MissEm

We've all made mistakes; I can't even tell the list of stupid calls I've made because the list is so long. Anyone who says they haven't is a liar, plain and simple. I bet you'll think about it closely next time! Just make sure to learn from it.

Azithromycin hurts if run too fast. Usually slowing the infusion helps a lot!

Well, what was the heart rate? How did the patient look? What was their history? If your patient was bradycardic with no high blood pressure, you would've been okay withholding the medicine. As for me, I've given it without tele and monitored their heart rate and blood pressure closely. But hey, get a tele if you're worried! No one can blame you for wanting to be as safe as possible.

I received a call at home today from the House Supervisor. Apparently, a patient complained that I "came into her room, gave her a shot, and just left without saying a word". She is now complaining of weakness in her legs and generally "not feeling good" since she received the shot. I'm baffled because I feel like I'm dealing with a "guilty until proven innocent" situation here. This patient is partially blind, a diabetic, with chronic anemia related to chronic kidney disease. Her blood sugar was below 100, with no orders to give regularly scheduled insulin (only a sliding scale was ordered). She wasn't confused when I took care of her, just soft-spoken and maybe a little tired. I didn't give her any shot; not insulin or anything else. I gave her blood pressure medications and a Nitrobid patch (of which I read out loud and told her what they were for). Her sister (who is equally blind; she couldn't see what was on the TV and I know because I commented on the show they were watching) was in the room and stated that she saw me come in, heard the patient say "Ow" then watched me leave without saying a word. A few things about this bothers me (besides the obvious fact that I didn't administer the shot), among them being that I always tell patients what they're getting and why as I open them, because it's the safe way to do things. Also, it's a pain to have to pick out the one pill they didn't want from the cupful. I always ask them if I can get them anything/ if everything is okay before I leave the room because it's a pain to just run back in if they press the call light. The Supervisor told me they didn't see a needle in my hand, nor did they see anything dispensed from the Pyxis or documented in the eMAR. But the sister is sure they saw me randomly come in, walk over to the patient's side, administer a shot, and leave without acknowledging them. Typically, nurses are only called on their off day if the patient was in serious distress as a result of a nurse's actions or if the family was extremely upset. But! "It feels like a bizarre situation, so don't worry about it. It's been resolved." Well, I'm worried. Why call (in the late afternoon) and ask after investigating if there is nothing to worry about? I was told that the patient was in no danger, nor is she in any distress at the time of the call (only feeling a little weak in the legs). How was this resolved, because obviously there must be reason for the patient's sudden weakness? I feel like this is going to be a case of them taking the patient's word over mine scenario. Of course, the management will take nurses aside and "coach" them for every little patient complaint. I don't know if I ought to be to worried about it though, which is why I'm posing this situation to you good people. Some words of advice from the more seasoned nurses, please? Thanks in advance!

I had a patient the other day that transferred to me from another unit. He had a PCA pump. While I was going through his orders, I noticed that a basal rate was ordered, however, there was none programmed in. I called the prior nurse and asked her about it. She said she changed the settings, stating he was too lethargic for a basal rate, but kept the demand because the patient was still in pain. She said she called the MD (with no answer) at 1000 and had been too busy to follow up. It was 1700 when he came to me. An hour later I notified the charge nurse and she said she'd get in touch with the MD. Another hour passes, and I charted that the patient came up with a PCA pump, basal rate d/c'd per prior nurse, no orders noted. Because CYA. The doctor called at about 1830 and gave the order to d/c the basal rate. Problem fixed. The nurse called me later and became very ugly and confrontational about the note. I pass it off as stress and forget it. Before I leave my charge nurse tells me my note was very inappropriate and that nursing judgement allows us to change the order based on the patient's needs. Now, I learned with a PCA that if a patient is lethargic or begins to have a respiratory issue, nurses may disconnect the pump and the MD needs to be reached. Never do we ever change a medication order without a doctor's approval. I also understand that the patient may have been in pain, but if he's lethargic enough to be completely asleep, I don't see that he needs the PCA at all. Let me note that was had no pain for the three hours he was my patient and was completely alert. He didn't touch the button at all. My questions are this: Can we really change part of a PCA order and leave the rest? Was that completely inappropriate to put in a note? Also, is it far fetched to believe that a patient could refuse the basal rate but not refuse the demand? Because it seems to me that either the patient can't refuse part of a medication any more than they could refuse the NS but not the antibiotic or maybe he wasn't as lethargic as I was led to believe. Anyway, I just want to know if I need to apologize and do my best to make it right.

I graduated June 2013 as an RN, started at a LTC facility in March 2014. It's been at least three months, and I still just feel like I make the absolute stupidest mistakes. I'll miswrite orders, totally blank on what medications are given for (only in conversation-for the few medications I have to give, I'll look them up if I'm at all unsure), and I always leave work ready to quit. For instance, when sending someone out, I'll forget to take blood sugar with the rest of the vitals. Or the other day, a family asked if I could take their resident's blood sugar for every fifteen minutes until it was around 200 and I did it for three hours! That's insane! (My only defense is that his sugar was at 47 when he came back from a doctor's appointment). Or, I do things like send out residents and forget to grab their wound vacs before they go. Really bone-head things. I feel like my managers are really exasperated as far as I'm concerned...they don't seem to like me at all. I know it isn't about like, but about doing your job, but it helps if they wouldn't speak to me like I'm an idiot. I talk to the other nurses there, but I feel like I'm being way to sensitive and whiny. So, here's the question: at what point will I feel comfortable and stop feeling like I'm fumbling around in the dark? They tell me that I'm lucky, because a hospital is way harder, and if that's true do I have any hope at all? I love nursing, clinicals were great, but they weren't anything like this.

