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athena55, BSN, RN · Aug 22, 2008

Goozgog:

Listen, nothing I am going to "say" will make you feel better but please believe me when I say your whole nursing career will be one huge learning curve.

One of my nursing school (diploma program) instructors gave me some very sage advice. It was: "At the end of the day/your shift did you do all that you humanly could for your patient? At the end of the day did your patient live? At the end of the shift did you learn one thing, either about yourself, your patient, your peers...?"

So the experience you shared with your patient: You caught his tachypnea and brought it to the attention of someone. You stayed with your patient providing what emotional support and comfort you could, AT THAT TIME.

Now you know there will be "a next time" and now you are a wee bit better prepared. For instance, after mentally kicking yourself over not knowing what silly lab slip to fill out now you know! You had the where-withall to obtain an ABG and lytes!!

Just because some fellow nurses can give you an attitude (speaking of my fellow ICU nurses and come on y'all you KNOW what I am talking about :wink2:) you are still a novice nurse. SO WHAT IF YOU DIDN'T KNOW WHERE THE ICU WAS? Now you know (unless you are like me and almost failed land/nav and couldn't find my way out of a paper bag:chuckle)

IMHO I think you are being a wee bit too hard on yourself. Give yourself permission to not know some things (like what lab slips to use or how to plug in the pulse oximeter)

Please give yourself permission to file this experience away somewhere

I think I can honestly say that every nurse practicing today has had moments like what you went through. Pick yourself up, brush yourself off and get through one shift at a time. It does get easier. Hey if you would like to hear some of the things that I did as a new novice nurse, gosh you would shake your head and think "she actually continued to practice?" shoot me a PM and I will gladly tell you a few stories. The main thing is, I learned from my mistakes or mis-judgments or from not "listening" to my gut and I'm still kicking!

athena

Goozgog · Aug 23, 2008

Thanks Athena55,

I appreciate your support.

Would you believe that when I went to work last night it was a continuation of the previous night? I got report and was slammed with three high priorities on three different pt's! One of which was tachypneic and had to be transported to SICU...again! This time I was more prepared, but still in shock from the night before. I couldn't believe this was happening again!

Anyway, I handled it better and got more support on the floor.

I have three more weeks in tele until I start my new job in L&D. I bet that since nothing major happened for my first year in tele, it's all going to unfold now, right before I move on to my new job.

I sure hope I will be able to think fast in L&D! I don't want to loose any mom's or babies!

Spatialized · Aug 25, 2008

Just out of curiosity, where were your coworkers, charge nurse? When things go south, the help of those around you can turn a "OMG!" moment into an "OK, this is not good, but I have help moment." The other question is, does your facility have a Rapid Response Team? They could have been immensely helpful in this situation as well as they provide rapid assessment and stabilization, plus they can help you transport said patient to the ICU if needed.

Looking at what you're saying, you did good. You got the patient transferred to a higher level of care that they required. At the end of the day, they're still alive (that's usually have I judge my shifts...). I think I would have done the same: non-rebreather, labs, CXR, 12-lead, transport to ICU.

Cheers,

Tom

al7139, ASN, RN · Aug 27, 2008

Hi there!

I am a Nurse who has been practicing since May 2007, so in my opinion I am still "shiny and new" and have alot to learn. I work on a telemetry unit, where we get all kinds of patients, and with their medical problems, anything can happen. A patient that was awake and talking to me 5 minutes ago can suddenly "head South."

My first true emergency off orientation was so scary to me! My patient had chest pain...I went blank, and could not remember the protocol (vitals, SL nitro, notify Doc, Etc.). I called my TL, and she helped me through it. The next time I had a pt with CP, it was easier...I had done this before I know what to do. But we constantly experience new problems in nursing, so as a new nurse, you have to be on the job to gain the experience that they cannot teach you in school. It is sometimes upsetting, and discouraging, and makes you think you should not be a nurse, but at the end of the day, you did what you could, and I still consider a good shift a shift where all my patients are still alive (it may sound cold but it's true).

You will be fine. You are still learning. Thats what you team is there to help you with.

Amy

UM Review RN, ASN, RN · Aug 27, 2008

I'm not shocked that this could happen to a newbie, but I am stunned that you were so unprepared and worse, that you had no help.

Like someone else pointed out, where were your coworkers? Why did the hospital policy allow you to flounder through a critical process without assistance?

Your coworkers are supposed to be your mentors and resources at a time like that! Your hospital policy is supposed to be designed to be "newbie-proof," for lack of a better term.

How much orientation did you get? Was there no preceptorship in which you had to deal with situations such as these?

Believe me, this is not the norm at many other hospitals. I would seriously question my future at a hospital that considered this a normal occurrence.

Please understand, I am not criticizing you or any of the actions that you took. In fact, you did remarkably well considering you were working practically by yourself.

However, in my hospital, as soon as I had a problem, at least two other qualified nurses would be in that room helping get orders, call doc, start a Rapid Response, and transport the patient. Your coworkers need to learn that if one patient crashes on the unit, it's everyone's business.

Spatialized · Aug 27, 2008

However, in my hospital, as soon as I had a problem, at least two other qualified nurses would be in that room helping get orders, call doc, start a Rapid Response, and transport the patient. Your coworkers need to learn that if one patient crashes on the unit, it's everyone's business.

Amen.

Tom

Goozgog · Sep 3, 2008

Hi all and thanks for your replies.

Honestly, in hind site, I have to admit that I didn't ask for help. I hate to admit it but it is true. Other than call the MD and RT.

I wasn't trying to hide anything. I called and talked to the MD while sitting next to my charge nurse, who didn't ask me any questions, so I kind of thought that it may not be a real emergency if both my CN and the MD weren't freaking out.

But I was. I wondered if I was freaking out because I didn't know if I should ask for help...again! I am always asking questions and asking for help. I feel so stupid a lot of the time.

I've been there just over a year and work night shifts. I just haven't seen this before.

The next shift I had another pt go to ICU, and the CN working that night was very helpful..so much so that I asked her to stand by and let me do the work so I know that I know what I am doing.

I'm even afraid to post this out of fear that you are all going to hang me by my toenails! :cry:

mama_d, BSN, RN · Sep 5, 2008

If you've been there for that long and your first response when you started to panic wasn't to think of at least two other nurses you could immediately go to for help, without worrying about it, then I think that you are working in an atmosphere which does not encourage teamwork. On our floor the standard for newer nurses or nurses who feel out of their element in a situation is to have several more experienced nurses help talk them through what is going on and why. Even when an experienced nurse has a patient go bad, the rest of us usually handle the management of the patient at the bedside to free up the nurse to deal with communicating between docs, family, etc.

All of us have had those moments where we looked back and went "D'oh!" I had a patient one time who had been c/o intermittent SOB for a few days, sats always were >90%, had a history of anxiety, COPD, CHF...ended up someone finally put together that she had been refusing lovenox/teds/scds, drew a d-dimer on her and low and behold, her VQ scan was positive. Hindsight is 20/20.

outside_child · Feb 1, 2009

I just love this website because it gives me encouragement to go on in nursing and to venture into the acute care arena!! I can see that I am not alone even with the lack of experience I have in acute care, but see that others go thru the same feelings of inadequacies, and LEARN, so long as appropriate actions are done, help is there with all the resources (rapid response team), and no harm is to the patient..