I used All Nurses throughout nursing school. Since I have become a nurse, my visits have not been as frequent. I read a recent thread and the many supportive responses to it and realized that what I'm feeling would be best received by all of you, so I decided to write this.
I began working at a level 1 trauma center in the ER as a new grad RN last October. I had worked (and still do) EMS 12 years prior so I felt that the ER would be my home. Now....now I'm not so sure how I'm feeling. I feel that this learning experience could not be topped by another facility. The vast amounts of things that I am exposed to will make me a better nurse one day. My biggest problem that I had when I started, and that I am still having, is prioritization. So my question to you all is this-how do YOU prioritize? Some things fall out of the Maslows Heirarchy of Needs and ABC's categories.
It is currently trauma season, and discharge is a priority at our facility. We often hold patients for long periods down in the ED. There are times that patients are down-graded and discharged after being admitted and they are still waiting in the ED because there was not a bed upstairs. The minute your patient is up for discharge, your room is automatically double-booked. So now you have one to discharge and to prepare for a new one. The new ones sit in the hallway until the room is clean. But I can't just NOT see my new patient just because the room isn't clean yet! My discharges are rushed, if it gets too involved I find myself panicking because I'm not getting rid of my patient fast enough and I already have new orders put in on the new one. We are so short that we often have 5 and 6 patient teams (common, I know). But I don't feel like I can practice safely. I cannot give adequate attention to that many people at one time. And if someone asks for a blanket, water, or a bedpan, my thought had become "this is going to take up so much time, I have so much to do". There was a shift I had two vent patients and an additional 3 patients. Both vent patient's BP's crumped and I was running around trying to titrate drips that I was clueless on how to titrate properly. Last Sunday I had three patients get clean rooms at one time. We have 20 minutes to call report and take them upstairs. I was immediately double booked and hadn't even called report yet, let alone taken them upstairs. I then had three new patients waiting in the hall looking at me wondering why I hadn't spoken to them yet, and three to take up. And of course, a nurse must travel with anyone who has telemetry ordered. In my rush, I saw an order on my screen and all I saw was "K". I hung a run of KCl. While on the phone with the receiving RN, I realized that the order was for KPhos, not KCL. I immediately stopped it and notified the admitting MD. I know no harm was done, but I also didn't benefit my patient. So, I ask you, when things get crazy, how do you do it? I'm just feeling very dejected and like I'm sinking. My co-workers are helpful. When they have time. But to be realistic, there are times it gets so busy that it's very nurse for herself (or himself). I do feel like I improve every time I go back, but it's the getting back part that's hard. I know that I have made huge improvements from my first day on the floor. It's just that some days I'm not so certain that patients are actually benefited because I was their assigned nurse.