dlcj

Shhhhh.....! Stop. Like others have said, no harm came to the patient. Yes, something COULD have happened. But nothing did. All is well. Except for the excessive self-flagellation. I'll bet the charge agreed that you shouldn't work extra shifts right now because you need the rest--NOT because you are a bad nurse. Every single one of us has missed something or failed to do something ordered. It is a known hazard of being a human being, and don't think the organization doesn't realize that. Missing Q1 VS is apparently easy to do, so this can also be chalked up to system failure. I once missed the significance of an already-tachycardic patient (had been in 130s since admission) jumping to 150s for 2 hours before the charge found it and we worked to correct it. Did I feel like absolute crap? Of course I did. But my manager said to me--and she was absolutely right--"You'll never do that again." She didn't mean it as a rebuke; she just meant I learned this hard lesson really well. So stop beating yourself up--it won't help you. Go back to work, hold your head up, do your work, and I'll bet that you become the most conscientious q1h vs nurse they've ever seen. You're a good nurse. We need you. Back on the horse.

I have always carried malpractice insurance on my LAc.

You can report anonymously. You should have a corporate compliance hotline, and those reports do not have to have a name attached to them. When I was a new nurse, I became sick on the floor. I left a number of times to vomit and tried to come back to work. When I started having diarrhea, I knew I wasn't going to be able to cover the shift. The charge asked me if I wanted any Zofran. I asked her if she had any, and she replied she would find me some. She took me to the Pyxis and started scrolling through patients. I asked her what she was doing, and she said she was going to "find" me some po Zofran. I said, "This conversation did not happen." and I left the med room. I told her very soon after that I was going to have to go home. She was very angry. She targeted me for months afterward. If you report her anonymously, chances are the management will start watching her Pyxis pulls and her habits. She has a number of bad habits, so she will call attention to herself on her own. But to ease your guilt (this isn't your fault, by the way), be proactive.

Opinions and stories, please: I am a fairly new RN, just about three years now. I started on Med-Surg and went to the ED just about a year ago. I have a BSN and graduated in 2010. I started in healthcare as an acupuncturist, earning a Master of Acupuncture degree in 2002. I was in private practice up until a year ago. For a number of reasons, I have decided to go back to school to become a nurse practitioner. I think I would also be able to practice acupuncture under my acupuncture license as a nurse practitioner, and that is what I am going for; to be able to make these two jobs into one so that I am not so fragmented in my professional life. Would like to know if any of you either are LAc/RNs or know of any and how that's working out for them. Think there might be a future in this?

Stop making stupid mistakes (a COUPLE of times?? How do they know you'll never make that mistake again? You did it more than once already!), stop ******* people off, and think a lot less about your self-esteem than how damn dangerous they think you are, apparently with good reason. Whoa. Stop right there, GrnTea. Your first comment: very helpful. Informative, insightful, etc. The vitriol of your second comment, however, completely undoes the good you did with the first. This new RN has come here, hat in hand, very honest and vulnerable, bravely asking for help and advice. What you offered is basically verbal and emotional abuse. You know what? What you say MATTERS. The energy you put forth in the world with your intent and your words has an impact. Seriously, you never made ANY mistakes? From your comments, I am guessing that you have, and that you were even harder on yourself about them than this new RN. This is more a conduct issue for me than the use of the word *** in an earlier post that offended someone. Just sayin'.

IndiCRNA, What is the name of that college you are referencing?

GrnTea, Yes, this point is well taken. I actually prefer to use correct terms and explain them. So I am in the habit of saying "anticoagulant" to patients, and not "blood thinner." I do explain it in terms of clotting, etc. I did, however, think that platelets or plasma might actually add bulk to the blood, and that is clearly erroneous. Much better to think of it in terms of presence and quantity of clotting factors.

OCNRN63, Um, yeah. Thanks. (Not.) Read what I said earlier about the value of "not berating." You see, I am in the future ALSO, and I well see the error of my ways. No need to bring that back to the fore. I will take care of the flagellating, thanks. And also note that I started second-guessing myself well AFTER the orders were said and done. And it turned out to be second-guessing. I did everything correctly, as it happens, and just suffered a small attack of insecurity. To me, this is not a reason to discuss anything with my department or report myself to my manager. I do know enough to get clarification at the time orders are given. I read back EVERY order EVERY time, no matter how impatient the doc is. So glad to hear you "always wonder" about people using this forum to check things out after the fact. The thing is, much learning actually happens this way, moral judgement to the propriety of same notwithstanding. If you care to educate me, love to hear it. If your aim is to have a free slap at my face, we're done here. To everyone else, thank you again.

Oh, man!! RIGHT?? He gave me the orders during assessment/med pass, and I said, "So, will you be putting the orders in, sir?" He said, "NO! That's why I'm calling you!" arggh.

Excellent. Thank you. And your gentle admonishment is noted and well taken. I will cease thinking of blood as either "thick" or "thin". Thanks again, all of you. You put my mind at ease AND educated me. Much better than simple berating, which is all to common in nursing.

So, FFP is used to lower an INR, then? Makes the blood more viscous? You guys are great. Thanks for the support.

Thank YOU!! He did specifically say "FFP". I did order "Set up FFP". I'm good here. Next time I'm there I will check it out on our system. *whew*.

Started freaking out about this at home. Of course, I didn't think about it when I was ON SHIFT. Had a lady scheduled for a colonoscopy today. Her INR was still pretty high, so I got a telephone order from the physician (who wanted me to enter the order) for Vitamin K administration--no problem--and to transfuse 2 units FFP if her INR was greater than 1.8. Her INR came back 1.36, so at least this won't be an administration issue. I put in the orders for "FFP" in our system, but now I don't know if I ended up ordering PLASMA or PLATELETS. I could find out, of course. Someone please tell me, is it plasma or platelets that would be used to LOWER an INR? Is it too late for me to go back and correct the order if it is entered incorrectly? HELP!