Yenta7

Hi guys! I was looking through this board and realized that last reply was a while ago. I'm still looking for recommendations for good hospitals/clinics to apply for in Washington State. Any changes to the previous recommendations? Thank you!

One night, I had a pt who was very confused and disoriented. At one point, I wanted to see if the patient wanted assistance back to bed: "Sir do you want me to get you into your bed?" He replies, "I'm gonna report you! I'm gonna report you for propositioning me!!!" That definitely helped temporarily take my mind off my frustration. Hehe

Oh yes. I'm starting to learn that Nursing has a tough way of teaching you how to do things. ^_^ Thank you.

Thank you all for you wonderful replies-even the blunt ones ^_^. I had a long talk with my supervisor and one of my charge nurses and actually, the talk was mostly spent on sharing my feelings about the issue and them sharing their own experiences with their errors in the past. In the end they told me exactly what a lot of you'll told me. Mistakes happen in this field and all we can do is learn from them. Thank you all again for your wonderful comments. They really helped me work through this issue and really learn to be more productive about my mistakes.

Thankfully the pt was ok and the md was already made aware. From what I understood from my supervisor, no one nurse is being fingered for the issue. As she said, three other nurses missed the mistake so it can't really be blamed on anyone person. If there are any other updates, I'll let you know. ^_^

Has your common sense ever gone out the widow at some point leaving you wondering when the stupid stick hit you afterwards? During the graveyard shifts, the staff nurses/lpn along with the charge nurse are in charge of doing 24 hr checks on their pts. This ususally involves going through all the pt charts, ensuring all the orders for the day are done and all the labs for the next day are ordered. All the orders for each pt are written in their invidual kardex's. Each Kardex is basically a handy guide utilized by all the charge nurses to keep track of all pt information and their individual orders including things like IV fluids. Usually, the charge nurse will go through each chart on the ward and order any labs for the next day and write down orders into the kardex. The staff rn/lpn in charge of the pt will also do a reconcilliation for their pts-writing down all pt orders and ordering anything the charge nurse misses. Anyway, I was reconcilling one of my pt's charts. This pt had been admitted during the swing shift. I noticed that in addition to the IV NSS order there was an order that said "IV Heprin per protocol". In my mind all I could think of was "hm, heprin's really important. they couldn't possibly have missed this. The heprin was probably d/c'd at the clinic" So instead of informing the charge nurse, I assumed the order was d/c'd. In the AM, as I was getting ready to leave. The charge nurse suddenly leaves the report room and says, "---- , there was a heparin order! Did you notice it in your 24hr check?" At first I was confused. I told her, that I had assumed it was d/c'd. Long story short, it wasn't. The nurse in the swing shift had not endorsed to us that the pt was supposed to be on a heprin drip. In fact, the pt drip had never been started! The charge nurse said that she herself had not looked at that chart and therefore did not know about the drip until she was doing report. Thankfull nothing was wrong with the pt and his cardiac labs had been decreasing since he was admitted and he had been fine. Anyway, after ensuring pt safety and ordering stat pt/inrs and heparin iv, my charge nurse wrote up the incident report. In the report she mentions my name- to what effect I'm not sure-but I think it might have been as a witness. I know your probably all looking at me like I'm an idiot. Don't worry, I feel like I am. I have NO idea what I was thinking at the time! I've been getting better and reconciling my charts. I'm usually pretty good at catching things that get missed but that night-holy crap I have no idea where my common sense went too. I was really hit hard by the stupid stick I guess. In fact, if anything is d/c'd it would say "d/c so and so" if it had been the heparin it would have specifically said "d/c heparin." I swear I just wasn't thinking about this at the time. My question is, I know I share the some of the blame for not realizing what I was reading, but who's fault would this actually be? Mine soley? My charge nurse for not reviewing the chart herself? or the charge nurse from the previous shift?

