to ask him again just to verify anyway as she can't really take a verbal order from me if I am correct?

I felt sheepish having to call back in to the floor today, but I'd much rather I get in trouble and know that the patient is fine and that someone is aware of what I forgot to do. The charge nurse wasn't angry with me though I felt like a big airhead when I explained the situation.

Thank you Esme for the sheets, every resource is helpful! I am trying to be less hard on myself, and I hope I didn't make any other mistakes that I am not aware of :sniff:

I appreciate everyone's words of advice and will do my best to learn from these mistakes, and let go of the past and what I cannot change. Does anyone have any advice on time management? How can I balance emergency situations, which come up often on my unit, and which are the priority, with everything else that I must do?

Again I am grateful for all of the feedback and I want to do all that I can to work hard and be better at this. I am thankful that all of you guys care and took the time to respond :redbeathe, and for being honest with me. I truly hope I will become as great a nurse as you all are.

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:redpinkhe

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kelrn215: Sorry I forgot to mention in my original post! I had called the doctor after he left and had written other orders, because the patient pulled out her iv's and was confused. She had a hx of dementia and I wanted to ask if he would like to order a 1:1 sitter since I didn't want her to hurt herself. He wanted an MRI of the brain ordered. I got sidetracked and forgot to write the order in the chart.

I called the unit today and felt pretty sheepish...I'd much rather get in trouble and know that the patient is fine/someone is aware of what I forgot to do than have something go wrong! The charge nurse wasn't angry with me and said that the doctor was just rounding now and that she would write it in the chart..I felt like a big airhead though when I had to explain the situation to her. I did realize after I hungg up that I forgot to tell her that he wanted the MRI without contrast...but if I am correct wouldn't she need to verify it with the doctor first since she can't really take a verbal order from me? I'd be frustrated with me lol :o!

Esme, thank you for the sheets. Every resource is helpful and I want to do whatever I can to be more organized and improve my time management skills. I know that it is not good to be staying late to finish charting. I am trying to be less hard on myself, I just hope I didn't make any mistakes that I am unaware of :(...Beating myself up is something I do very well :smackingf...I will try to leave the past and what I cannot change behind me and learn from all of this so that I will be more organized next time.

Thank you everyone for caring and for taking the time to reply to my post. I wish you could truly see how much I appreciate all of your advice and constructive feedback as I really do take these things to heart. Thank you for being honest with me. I hope that one day I will be as great a nurse as I know that all of you are :redbeathe.

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Specializes in Med/Surg, DSU, Ortho, Onc, Psych.

I'm also a bit confused by this post.

The treating doctor would have to write in the pt's notes re the MRI & leave a treatment form for someone to make the booking for the MRI - whether the t/ment form is picked up by radiology or rung thru by the RN/Clerk - I don't know your system. It's up to the doctor to ensure it is booked usually, well, down here anyway. Our doctors usually do it themselves.

You need to always recheck VS if they're abnormal. Always report these to the senior nurse on that night }

& contact the doctor on call. You shouldn't be worrying re what treatment to give unless the doctor had written specific instructions re BP meds, ie: if BP more than (whatever) give such & such medication in whatever dosage. Always document abnormal vitals in the notes. ALWAYS report abnormal vital signs immediately.

Do u use a cheat sheet for ur patients? A new admission can set you WAAY back wen ur busy with ur time management.

But just realise you can't do everything for the new admission and may have to leave some of it for the next shift, as that is what we do - handover work that isn't done.

You are not a BAD nurse - you just need a bit more experience with time & people management, & also managing pt conditions as well.

You sound like you handled everything quite well, and sweetie, I have known nurses who have been RNs for 20 years - and they STILL get behind on their time management - we ALL do when it gets busy. So do not stress too much, just try to maybe organise yourself a little better next time.

And BTW, we don't have CNAs down here to do VS and other work -we do it all ourselves and have to figure that into our time management. So I actually think ur quite lucky!

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Welcome to nursing. I think any intelligent nurse has felt the same way you do.

You did the right thing with the BP, we can't fix everything on our shift... remember that.

That stinks that you have to write orders for doctors... think about it... that is the VERY reason hospitals are going to electronic documentation (docs put in their own freakin' orders)

because mistakes like yours happen. You are too busy to have to do their work for them!

Try to relax because stress makes it harder to concentrate.

Sounds like you are doing fine... it is an on-going process to become a proficient nurse. I'm still working on it after 30 years:)

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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!

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