ljgonz

Thanks to everyone for the support and advice! I feel a lot better now it's been a few days after that night. I also talked to my old preceptor about what happened and found out that the patient was discharged and was fine. I still have a lot to learn but every experience I have (good, bad, and terriable) will just make the next easier to handle. Thanks to all who responded, your words and encouragement have really helped :)

Sorry but this is gonna be long.... I just graduated in may and started working in a whole new state and new hospital at the end of aug. It's a PCU. I've never had a tele or cardiac rotation in school but thought this floor would be a great learning experience for me. So I started Orientation on the floor in september and already I'm on my own! I had my second day on the floor by myself last night. I felt extremely overwhelmed and scared during orientation, but my preceptors have told me that I'm doing well and I just need more confidence. So after just 6 weeks on the floor I've been let loose. I didn't feel ready to be on my own but I figured I just neeeded to suck it up and do it. So my first night alone was okay.... I only had 3 patients (4 is average and 5 is the max for nights on this floor). I got everything done and got out on time even though I was nervous. The second night I had the same 3 patients plus one more. Apparently two of the patients that I had had the previous night had some respiratory distress earlier but were doing ok now. Of course I checked them both out right away to make sure they weren't in distress and to see if I needed to call the doc's right away. They were fine, but I still felt pretty overwhelmed because there were a lot of changes and new orders from the previous night. We were short staffed and they tried to give me a 5th patient. Even during orientation I never had 5 patients! I refused and luckily another nurse volunteered to take the extra patient. So I was really busy all night, one patient was very confused and kept trying to pull out lines, o2, getting out of bed, (very unsafe) so I had to put her in restraints, another confused pt had a critical K level of 2.8 and refused oral K so I had to give it IV, he kept picking at his one good IV... I had to reorder K with lido... that took forever to get done. Another had a PCA and I had to check neuro Q2 hrs. Another had a low phos leve and I had to get that replaced. The pt I had to restrain somehow got out, got her O2 off and was anxious and sob. I went in immedietly, put the o2 back on, checked her sats (which were 85 on RA but came back up to 95 with O2), calmed her down, restrained her again, and gave her prn xanax. After that she was resting comfortably. At 0645 I felt like I was almost home free. I still had charting to do but the day nurse who was taking my pts already had come in to get report. I gave report and felt like I actually was able to handle the night on my own when I get a call from the desk that the restrained and confused pt is in SVT with a HR in the 170's. The day nurse and I run in and luckily the other night nurses are already at work. Her HR jumped up to the 240's, they were pushing amioderone, cracking open the crash cart, putting the pads on her....... All the while I felt like a deer caught in headlights. I was just stunned and didn't know what to do or how to even help. This was MY patient for crying out loud and I didn't know the first thing to do. Someone else called rapid response, other people were taking all the vitals, and recording times for the amioderone. When rapid response came they were asking me all these questions I didn't know! I felt like I didnt even know my own name at that point! I ran and got the most recent labs, and all the meds she was on (I only knew the meds she had on my shift). They were asking who her cardiologist was and all I could say was "I don't know". She had come in with renal failure and decreased LOC so she didn't have a cardiologist. The other nurses were telling me to call the doc and tell him what was happening but again.... I was a deer caught in headlights. I was just frozen and couldnt move. I didn't even know what everyone was doing and exactly what they had given. There is an emergency standing orders class that I take in 6 months... so after that I'll have more of a clue but right then and there I was just ready to cry and felt helpless and useless. Luckily the day nurse I had given report to took over and called the doc and everything... But it wasn't even 0700 yet, what if she hadnt come in early? I dont even want to think of how I would have (or not) handled it. The woman was stabelized and put on a cardizem drip. The day nurse asked me to write a narrative about everything that happened during the night with the patient. I wrote it and was trying to figure out if I had dome something wrong or had missed something and that's why she went into SVT. She had been a little hypertensive all night (bp in 140's 150's) but that wasn't unusual for her so I never called the doc about it. Her rhythm was NS with rare pvc's... again all normal for her. I came home and cried for an hour after. Maybe I didn't miss anything and she would have gone into svt regardless... but I'm so upset and angry with myself for not knowing simple questions about her during the situation... like who were the consulting docs, her labs, her daily meds. I should have had a clue! And then I couldnt even call the doctor! I was just so scared. Thank G_D the people I work with came together and handled the situation, because I obviously couldnt. Anyway, I don't want to go back to work. I'm embarressed and scared. Maybe I should have started on a less acute floor. Maybe I should have listened to myself and stayed on orientation. Well I'm just venting over here. Any advice, tips, ect, would be appreciated. I think I need a new floor with a longer orientation. I want to call out of work because I just don't feel ready to go back.