Smilie0809RN

This woman was fully alert and oriented. She even told me at the beginning of the shift that she had previously been rude with other staff members but that someone told her it's ok because being her age and being sick she can say and do whatever she feels like. And I didn't tell her to cut the crap but I have never in my life had anyone demean me like she did. I was just curious how others handled this type of situation.

So I had this older lady who was hospitalized for pneumonia. All evening she was very pleasant and even offered chocolate each time I went in to see her. It was mentioned to me at the beginning of the shift that the night before she had gotten out of hand and I thought this lady is so sweet I wonder what they are talking about. Well at 6am I found out. She was screaming down the hall that if someone doesn't get her water right now there is going to be a dead patient. I go in the room and her eyes are red and puffy and she starts screaming at me saying I am a horrible nurse and I neglect her and this is a horrible hospital. When I asked her why she was so upset and what she needed she started screaming how she hasn't had a bowel movement in 2 days and I don't care because I'm not calling the doctor. (The night before I did give her something) I wanted to tell her the reason she isn't going as frequently is bc she won't get her butt out of bed! She refuses to get up to a commode or a chair. But I wasn't going to fight. She yelled for us to get her fixed up in bed so we pulled her up in bed and I laid the blanket on her and she said "this is how you're gonna leave me, you aren't even gonna make it nice." Omg! I wanted to just tell that lady to cut the crap bc she was just out of control but I know we are supposed to be cordial with the patients. Has anyone ever told a patient to just cut the crap and stop being nasty?

So I lost my first patient the other day and it happened so quickly it was all just a blur. It happened within a few minutes after change of shift so I was already pretty busy. In report the day nurse actually had said to me that she didn't think this patient was going to make through the night. She was 92 and had everything wrong. Pneumonia, GI bleed, anemia, heart and kidney problems. The patient even said she wished she could end her suffering. Anyways, at the beginning of my shift I checked in on all of my patients and she looked like she was sleeping but she was still breathing and she had some mucous in her mouth and I felt she needed some suctioning. I went and got the equipment and I came back into the room and set it up. The charge nurse from days was in the room with me. She knew the patient better than me and I guess she just wanted to check in on her before she left. Before I could set the suction up, another nurse came into the room and said that she was reading asystole on the heart monitor and sure enough she had passed. When I had first seen her at the beginning of my shift just a few minutes earlier she didn't look like she was in any distress or pain or gasping for air and even while I was setting up the suction, she didn't look like she was in distress. I just couldn't grasp what had just happened. How did it happen so quickly? She was a DNR/DNI, so once she passed I wasn't able to resuscitate, but I just don't know if I did everything I could have, and it seems as though she passed so suddenly and quietly. Anyone else been in this situation?

The reason I consider it an error is because for the 2 days that she has been in the hospital she has been receiving the metoprolol and dilaudid and it hasn't affected her like that. It was once I gave her the muscle relaxant, which she didn't receive during her stay until I gave it, that she had a problem. But she claims to normally take it at home and it was on her mar as a prn med. I guess it was too much at that time?

I cannot believe that I made such a stupid mistake!! So...I get on shift and right after I get report I go to meet the patient, and she is sitting up hunched over grabbing her legs crying and screaming about how much pain she is in. The patient was in the hospital for gastroenteritis and narcotic withdrawal. She takes at home percocet for chronic back pain post MVA. So my first thought was I have to get her something for the pain. She was crying and screaming. She was being treated with iv Dilaudid 1mg. So I gave that. Then I gave her regular meds which included Metoprolol 25mg. Her bp was 150/78 and HR 65. But the mistake I made was I also gave her Tizanidine 4mg. When I was giving her meds the patient said she takes it at home routinely because of her muscle spasms. I was stupid to give it. I should have waited to let the dilaudid kick in. I guess I was just focusing on getting her out of pain quickly. But what happened was she was bradycardic all night long, her HR was in the 40s. No other symptoms, so the doctor told us to monitor but it could have been a lot worse. I will always quadruple check everything! And even if a patient takes certain pills together at home doesn't mean its correct. I feel so stupid!!!

So I am a new nurse just off orientation this week and for the most part it is going well. I am doing well with my time management and getting everything done with my patients. The thing that is worrying me is that when urgent situations arise (not just codes) I feel like because I've never been in those situations before I find myself having to ask for help a lot. And whenever I ask for help the other nurses are happy to help but idk if after they may feel like I am incompetent? And being on the night shift, a lot of issues we resolve on our own. And initially I will try to do something about the issue but if it doesn't work I'll ask for help, and the way the other nurses come into the room with much more confidence, knowledge and experience, I feel incompetent and wonder to myself, is this how I am supposed to be at this point? Am I behind, do I need more training?

I completely understand where you are coming from, however he only showed me things once and breezed right through it and then after that expected me to be fully independent on the tasks. And when I was charting it's not like I was super slow, yes I was slower than him because I was being careful not to document incorrectly, yet he still criticized me. And like I said in a previous post, we got out with plenty of time to spare maybe like 15-20min early.

When I am done orienting I believe I will be working on night shift :) . But I'm glad to see I am not crazy in thinking that was a bit much for a first day. Especially when I have never used that equipment before and the charting system is all new. All he kept saying though is "you're gonna have to do this stuff when you're on your own."...No **** sherlock, but I am not gonna be on my own for another 12 weeks, so I don't have to be totally independent on my first day!

Yes I believe he meant the crying would be due to him yelling at me or making a mistake, etc. And I think you may be kinda right about the lazy, bc as I was doing the charting, he would criticize how slow I was (again I'm not used to the system), and while criticizing me he was on the other computer on some website not work related. He's been a nurse for a long time and he likes to just get his stuff done and get out on time. He even said that my main goal should be to get out on time. Which by the way we got done so early we had to wait like 15 minutes before we were allowed to punch out!

So I am in a new grad RN residency program at a hospital. I am trying to gather some input on whether it is common to get a preceptor like mine or not. So yesterday was my first day and the first time that I met him and one of the first things he said to me was that if I am going to cry I shouldn't do it in front of him and I should go somewhere else and do it. Nice first impression. After getting to know him he did lighten up a bit, however I noticed he is the kind of person where if he shows you something once, he expects you to know it. Now the charting system here is very complex and the IV pumps are unlike any that I've used before so it's not exactly easy. So we did morning rounds together, then in the afternoon he sent me on my own to do afternoon meds. And he said to me that he wanted me back in 15 minutes (5 patients, 1 on isolation, all meds were IV push/fluids and injections that had to be drawn up). And actually everything that he sent me to do on my own he gave me timelines and anytime I went over he let me know! I just felt rushed and I don't like to feel rushed when giving meds (especially like heparin/insulin/mag) and especially when it's a new system/ MAR/iv pump that I have to get used to. I don't want to make any mistakes. And apparently he is supposed to be really good at mentoring because he was mentor of the year for the hospital last year so I don't know. Are most preceptors like this on first day?