MasonDixieChic

I've recently hit my 1 year mark as a new grad nurse on a step down ICU/tele floor and, while part of me wants to sympathize and tell you how much I can't stand when this one particular nurse gets report from new nurses she looks for any tiny thing to reprimand them on ("the tubing on that ER admissions' IV fluid isn't labeled?! You don't know how many doses of this one super specific antibiotic the patient has received, even though its been discontinued???" yet when she gives report its maybe 4 words long and is a take-what-you-get sort of thing. She is mean, she IS looking for things that are wrong, and her criticism is NOT constructive. With that said.. I have learned more than I ever imagined in my first year as a nurse; I had to grow a bit of a thicker skin and it sounds like you might need to as well. I know its not want you want to hear but if I can tell you anything it is just to relay what a very wise professor told me in nursing school and it rings true. You've got to "own" your practice. Never make excuses, never try to deflect or blame not knowing something on another person. You've got to do what you need to do to find out what is important to care for your patient. Learning to give a good report is hard, and the only way it gets easier and you get better is with practice. Start to anticipate what questions will be asked and how they are relevant to the patients' clinical picture. The nurse I experienced and wrote about wasn't "building up my self-esteem" as a new nurse, she never sought to find the most effective way to right my newbie wrongs; but to be honest, that's not her job. I had to learn to work with her. I had to learn to ask, and to be asked, all of the questions that make up a thorough report. I think the three most important things you should take away are.... 1. its not about you -- (really, its not. It's about the patient. and even when a nurse gives you a hard time about something, you can't take everything so personally...it will be exhausting and not help you out at all 2. own your practice -- be accountable for your nursing practice. When you are getting report and giving report on your patient, assessing your patient, giving medications to your patient, documenting about your patient...take the time to do what you need to do, ask the questions you need to ask, double and triple check the things you need to check to ensure you give the best care to your patient. If something you failed to ask or do raises an issue with the patient, accept your responsibility in that situation, learn from it, and move forward. 3. being a new nurse is hard! It (frustratingly) takes time and practice to learn how to feel and truly be competent and confidant nurse. It will get better, you will get better. Hang in there and focus on learning how to be the best nurse you can be!

I absolutely agree we shouldn't and couldn't know every side effect of every drug. My dad happened to get the side effect that happens to 1% of people. I know in my hospital, we try and give education on a least one medication and one "problem". Yes it would have been ideal, but I don't blame them for not having the time to educate my mom and dad on every med or discharge instruction. I think my post was more of just a wake up call (to myself and others) not to assume a patient knows something, or that they know how to navigate the system like we do. I think doing everything you listed in the second paragraph is an awesome way to do everything we can reasonably do as individual nurses to minimize problems post discharge.

I agree that its a bigger issue and there would need to be more of a system wide or hospital wide change, but I will approach discharges with more perspective now. Unfortunately I don't have the time I want (or often need) when discharging patients, but from now on I'm definitely going to make sure the patient or caregiver can tell me what number they're going to call if they have any problems. (I'm going to highlight it). We go over all meds with patients on the med rec, but I'm going to try and make sure the OTC drugs are in generic and trade names, and make more of an effort to do discharge teaching as I work with the patient during their admission.

