DreaRN80

The pt was very lethargic, almost stuporous and suddenly he became restless, HOB was always elevated, I noticed he was pulling at his NRB and his sats were dropping before he really tanked and I was suctioning more often...if memory serves his GCS on arrival was 12-13, in no condition to self-suction...NIHSS upon arrival was 18-19 and quickly deteriorated to 23. A pt like this is supposed to be 1:1 but I'm sure you know how that goes...Thanks for your encouragement and words of wisdom!

Thanks for all the great insights and encouragment everyone!!!! I'm not giving up yet! I accept this will probably be the hardest year of my career but I'm just going to keep learning and keep asking questions. At least I feel better than I did 5 months ago when I first started and lately I've been getting more and more highly critical pts...just more and more learning experiences!! And I still love it!!! Thanks everyone!

Hello allnurses community! Love the postings here! I'm a new grad and have been working in the ED for 5 months now. I had the worst night ever! I had a pt with CVA who we ended up giving tPA. However, as the night progressed post tPA administration, the pt's respiratory status seemed to be deteriorating. The pt began to desat, his RR shot up, the pt became more and more restless and agitated, and suddenly the pt became extremely diaphoretic and had audible rales...he ended up with aspiration pneumonia d/t dysphagia. When the pt started to desat and I noticed I had to suction him more and more often, I had asked the ER MD multiple times to come take a look at the pt, only to be told to put a NRB on the pt. Well in the end, we ended up having to tube the pt and it took another nurse to yell at the MD to come in and take look! I'm so frustrated. First of all, does anyone know of a good way to prevent these types of complications post ischemic CVA? I've been searching journals and haven't found much. But the bigger issue for me...is it normal for new grads to feel the like the dumbest nurse that ever came down the pipe when things like this occur? Is it normal to feel so incompetent when other nurses have to "take the reign" of your own pt? I totally feel like I could have done more to avoid these complications but I don't know what. I know I have my lack of experience working against me, but I hate feeling like this. My charge nurse was extremely supportive and told me not to worry that we all [meaning all ER nurses] have been where I am now in a hot mess and sometimes things like this just happen no matter how proactive you try to be. I just feel like I have a few good days where I just start to feel confident and then WHAM! I get a curve ball like this thrown at me. I probably shouldn't take it so personally but I honestly just want to give the best possible care I can to all of my pts. The new grad period of a nurse's career is so littered with ambiguity and uncertaintly. I watch other nurses I work with and they seem so confident and orchestrated. Will I ever reach a point where I will be just as confident? Help from other new grads and experienced alike please...and thank you!!! All pointers/criticism/advise welcome!