My gosh, you rock! I wish I had that. Turns out, they want me to take a floor by myself after five days. My nurse today left and I was alone for a few hours (and wouldn't you know it, a patient coded in which I froze and totally blanked-thank God there were other nurses around that heard the CNA calling for help as well, we had a discharge and sent someone else to the ER). I had a few nurses helping me, but it was still quite overwhelming.

Luckily for me, we have CMA's who do med pass. I'm responsible for Insulin, Inhalation meds, and Narcotics.

Some background: I passed NCLEX in June 2013 and was hired on as a Private Duty Nurse in August 2013. PDN is not my niche, to say the least. I feel guilty about leaving the family, but I've become so anxious over this case that I'm losing sleep and dreading going into work; that isn't fair to me or the family. So, time for a change. I interviewed at a LTC facility today, and I think I'm going to love it! After my interview, I was shown around the facility and introduced to all the other faculty. I am going back in for my orientation in an hour and will have 8 days of training (shadowing a nurse for their 8-hour shift). I think it's safe to say I'm hired (or at least according to a former classmate of mine who worked for a time there). I'm nervous, however. There are 30 residents to a unit, so 29 more patients than I'm used to (though not as much as I've heard reading through here, God bless you wonderful nurses!). Any advice for me? Tips? I want to really be an asset to them and feel fulfilled. Thanks for listening to me! :)

Yes, it is hard to keep the boundaries in place. I strive to maintain a professional atmosphere because I'm too worried about becoming complacent with the patient's care and making mistakes. I don't want any of the horror stories I see here to happen/ be caused by me.

So, for anyone interested: this case has been going well for me. I really feel that my job is just as fulfilling as the rest of the RNs I graduated with! The wee baby I watch is non vent, stable, and so sweet. Not to tell too much, but I'm there for basic nursing care as well as respite care and monitoring. I go to DR visits, therapy, and am usually in attendance for any other therapists coming to the home. The only downside is that the patient's mom, while awesome, has a certain way of doing things around the house that I'm simply not used to. It's still easy to make a mistake with laundry or the feeding preferences as outlined by the mother for the wee baby, but I'm still learning and we're making it! I'm fully aware that Mom is the expert! Also, the house is creepy at night.

Well, this is my first PDN case, so I guess technically it is the best where I'm concerned! I am in awe of each little improvement my patient makes, from better head control to making new sounds to the decreased incidence of seizures. However, the best thing ever was the first time my patient smiled and became excited when she heard my voice. Patient's mom is awesome! When she can make dinner, she makes enough for the both of us and always asks for my preferences. The house is always stocked with snacks and movies! The family never fails to ask about my day and life as though I were a family friend, not simply the baby's nurse. It's a very comfortable atmosphere.

Thanks so much, you cleared a lot up for me! You weren't kidding about it being a culture shock! :)

I just started a new job as a pediatric private duty nurse right out of nursing school. So, I'm looking for advice (and maybe reassurance) for the veterans here. There have been a few scheduling problems thus far. I was hired on without a clear schedule. (As a matter of fact, I called Monday to ask about when I'd get one and was informed that I was due to work since the family needed me ASAP! Yikes! Luckily, my shift started later in the day.) During orientation, they hadn't received a schedule from the family so it seemed a bit touch and go. However, I was assured it was a 40/hr a week job. I got there at my scheduled time (as agreed between myself and patient's mother, based off of her work schedule) and turns out, the patient was at an appointment and didn't come home for another hour and a half. So, a short day. Since the patient's mother didn't work on Wednesday, I asked if I'd be needed. I was told that I wouldn't be (at which time I stupidly shared that I preferred that, since I had a family function I'd like to attend in the middle of the day) and assumed it would be my day off. Next day (Tuesday), I was asked to accompany the patient and family to an all-day appointment at the local medical center. Another short day. I tried to call scheduling and they were out all day. Cue the major anxiety and sleepless night. However, I called my agency and asked about the effect my shortened hours (upon the time their insurance granted them and my job) and was assured that since the patient's schedule necessitated the short hours, it was fine. Wednesday, I call scheduling and figure that from one to nine, Monday, Tuesday, Thursday, and Friday is what the optimal time would be to care for this child. They call the patient's family to confirm. Cue the callback, in which I was informed I was expected to work Wednesdays as well, even though the mother doesn't work. I'd get this day off, since I discussed it with them family but in the future, I'd work M-F, 1-9. (It sounded like I was made to look like I asked for this day off, which I suppose is arguable.) My question is this: do all new cases follow along like this? I feel I was thrown into the water and expected to dictate my hours based on need and what they were allowed. Is that normal? I have to admit that it sounds strange to me, but this is my first job and clinicals took place strictly within hospitals. Another question: is it normal, in this field, to accompany the child to all of her out-of-home appointments? At the moment, she goes to these appointments with family members, but they expressed interest in my presence there. I feel like I may look disorganized, and I don't want to present myself in this light. Or is it simply that I'm experiencing the same thing that other private duty nurses do? Also: My patient has seizures that aren't controlled by medications. The family was instructed by the DR to increase the medication verbally, however the only script that I have has a lower dosage. How do I communicate this while charting? Please help? I'm feeling overwhelmed. I really like this case, but I feel like a chicken with my head cut off.