Don't mind my Adele reference in the title. I'm an RN who works on a cardiac unit of a hospital. We do a fair amount of discharges. Many of the patients are elderly, but a lot are not. I've known the importance of good patient education, and always do what I can to make sure a patient (and/or their caregiver - whether that's a spouse, child, visiting nurse) has all the education and resources they need. Our unit even does discharge call backs the day after to ask if the patient has received their prescriptions, made the follow up doctor appointments, and to ask again if they have any questions at all. My dad is in his mid 50s and just had a total hip replacement, so this is my first time being "on the other side". This is my dad's second hip replacement, he had the other side done in his mid 40's (its a combination of playing football when he was younger, working in construction for 25 years, and genes). The first hip replacement he was discharged to sub-acute rehab for a few days. This time they wanted him to be discharged home. My mom was nervous, but they explained he would have a visiting nurse and PT come to the house, and that by discharge he would be able to get up and go to the bathroom on his own, and wouldn't need to be doing any wound care, so she felt she could handle it. This is what I have learned from this experience. It's going to change how I educate pts and give discharge instructions so I thought I'd share. (my hospital has policies to do some of these things, but not to the level I now think they should): make sure patients know the trade and generic names of drugs, and which can be bought vs. which need prescriptions. -- it sounds silly, but don't assume someone knows acetamenophen is tylenol, or that it can be bought at the drug store. My dad was prescribed senna and docusate, but my mom (who is in her mid 50s and a very intelligent woman working in a field that is not healthcare) didn't know he didn't need a prescription for them, and that they can just be bought at CVS. This really stressed her out, she thought she had missed getting what could be an important prescription. when someone is discharged on pain meds (especially multiple), tell them to keep a schedule of when they take them and to high-light how often these meds can be taken -- . My dad was discharged on tramadol q6 and nucynta q4. he also is prescribed lorazepam for anxiety. The nucynta is having side effects (i'll get to that) so my dad isn't with it enough to know when to take his meds, and my mom, who works full time from home, wasn't sure which was which, when he last took one, if they could be taken at the same time, or how the lorazepam played into it. It was a hot mess. - now my mom is keeping a log and it's sorted out, but if I wasn't here I am worried about what could have happened. make sure your patients and families know when and how to call their doctor or nurse...and make sure the number works -- trying to find the number to call when there was a concern (below), that actually went through to an real life human on a Friday evening, was about a 30 minute task (and this is for me, not some 80 year old lady who isn't familiar with this stuff).....in short: highlight phone numbers to call for medical questions that are not obvious 911-type things...also my dad had some urinary retention in the hospital and they wanted him to follow up with a urologist "1-2 days after discharge"...when I called the number for the doctor on the discharge papers, the receptionist told me this doctor didn't take new patients. I was surprised! I called and got him appointment with a different urologist I know of, but a lot of patients and family may get seriously stressed and upset about this, or worse, fail to follow up on an important issue. 4. Make sure you tell your patients about possible side effects...especially with unfamiliar meds --- this sounds obvious, but still. My dad was prescribed nucynta, which I had never heard of. It's a newer narcotic and helps prevent constipation (it totally did by the way). Anyway, my mom was saying how my dad was having these horrible nightmares, and was acting "weird" - I come over and hang out with him to notice he's not "drowsy" or just a little loopy, like on some narcotics, he is having increased anxiety, restlessness, and occasionally twitching - and then he's saying things like "I was thinking about driving down to visit nan" (aka his grandma who's been dead for 20 years) - he immediately realized and laughed about it, but that was odd. my mom said he had been out of it and was occasionally talking to himself - she just thought he was on heavy duty pain meds because he just had a joint replaced --I first got kind of pissed at my mom, like "how didn't you think this was something to tell me" but she said he was talking to himself not in this obvious, how-can-you-miss-it way, but just kind of mumbling to himself before and after sleeping. I asked him if he heard anyone talking to him that wasn't there, saying it could be a potential side effect - and he said yeah, but I thought it was just the nightmare thing (he was awake and on meds, so yes this sounds ridiculous but I got my answer - he was having audible hallucinations!) -- there was no information given to them on this drug. I looked it up and sure enough "call your doctor if you experience" and under that there was "twitching or muscle spasms, hallucinations" - it also had sleep disturbances/nightmares.[/font] finding the phone number for the correct person to contact was ridiculous. Finally calling back the hospital, they said to call his visiting nurse and to also get his blood work to see if possible electrolyte imbalances. I find the folder the visiting nurse left, but the front that had a line where your RN's name is suppose to be was empty. I asked my mom if the nurse left a phone number and she said she didn't know. I sort through the paperwork and just call the agency and it takes me forever to actually get the RN on the phone. To sum this all up... My dad is not an elderly man, he was discharged to home, where he has my mom, who works from home and can be with him all the time, and to top it all off he has a daughter who lives 10 minutes away that is an RN! He isn't what comes to mind when you think of the patient that will have any issues related to confusion after discharge. Yes, dealing with it was a pain for me, but for someone who doesn't know how to google the number for the visiting nurse, or doesn't know what is not a "normal" side effect, this whole thing would have been really overwhelming and could have had a bad outcome. It's easy to forget how things that seem obvious to people who work in the healthcare setting can be completely foreign to all types of patients. I just wanted to share!

