I got my license in January. I've been working at a hospital I really love, with healthy newborns and NICU. The training to NICU was only 4 weeks, and sometimes I go home and replay over and over in my mind what I forgot to chart...document...notify the doctor for....etc....
So many things happen in one day. I guess part of this is just a vent. About 2 months out of orientation, I got a feeder/grower assignment. Well I got in report that one of the babies had a " tiny nodule" on the arm, and the nurse told me the doctor had looked at it and that is was probably a "calcium deposit". Well in my inexperience I thought, ok, I have a couple of those, no big deal...so I charted it and its current size. About 4 weeks later 8 nurses including myself got written up. Turns out it was an infiltrate from calcium glutenate from TPN, and the baby had to have surgery. Well, the nurses who didn't document anything was wrong didn't get written up. The one nurse who never reported the infiltrate when it happened on her shift didn't get written up, because she didn't document anything about it. We got written up because nowhere had it been charted that the doctor had been notified, (basically didn't cover the intervention part after the assessment was their reasoning) and he never bothered to write it in his progress notes.
OK, then the last couple of days, I was given a pretty heavy assignment. I was trained to level 2 which are feeder/grower babies. However, they will still assign pts to a level 2 nurse who are classified as level 3 babies as long as they are not on a vent. The ratio for that is suppose to be 2:1. I had 3 babies, two level 3's and one level 2. The level 2 should have been a level 3 IMO. All three were desatters, one baby hadn't even reached the 3lb mark yet. We had no charge nurse or clerk assigned (we are in a seperate unit that sometimes gets opened with overflow pts upstairs from the main NICU) They are suppose to be there for resource for us but are so overrun downstairs that they are regularly unavailable. One baby constantly had to get blow-by at least hourly and sometimes up to 4X per hour. One time HR was 51 and I thought he was going to code. Anyway between feedings and parents calling, rounds and new orders, putting in and executing my new orders, notifying the NNP everytime I thought any little thing looked wrong, distended abdomens, thought maybe the baby threw a pneumo (hard for me to discern O2 flow on an NC and clear lungs really...I just couldn't make out an actual breath sound) then more new orders, a new KUB and CXR would come up (all three had sonos and XR's that day because they were ALL going downhill) I had 30 meds to give on my shift. We are suppose to use this electronic MAR which tells you when meds are due, but there is also a paper MAR and you write your notes on your own sheet. I had them on my status board, somehow two meds did not show up on that, and I didn't write them down on my sheet, and don't know how I missed them off the paper MAR, but incidentally when the paper MARS are printed out for the next shift, that is when I saw they were not given. So I had to write two incident reports with Med errors that I made (Reglan X2 and NaCL X2, both PO) I also had a Vanc to give and noticed that it was the 9th dose so I put in for the trough and peak, and noone had done a peak or trough after the 3rd dose. One nurse told me I should write an incident report on it because it was my license, the charge nurse told me I didn't need to because I wasn't the one that had made that mistake, I was the one who had caught it. Well, I've already seen the damage that can be done, nurses getting blackballed for "writing everyone up" I informed the nurse when she came back in of the mistake, and thought she could report herself if she wanted to. No harm came to the pt. Anyway, since the TPN incident, all I can think about is how much crap I have to chart, what all is important to notify the doctor about and constantly trying to CMA....did I get everything? Did I miss something extraordinarily important? What am I going to get in trouble for/written up for now?!?!? Now, since yesterday, I am really paranoid even more....... sometimes just plain scared to go to work...
What do ya'll think? Any advice?