Actually, this was in reference to a previous post. I've realized why she was irritated in the first place actually and have made it a point to sign my MARs after I give my medications, no matter how "busy" I feel. In fact, this really isn't a problem for me anymore. I've gotten a lot better at ensuring all my MARs are signed as I do realize (after my first post) how much of a potential it can be for a med error. I suppose I mentioned it to demonstrate my concerns.

Hi everyone, it's me again. You guys were great in helping me out before, I decided to come back again. Let me start from the beginning. During my first week on my own (following my orientation) my first three days were a nightmare. On my frist day, m pt coded. As a result, I finished late and was not able to finish signing off my MAR and my IV administration records. The incoming LPN just calmly reminded me to sign it. The following day, I got busy again and I again forgot to sign the same forms. On my third day, one of my pt's coded and I spent the whole shift trying to deal with a delirous pt who eventually pulled out his permacatch. Again I forgot to sign off on my MARs. This time, the same incoming LPN, began to give me attitude. She literally "gave me the hand" as they say, when I went to apologize to her. Still, I said to her, I'm really sorry, I'm still trying to learn how to deal with things during the shift. After that, she suddenly winked at said, "that's ok" as if she had never gotten angry in the first place. My realtionship with her was strained at best. It always felt awkward talking to her, and I always felt as if I was making a complete idiot out of myself. It felt as if everytime I forgot something, I swear she was always my incoming nurse! I didn't blame her for being upset, but at the same time I eventually STOPPED trying to talk to her. Yesterday, things were going relatively well. I had some crisis' at the end of the shift, but I thought I had managed to get things done fairly well. During this particular shift, I had a pt on a chest tube. The chest tube had come out during the previous shift, and the chest tube suction had been switched to an external suction Throughout the whole shift, the chest tube was drainin.g well, and the pt only complained of minimal discomfort to the insertion site. On two occassions, he requested his morphine, but immediately recovered after it was given. His sats were good, his breathing regular and his chest expension equal. The dressing at the insertion site was also dry. As the shift was coming to and end, I had some minor issues, but I (suprisingly) was able to deal with them. As this LPN was coming in, I greeted her warmly and asked her if I could resite one of her patients. She laughingly said it was fine my her. We both got our tasks done and had a fairly light conversation. After I resited my patient, she suddenly came into the room, asking me why my other pt's chest tube was clamped. Confused (and frantic) I said, "clamped? but it was draining all shift?" She asked again, why is it clamped? So I checked my pt, and sure enough it was clamped. Confused, I tried to remember if it had been clamped during my shift. I frantically told her, that I wasn't sure if it had been clamped during my shift, but I was sure it had been draining. At one point I even assumed (in my what I call "dumb panic") it may have been clamped because the suction was changed to an external one. However she calmly informed me that the whole system would not work if the tubing was clamped (I know, I know you're all probably wondering if I was hit by the stupid stick to many times-but I seriously blanked for a second) then walked out. Kinda freaking out at that point, I called my charge nurse who then calmly unclamped it and said the tube may have been clamped by accident when the pt was walking around. By then though, my confidence was shot out the roof. What made it even worse was that I saw the incoming LPN asking my charge about the pt's status. I heard my charge calmly tell her, that the chest tube was draining the whole shift and that the pt was ok.At one point I overheard this LPN say, that I had missed an IV resite (we have to resite pt's every three days) and looking over, I saw her give me the same dirty look she gave me that day I forgot to sign my MARs. I suppose I should have spoken to her, but by then, all I wanted to do by then was crawl into bed and never come back. I swear I felt as if I had a big red letter on my chest signifying to the world about what an idiot nurse I was. As I was going to my locker in my lounge, I realized the same LPN was also coming into the lounge. I barely even looked at her and didn't really chat with her as much as I usually tried to do. As I was putting my things away and she began making coffee, I heard her jokingly say to me, "I can't work without my coffee" I sorta laughed (suprised), but then she walked out before I could really talk to her. Now I have to go back tonight and work graveyard with her. I've been really trying to prove myself but now I have a feeling it's to late for me to prove myself to her. I know she's only one person and I can't please everyone, but I've seen how the nurses there talk about other nurses with bad habbits or who are not dependable. In hindsight, I could have done a lot of things differently. I've only been working at the hospital for a few months (three by the end of Feburary) and this is my first job. Can you guys give me suggestions on how I can "re-prove" myself to her and to the other nurses?

