Plantladynurse

Worried new nurse here, I have been a nurse for about a month at my job. I took care of an elderly patient yesterday who has been in severe knee and generalized pain. This patient had an order for PRN Tramadol and IV morphine 1mg. I administered the Tramadol, checked on pain an hour later and my patient was still screaming out requesting something else. I readjusted them, and went to grab ice packs since that worked before. My preceptor asked how the patient was doing and once I explained it was suggested to me to administer the PRN morphine. I explained that I just gave Tramadol an hour ago and if that would be contraindicated? My preceptor and another nurse agreed it was acceptable. I ask my preceptor to come with me - patients vital signs were within normal limits. I administered the morphine. I check back 15 minutes later - my patient is awake and sitting up but appears spacey and "high". I gave report to the oncoming nurse, my shift is almost over and we discover the blood pressure is 99/60, respiration's are normal. I know this reading is not incredibly low, but it was the lowest reading I've had from this patient. I do not feel that I used my better judgment. No one else seemed to be alarmed by the BP besides the CNA that took the vitals. I feel I made a major mistake. Why on earth would I believe giving two narcotics so closely together is acceptable? Is Tramadol and Morphine combined therapeutic? My gut tells me no, and I am so worried today. I have the day off and have no idea how my patient is doing. I feel that I failed my patient. I wanted them to be comfortable, and I did everything I could to provide that. I love my job. I would never want to put someone in harm but I feel I did not use good judgment. I expressed my concern to my preceptor after this and she guaranteed she will be fine. However, I am not only extremely worried sick but also confused about combining these drugs. Is this common?

I think that's a great way to explain it, and I'm going to take your advice. Thank you to both of you.

Hi, I have applied to LTC facilities and hospitals. Mostly all entry level positions. I would be happy to accept a position anywhere.

Hi everyone, I will try to make this as brief as possible but I am in need of either support or advice - I am feeling so lost. I was technically homeless throughout my 3 years of nursing school. I couch surfed and lived with boyfriends and their families to have a place to live. (I came from an abusive family and have little contact with them.) At this point I became very depressed and suicidal. I began to take antidepressants to stay afloat, while I accomplished this, everything else suffered. I was so depressed, I could barely care for myself but I dragged myself to class, clinical, and lab. My teachers/instructors began to find fault in me for not being as engaged. My depression became worse but I dealt with it the best way I could at the time. I kept everything a secret in fear of being removed from the program. I ended up graduating last May, powered through a month of non-stop studying and passed the NCLEX-RN on the first attempt. A month after, I was exhausted and my depression finally came crashing down on me. I attempted suicide. I was unsuccessful thankfully and was checked into a mental health facility for a long stay. Since then, I have been working on my mental health religiously. I have a therapist, I do not engage in any alcohol consumption, etc., I have a stable home life, I work out regularly, which has made a huge positive impact on my mental health. I have worked hard to change my mindset. Fast forward to now - I have been seeking employment and have applied to over 60+ positions and none have worked out. I am getting close to my year mark of graduation and I feel like I may never find a job. I am terrified for my future. During interviews, I have been asked "Why do you think you haven't found a job yet?" I don't know how to answer this question, but I feel I can't be completely honest about my situation. In school, I worked part-time in an ICU and never had any complaints about the care I gave, work-ethic, etc. but that I would call off often. The only good thing I have going for me are my compassion and dedication to patients in my care, my co-workers also praised me on how willing I was to always help. I have won multiple patient satisfaction awards with past employment - but my references aren't good from my supervisors because of call offs and tardiness. This downward spiral took place all over a course of 3 years, These consequences are my own fault but I am in a much better place and cannot seem to rid myself of my past. I know what it takes to be a nurse and to be apart of a team. I know that my past reflects on my mental health and not who I want to be as a professional nurse, but I fear I may not get the chance to prove that. Any advice or words of encouragement is greatly appreciated, I feel so stuck... Thank you for taking the time to read.

Yes it shows last employment date. I'm not sure if it shows if the worker was terminated or resigned. That's what I fear.

Long story short I am in a temporary position working as a CNA before I take the NCLEX-RN (1 month away). I have 2 years experience as a pct and accepted this job as a cna at a Ltc facility. My employers were on board that my position was temporary. This position is more hassle than it's worth, I see too many things that CNAs are doing wrong that I fear will jeopardize the residents safety (pulling their arms to turn them, pulling diapers from under residents instead of log rolling) the nurses ignore red flags (GI bleeding, bladder distention), I have to get patients up alone who are high fall risk, and things I have mentioned to the nurses and they have blown off. I feel this place is a lawsuit waiting to happen which for obvious reasons I want no part of. I have mentioned my concerns to nursing staff and nothing has changed. Here is my question: Today was my final orientation day, I am supposed to be back tonight for the NOC shift, but l I don't want to come back, I want to run far away from this place. I have already written up a letter for HR, but my fear is that future employers for an RN position will see that I quit on the state healthcare registry. I feel my CNA certificate is in jeopardy working here and I don't know if I can stand to be here another night. I know its unprofessional to leave at such short notice, I am so confused and just don't know what to do, I've never just quit a job so quickly and I've just never wanted to run so fast from a job. I'm sorry this is so long and if I am misinformed on anything. I'm genuinely just concerned for patient safety as well as protecting myself. Any advice is greatly appreciated.