CYMBALS

At the end of your shift, review all the new orders during your shift and make sure each one was filled (lab tests ordered, new or changed medications on the mar correctly, etc.). Don't trust that the pharmacist/pharmacy filled the medication order correctly. I once had orders to start a patient on a new medication stat, and then receive the medication every 12 hours. I gave the stat dose of the medication, but then forgot (on a particularly hellish shift) to check before my shift ended to make sure that the pharmacy filled the q12h order. Well, the pharmacy screwed up and never put the q12h dose in the MAR. The nurses after me didn't realize the patient had been ordered the new medication. The patient ended up not getting the medication for 3 days before the doctor asked after her condition worsened, "isn't this patient getting this med?" Now before I leave, I double and triple check that new orders are filled correctly. Also, our manager now makes all nurses do a chart check at the end of each shift and it must be signed by two nurses. You would be surprised at how many times we find errors. I still feel horrible for my mistake.

I just wanted to say that I think you're making a smart decision by leaving. Your manager sounds horrible. You might consider turning in your letter of resignation before she has the chance to fire you.

You're not a failure! Don't be afraid to try out new areas...you may be surprised. Also, liking who you work with makes a huge difference in your job enjoyment. You may end up loving the other nurses in the telemetry unit, and with your ER experience, you'll fit in well. Whatever you decide, though, I just wanted to wish you luck.

Hi, I'm a recent graduate nurse with a little less 6 months experience on a busy telemetry unit. I was pulled aside by the nurse manager yesterday and made aware of an incident that involved the infiltration of one of my former patient's IVs. The patient was on a narcan drip for an opioid overdose. I feel horrible about the incident, and can't stop going over and over on how I missed this. I'm so confused about what happened. Here's what happened: I was on an overnight shift and picked up the patient from another (ICU trained) RN at 11PM. The patient had overdosed on opioids, and was now on a narcan drip. In report, I was told the pt had not had much response to the narcan (including several boluses earlier in the day) and was obtunded. Additionally, I was told that the pt's upper extremities were puffy and skin was taught. The nurse attributed this to the amount of fluid the pt was receiving (narcan drip plus additional IVF Y'd together). The fluids were entering through an peripheral site in the pt's right AC. I did two formal assessments of the pt at midnight and 4AM, and I did 15 minute checks on the pt throughout the shift. I observed that both of the pt's hands, wrists, and arms were puffy, and questioned the cause. However, I did not observe redness, coolness/warmth, or swelling localized to specifically the IV site. Around 6:30AM, at the end of my shift, the pt's ABG results came back and were worse than they had been on the previous day. I contacted the pt's physician, who had me give the pt a bolus of narcan. When I gave the bolus, it pushed and flushed without difficulty. Several minutes later, the pt awoke and became combative, resulting in restraints. The pt's IV had become dislodged during this episode. Initially, I thought this may have been when the infiltration occurred. However, my nurse manager said that she was told that it appeared that the IV site had been infiltrating for at least 3 hours. Sorry this is so long. I'm just so confused. Obviously, I need to have a better understanding of IV sites. Can anyone please offer me insight into what happened?

I've been an EMT for over 4 1/2 years, and an RN for 2 months (just graduated nursing school in May). I'm currently working on a telemetry unit, but EMS is my heart. I work as an EMT on my days off. Everyone's encouraging me to get my PHRN cert. I've been told that I can just take the state written exam, but I wouldn't want to work as an ALS provider without the proper training first. For other PHRN's out there, how did you achieve your cert and prepare yourself to work in the field? Any suggestions or advice is most welcome. Thank you!

I was in this same situation myself, until I had a miscarriage at 16 weeks. I had accepted the position in February (while still in school), and was 6 weeks pregnant when I began my first week of work in June. I had planned on waiting until the 2nd trimester to announce the pregnancy to my supervisor. However, I ended up having to tell my preceptor and several other nurses when they would ask me to assist in a room with a shingles patient. So I just let word spread, with the intention of talking it over with my supervisor during the early weeks of the 2nd trimester. Unfortunately I had the miscarriage before I ever got a chance. When I told my supervisor I miscarried, she was very supportive, and had already learned of the pregnancy. You're human, and you're allowed to be pregnant and have a life outside of work. Don't let anyone make you feel bad about that! Chances are, they'll be supportive of you. Make sure you take care of yourself, and try to keep the first year in nursing stress down. Good luck & congrats.

Hi Healer, Your preceptor sounds like she could be a twin sister of my preceptor. I actually just started on my own, but before that I ALWAYS felt like my preceptor hated me. She would get annoyed with my questions and ignore me when I needed her help because she was too busy flirting with the cute male charge nurse or talking to friends on the phone. Then at other times she would say (in an annoyed tone) "Have you done this yet? Have you done that yet." I put enough pressure on myself, but her pressure at times was just too much. I have worried often (and still worry) that everyone on the floor thinks I'm the stupid slow nurse. It's very stressful, and probably not very constructive. You're smart to keep a positive attitude in front of your co-workers (I tried to do the same myself). People will warm up to you, give them time. I always remind myself that in 6 months I will feel differently, and if I don't, then there are other options. Keep you're chin up. You worked hard to get here, and you've been successful so far. This too will come in time.

I too find it a relief to know that I'm not the only one feeling like I can't keep up. I can start out a shift on top of things and keep up with charting, but then something unexpected happens, and then it just snow balls. I feel like I'm constantly putting out fires. I have gotten better at keeping up with charting, but it's hard when you're patients needs come first. It will be an hour before the end of my shift, and everything will suddenly go to sour, and I end up having to stay late to chart the events of the last hour. I dread going to work, and constantly stress that I won't get out on time. I will give up every break, just so that I can make sure I get everything done by the end of my shift. If I have to stay 15 or 30 min late to finish charting, I worry that I'm going to get in trouble or fired because I'm too slow (and costing too much overtime). While advice from more experienced RN's is helpful, it can't make up for the inexperience. I just hate it.