Neuronurse88

I made a mistake and it's eating me alive. Would like to vent about it/maybe get some insight from other nurses... before I tell you about the mistake, here's some background. I'm a new nurse, I just got my license and started working in August 2022. I work on a neuro stepdown unit where we have 5-6 patients every day. I had five patients on Thursday and here is what my assignment looked like: Patient 1 - (not a neuro patient) came into the ED with shortness of breath and chest pain. She had orders for intermediate care and we were the only step down unit with an open bed. Patient 2 - stroke patient with major deficits. Likes to jump out of the bed/chair to walk to the bathroom or for some other reason every five minutes even though this patient is unsteady af. I'm in the room every five minutes because she has jumped up again Patient 3 - another stroke patient with major deficits. Patient 4 - fresh post OP spinal surgery from PACU Patient 5 - patient had bone and lung cancer and it spread to the brain. Patient had multiple tumors on the brain. This was making him confused and aggressive. He kept getting out of bed also and he is not steady and he is a major risk for falls d/t brain tumors. Bed alarm keeps going off, and that makes him agitated. He would yell and hit things. Also, getting him back in bed was impossible.... So on Thursday, patient 1, who is on tele, randomly converts to AFIB with RVR. Heart rate went from 60s to sustaining 130s-170s Drs paged, they ordered an amino drip and a heparin. I go to get those started. Her only IV has now infiltrated ? I start 3 IVs on her, so both the heparin and amino can have a dedicated line and then have a line open for other various medications she was getting. I start the two drips around 12:30, drew the APTT at 6:30pm. It didn't result by the I left so I told the night nurse in report that she should be on the look out for the result so she can titrate the drip accordingly. She didn't titrate the drip or draw labs all night. The Heparin drip was started at 12 units/kg/hour. I looked at the result from the APTT that I had sent down last night. It was 89. According to the order, the drip should have been titrated down. This was never done and labs were never collected overnight. I asked why labs were not collected all night and she said the patient is a hard stick.... At this point we do an APTT and it results as 39. I assume the low result was because the night nurse said that she paused the drip a few times for the intermittent antibiotics the patient was receiving... I made sure the patient had three IVS before I left so that wouldn't happen. Anyway, according to the order, we had to bolus heparin and then titrate the order from 12 units/kg/hr to 14. We did that at 9 am. So labs should have been done Q6 after the bolus. I start trying to get the lab around 2:30. I'm having no luck, patients veins are blowing, not giving any blood. After asking two other people, we finally got a blue top sent to the lab. Lab rejects it. They rejected it because they said I mislabeled the tube. I labeled the tube with the routine APTT lab that was ordered but I also put in a STAT order so lab would process it fast (they are ridiculously slow and this was an important lab) I put the routine lab on the tube and just put the STAT label in the bag. Because of the STAT label in the bag, they said the sample was mislabeled and wouldn't accept it. I didn't know that was a thing, I have seen others do it and it was fine. Lab rejected that sample and put in for a re-draw. After two nurses trying, we got another blue top and sent it down. Lab calls and says that can't accept it due to insufficient quantity. That tube was full... Lab puts in for another re-draw. At this point it's after 3:30. We are struggling to get blood off of her and the patient is tired of being stuck. Every time I came in the room she literally would say "please no more labs" I put in for a STAT order for an IV nurse to come draw the labs with the ultrasound machine. When I left at 7 pm the IV nurse never came. Therefore the lab post bolus and titration was never done. I am now overthinking it and feel horrible. I don't want to cause harm to any of my patients.? The drip was essentially running my entire shift without an updated lab result. I am sick to my stomach about this. Also I would like to add - when I got off Thursday, I went and spoke with the night shift charge nurse and asked her to please change my assignment for the next day. I told her I couldn't handle this group with 5 patients. (5 patients and four of them are Q4 neuro checks, two high fall risks that keep getting up, patient one had the heart changes and two drips were started. That same patient also kept having sugars from 400-500. When I left Thursday they were considering an insulin drip) I couldn't handle it.... And the assignment was not changed. I went and talked to the charge nurse when I came in on Friday and noticed it wasn't changed. She said "look at the assignment you have an orientee, that's why I didn't change it. The orientee can take patients" The "orientee" was a travel nurse who could not take patients, didn't have access to anything, and was trying to learn about the unit, how we do things, our policies, etc. she would also go MIA for hours at a time. I had the same assignment from the day prior, with no real help when it came to patient care, and I was now tasked with teaching a new hire. ?