Smhcdh0623

I truly appreciate all of your advice and encouragement! I already know that when I go in for my next shift I am going to think of it as a fresh start. My unit director talked to me after my shift and told me 2 things that I will certainly take with me always. He said, "One, I don't want you to take this shift home with you. Leave it here. Today. Two, this does not change my perception of you at all. I still think you will/are a great nurse and will continue to grow." I feel very lucky to have co-workers and a unit director that are so supportive. I am going to take this a learning experience. I will advocate for safety precautions to be put in place when needed, ask for more help when I feel overwhelmed, and ask questions even if I think they are stupid. Thanks again for your advice! It is much appreciated!

I feel like I need to get this off my chest in order to really be able to move past it. Anyway, I am about 4 weeks off of orientation as a new grad nurse. I work on a tele/cardiac unit. Last night I had the WORST shift of my life that really made me question whether I should continue in this career. I should preface this with the fact that I'm on night shift and had worked every other night for a week straight. I was burned out to say the least. Anyway, I started on the floor with 3 patients and 1 admission coming up from the ED. 1 of my patients was totally fine and didn't have many meds so I didn't have to worry about him too much. My other 2 patients were a handful. One of them was from a memory care unit, impulsive, combative, agitated, and yelled "HELP!" every 5 min (that is not an exaggeration), and on an Amnio drip. Other pts were complaining that it made them feel anxious and they couldn't sleep. My other pt was an elderly woman who was admitted for a previous cardiac arrest from another hospital. Her daughter (who is an experienced ICU nurse) was in the room overnight. Within 30 min on shift, my dementia pt was already consuming most of my time. I had to sit in the room with him to chart because he kept calling out so much and the bed alarm went off every 5 sec. There was an order for a PRN 1:1 sitter but my charge nurse told me we should just wait to see how the shift goes before pulling a PCA off the floor to sit with him. Within a couple hours of being on shift the other nurses are telling me to call the Resident and see about getting him an order for Ativan, which I did but the Resident opted against it. I felt like I shouldn't have asked for a sitter because then everyone loses a PCA and the other nurses were trying to help manage the pt with me. Anyway, no sitter the whole night is what happened and instead we all ran in there every 5-10 min to manage him. In the meantime, I have an admission from the ED coming up with a BS in the 40's, asymptomatic, and my elderly lady is going into fluid overload. Then her doppler results come back and she has DVT in one of her arms. So I rush to get a Heparin drip started and her daughter is asking me explain why so I have to call the MD to have him explain that they found a DVT. Heparin drip is hung, verified with a second RN. I had previously explained that the pt has DVT in her right arm. The pt also needs abx but only has one IV access so I need to start a new IV. The second RN gets me all the IV materials and finds a good vein for me which ends up being in her right AC. I don't even think twice about because the other RN has more experience than me and I figure it's ok to use that arm if she says it is (1st mistake). In goes the IV and I hang the antibiotics. Now this whole time my dementia pt is yelling, needs a new Amnio bag, and my admission is now waiting on pain meds. Everyone else was tied up so I had to figure out how to handle everything on my own. I couldn't find my charge nurse for hours. My elderly woman's PTT comes back and I am on autopilot so I follow the protocol for Heparin drip rate change based on PTT....except I forget that this is her baseline PTT for the initiation of the drip and I don't need to do anything about it (2nd mistake) because this is only the second Heparin drip I've ever hung. A second RN comes in to sign off and verify the bolus and rate change with me. As I am giving the bolus the daughter states that it's her initial PTT and the dr didn't want her to have a bolus, which is true. We never gave her a bolus when I first initiated the drip. When the second RN came to verify the rate change she asked me if I was starting the drip and I said no because the drip had already been started so she assumed that this was just protocol as well. Miscommunication. Anyway, I call the dr to let her know I gave the pt a bolus by mistake (who said the bolus amount I gave her wouldn't really make a difference and it was ok), write up an incident report, and continue with trying to manage my other pts (meanwhile feeling guilty as hell the whole night). Later the daughter calls me in to the room to assess the pt because she thinks she is getting more fluid overloaded. I assess the pt and agree so I call the dr for an order of Lasix. Lasix ordered, no problem. The end of my shift all hell breaks loose. Every pt needs a new bag change of either IV fluids, Amnio or otherwise. My Heparin pt's PTT comes back at >150 so I stop drip for an hour and then reduce rate. I triple verified that before restarting the rate with second RN. Then during shift change the day nurse and daughter notice the abx bag is still full and I know for a fact that I saw the pump say secondary infusing but apparently the clamp was still shut so it appears that I actually never infused the abx (3rd mistake?). Finally, I realized my new admission had an order for a 1:1 sitter as well and call to get it D/C'd because I wasn't given any indication of that in report and he has been fine since arriving on our unit. The Resident says he thinks the admitting dr still wants him on it and I have no freakin clue why! To top it all off my new admission has an order for a pain med he is allergic although I did verify with the Resident who said it was ok to give. Overall, I feel like I just couldn't get my stuff together this shift and most of my mistakes happened with one patient. I honestly feel like I was burned out from having to work every other day for a week straight and then I had a pt whose acuity was just too much for me that night. On top of that my dementia pt was yelling and extremely rude and disrespectful to me the whole night. I know he has dementia but it still sucks being told "You need to come when I call you" OR "You're not moving fast enough otherwise I wouldn't have to yell Help so many times". I just wanted to curl up in a ball and die. I mean how many mistakes can one make?! And it's simple stuff that I just didn't think to ask about because I felt like if I keep asking questions I'll look even more incompetent. I should have just asked ALL the questions. Like the DVT in the arm. I only later had the thought to put a limb restriction band on the pt but that was AFTER we put in the IV. By the end of that week I should have called out or something because I was not able to think clearly. And I always have trouble with IV bags running out before I can switch them out. The thing that really blows me is that I set an alarm on my phone for when to change out the IV bags and they never went off when they were supposed to. I'm just so disappointed in myself and my lack of critical thinking skills. I'm also disappointed in that fact that I basically made sure that this ICU nurse knows I'm incompetent. I mean it was the absolute worst feeling of my life having to leave the floor and not being able to make eye contact with her. I don't know if I can handle this type of stuff anymore.