One bad night vs. overall "bad" at the job

[perfectbluebuildings, BSN, RN]

Ok... I know I am always complaining here and asking for advice. I'm going to do it again.

Last night was not a good night at work. I made a med error, then a patient with borderline B/P who had PRN's to cover, the B/P didn't get checked as often as it should. She was just down from the ICU and there were some other things, not necessarily huge in themselves, but little things with her care that I think I messed up or make me a bad nurse. Her PICC dressing was sort of coming apart and I didn't change it. I would say I just didn't have time to, but isn't that something I should have prioritized? Her surgical incision had drainage toward the end of the shift and we had no orders about changing the huge dressing, so we reinforced it.

And I think the nurse who followed me was kind of irritated, which I don't blame her. I didn't think that dressing was something I should call the doctor about, but was it?

My question is, how do I tell if this was just a bad night and I just need to get more mentally tough about it, or if this is symptomatic of something more serious and I need to consider actions to take for improvement, or switching to another type of nursing or out of nursing. It's not the environment- I have a supportive, caring environment for the most part.

I welcome all advice and feedback. I don't want to keep on being mediocre or worse than mediocre, and compromise patient care. Thanks.

[twinmommy+2, ADN, BSN, MSN]

Nah, I would say that was a bad night. Sounds like you were distracted and had a tough time prioritising stuff right? Put that behind you now, take your vitamins, put your game face on and get down to the nitty gritty the next night. Just make the next one a really good night no matter what

[beautifulb]

Sounds like you had a lot of things going on. Sometimes there is nothing you can do but your best. Don't let that night get to you, we have all had nights like that. With nights like that it is also common to question yourself. Relax. You will feel more confident.

Good luck on your next shift!

[perfectbluebuildings, BSN, RN]

Thanks. I appreciate the feedback very much!!!

I would ask how would those things prioritize, in your minds? Would the dressing be something to call about? I have a LOT of trouble figuring out what to call the doctors about.

And not that it makes a lot of difference b/c it was still ultimately my responsibility, but the nurse's aide was responsible for the B/P checks and I thought from some verbal miscommunications, it was getting checked more often than it did. Didn't realize till the end of shift when looking at the charting, what had happened. I know I should have realized it before then, though.

Thank you, again very much :) :) twinmommy+1 and beautifulb!

[Iluvhospice]

At my hospital, you don't change a dressing until the doctor writes an order. I wouldn't think that it would be unusual for it to have drainage on it - particularly right after surgery.

As far as cardiac meds and monitoring - which floor do you work on? I am not very familiar with cardiac issues because I work in Oncology, and anytime there's a cardiac issue, we send them off to IMC or ICU.

I also need to learn how to change my user name. I have been an RN for 6 months already - I need to lose the 2B! Any suggestions?

Pick yourself up, dust yourself off - and start over again. It WILL get better!

[greatshakes]

Hello to all of you who have been in nursing a few months. I want to know as a new grad, what were the hardest things for you to get used to in those first few weeks during orientation? Was there anything that really stood out as more difficult than other things. What did you find you achieved more quickly than other things? I guess I am just wondering what to expect. I've been told there's a lot of information overload in the first two weeks and people feeling they're drowning in facts. Everything you can throw my way will be appreciated. Thanks:Crash:

[DONN]

With regards to the dressing, was it the original O.R. dressing or had it been changed previously? If it was the O.R. dressing then we leave those alone until the Doc removes it, next day or whatever, and then do dressing changes prn if necessary. You reaLLY dont specify what the drainage looked like but if it was at all purulent looking then obviously a call to the DR. would be in order, or if the amt. of drainage had increased considerably then again a call to the DR was in order. As for the PICC line dressing I just would have worked it into the evenings duties and made sure it was done prior to end of shift. This is all JMO though.................

[DONN]

Also just wanted to ask you by what you meant in "borderline bp", are we talking hyper or hypo ?

[jwrightstone]

Things get busy at times in fact most of the time. In reguards to the dressing depending on what the drainage looked like and if it had an odor you may have wanted to call the doctor, if it was less than 24 hours post op we only reinforce it. If it was over 24 hours I would have changed it. I do not know how your floor is but in our unit if one person is having a rough night they ask for help and someone else will help change the PICC dsg or do something else so you can complete all you tasks. We all for the most part try to leave the room and the patient the way we want to take them over. I hate giving report and telling the next nurse all the things that I did not get to, but sometimes you have those nights. Good luck!