UPDATE: I can't thank everyone who took the time to read about my situation and post such thoughtful responses enough. I was shocked at the amount of and quality of the responses. Saturday was one of the worst days for me, and reading through all the responses from both new and experienced nurses made me see that this experience (as horrible as it was/is) will not define my entire career as a nurse, and that I can become better for it. I did have a meeting with my charge nurse and nurse manager. I explained that I made the error, which there is no excuse for. I told her that I was, essentially, devastated that my error could have lead to serious implications for the patient and that when I found out she was okay, really thought about what factors lead me to make such a mistake. I'm not going to lie, I got emotional and shed some tears during part of the meeting, but I was being honest and really made it clear that I never want to feel that I've put a patient at risk ever again and would do whatever it takes to grow from this. My manager reiterated the seriousness of the error and as per our hospital policy, the meeting served as a "verbal discussion and response" to the incident. I'm on a mandatory 2 month probationary period and have to check all IV drips with the charge nurse (I'm happy with that, but I"ll expand on that later). At the end she told me about a med error she made as a new nurse, and said what many of you posted; that good nurses learn from their mistakes, are extremely careful after, and move forward. She told me she believed I have the foundation to become a great nurse and not to let this make me jittery and scared around patients, but to focus on the task at hand, and to always ask questions and get a set of second (or third and fourth if needed) eyes. I walked out being happy it was over (it sucked feeling like that meeting was hanging over my head) and feeling like I can move forward and be not only allowed to take the time I need to learn, but expected to question everything that is new to me (which is a lot). Does it kind of burn to be on a "probationary period"? Yes. But, I now I feel like there are so many people I can go to then I am not 100% sure about something. I did not feel this way before, which I realize now was when I should have said something. Giving medication correctly and safely aside, before this event I felt like I needed to be able to get things done in the time schedule that the other nurses did. I was so overwhelmed and felt so alone, and like I was such an idiot and that I was suppose to have learned how to do a lot of this stuff in school. (Of course I knew that you should always ask when you were not 100% sure, but in the midst of a million things going on and a hundred things being asked of you at once, I didn't feel like I could press the breaks, stop everything, and get the charge nurse to answer questions I had (ex. is there a policy on the amount of time a patient needs to be off BiPap after breathing or is this left up to the doctor or respiratory therapists discretion? OR do you need to clamp the foley before a patient goes down for certain renal tests? --- these are random and not 100% accurate examples I can think of now, but I hope you catch my drift). Now, I'm expected to ask a million questions and will meet with my manager weekly to go over progress. Of course I wish this hadn't happened, putting a patient at risk is the opposite of what it means to be a good nurse. But I do think good will come out of this. I know I will always be extremely vigilant when it comes to medications and patient care, and I feel like I'm getting the support I really need as a new grad. Thank you again to everyone who shared their stories and gave advice. It made me realize I was not alone and that I can work hard, be diligent, and become the nurse I want to be.

I need some advice. I made a big med error today and I don't know what to do. I can't put into words the way I feel right now. So afraid, ashamed, embarrassed, discouraged. Here is what happened. I'm giving other information NOT because it is an excuse for me making such a blatant mistake, but just to give some insight into how I feel. Even before this, I've been feeling like I'm just not cut out to be on such a hectic unit. I know all nurses have hectic jobs but our floor is one that all float nurses and nurse assistants say they hate and tell me "good luck" once I tell them I'm a new RN on the floor. The other nurses are really great, its just so fast paced, its an ICU step down and in one day you can get several admissions and discharges. Even before today I felt like I was struggling just to keep my head above water. I had two months of orientation but looking back it was kind of like having a team mate to do the work with, so I didn't learn things from the perspective of a nurse working solo. But Today I did the worst thing. I messed up, it was no ones fault but my own. Basically a patient was ordered to switch to a Lasix drip. When I started the drip, I entered the intended ml/hr into the mcg/kg/hr. I looked at the orders in the computer and remember thinking "double check" - and I **thought** that I had. The patient showed no signs of distress, and only when the bag was empty 3 hours later and I called for another and pharmacy said I had enough for the next shift did I realize that the drip was going at THREE TIMES the intended dose. My heart stopped and immediately I felt this feeling of doom. I immediately checked the patients' vitals, which were fine thank god then told the charge nurse. She (rightfully) freaked out and asked why I didn't have someone double check the rate. I thought we only needed certain drips checked and honestly did not realize. I called the doctor to let him know and filled out an incident report with the charge nurse. She said I was unsafe with patients and after this, I agree with her! I was under the impression I would be fired and was worried about my license. I have not been able to sleep or eat since this happened. I just found out that the patient has been fine in the last 12 hours since this happened and that he is okay. I am SO SO SO thankful that the patient is okay but just feel like such an idiot. I feel like I've worked so hard to become a nurse and apparently I'm not cut out for it. I'll be meeting with the supervisor, manager, and charge nurse in a couple of days (which I'm already so scared for and dredding) but am scheduled to work before then. I'm new and I honestly doubted that I even had a job after this, so when one of the other nurse managers emailed me telling me everything with the patient was fine and that she would see me for my regular shift on Monday I was surprised. I'm scared to go back. I'm not only devastated to have made such a blatant and terrible mistake that could have been life altering for that patient, but I'm doubting my future and career as a nurse. Before this, my patients and colleges have had good things to say about me but now I feel like I'll always be known for this. I feel like i'll be walking around with a big X on my head. I could my patient serious harm! I honestly feel like resigning, but feel a weird mixture of having just disappointed everyone and yet like I would disappoint them more if I express interest in moving to a different unit with a slower pace. I just want to crawl into a hole. Help.