thank you all for your wonderful posts! Your advice really makes me feel like I can do become a great nurse someday. It also helps me realize I'm not alone in my experiences. thank you! P.S. HAHA, your right about the spelling error! ^_^ That's what I get for posting without checking everything.

I've started working at a telemetry ward in December-this is my first nursing job since I graduated. This week was the first week on my own. During my orientation, I was a little slow, but generally I think I was successful. Now that I'm on my own I'm encoutering all kinds of problems. During my first day on my own, one of my pt's coded. She had a history of "faking" symptoms when she wanted attention. At one point I had the charge nurse check her, but the charge nurse said she still looked "good."It was only when she started to becoming diaphoretic that I really realized there was something wrong. According to the another nurses, she had had a bad a history and was already heading down hill by the time I got to her. Still, I can't help but feel if I had just been more attentive to her I would have realized something was wrong earlier. When I told this to my supervisor, she just accepted it and didn't reprimand me. She also told me that the pt was already unstable. A day afterward, one of my pt started having severe CP. After talking to her incoming nurse I gave her NTP and her bp meds. When she was still having unrelieved CP, I gave her NTG (her sbp was around 165). When she was still having unrelieved CP, I gave her a second dose of NTG (her VS were still stable). Within a few seconds, she suddenly bottomed out. During the code, I felt like I was sweating bullets and I didn't know what to do except get her up, increase her O2 and arouse her. We stabalized her and she was oob within the next hour. I talked to the charge nurse and she stated that the actions I took were correct and that some pt's were just more sensative to the effects of Nitro more than others. Later that night, one of my disoriented pt was put on restraints because he kept trying to pull out his tubing. I warned the family that even with restraints he was still at risk for hurting himself and he needed a 24hr watcher. The family left anyway and I spent most of my shift trying to make sure he didn't fall or pull out his foley. Before my shift was over, he pulled out his permacath. Basically, I was late with everything while another nurse managed to finish all her tasks, and still show me how to do a task I had never done before. During teh change of shift, the incoming nurse was giving me attitude because I hadn't signed off on all my meds on my MAR. Grant you I've been late to sign things when I started on my own, but I've been doing all the things I needed to do during the shift. Last night was the first time I felt like crying. I'm so frustrated and I'm scared that I'm to dumb to be in nursing. I did well in school, but now I'm scared that passing was a horrible accident. I'm feelin naseated and I really don't want to go back to work. Am I to incompetant to be on this floor? I've talked to my supervisor and so far she's telling me I'm doing fine. From what I've gathered from the other nurses, what I'm feeling is perfectly normal for a newbie. Still I feel like I'm fumbling around and depending to much on the opinions of other nurses. Not to mention, I feel as if the other nurses feel as if I'm not good enough for the floor. What do you all think? I know I'm whinning and I'm probably to sensitive but I don't know who else to turn too.

Please help! I'm scheduled to take my exam soon and I still can't find questions on delegating to other RNs. I've been using Saunders and Kaplans, and while they have several questions on assigning patients to LPN/LVN they don't have any guidelines for which patients to assign to say a nurse whose floating on another ward. I remember there was a presentation done at the NSNA conference that did featured a question like that. In the question a charge nurse on an OB ward had a nurse floating in from the telemetry ward. In the question the charge nurse had to decide which patient to assign her too. I remember (vaguely) that the rule for that question was to assign her to a patient that was similar to what she was used to (I think it was a patient with Pre-eclampsia on Mag Sulfate or something) since she would be more familiar with the symptoms. So my question is, are there any other rules/guidelines for assigning patients to nurses floating in from another ward?