Let me start with my background. I’ve been a nurse for almost three years. I stared off on a trauma/surgical step down unit for a year- only left to relocate closer to home. From there, I went on to a neuro ICU unit and stayed for about 10 months. LOVED the critical aspect of that unit, but the unit was cliquey and headed sown a mass exodus and I wanted to finally be on day shift. Same hospital, transferred to an ortho/Neuro/trauma floor. Was made a charge nurse after only 4 months of being on the unit, precepted. Good relationship with co-workers, management, etc. Only left because I remembered why I left the floor in the first place. Just not for me. A positioned opened up in the ER (something I’ve wanted to do since nursing school) so I decided to apply and see what happened. A day after submitting my application, I had an interview. The day of my interview, I had an offer by the time I got home.
SO fast forward to my ER experience so far. I’m going into the last week of my orientation. My hospital has two campuses on the opposite side of town. One is trauma, the other is everything else basically. Mostly strokes because it’s the only campus they can do embolectomies. I’m at the latter campus.
i had my first week at the trauma ER last week and did well. My preceptor said he thought I was ready and really only needed to work on my speed, but that all comes with time. Great. Feeling good. My preceptor on my home until says I’m ready and trusts me to go into rooms by myself.
I had a new preceptor at trauma ER this week. I also had my first lapse in patient care that was completely my fault.
We had a patient who came in with CHF. Homeless, wasn’t taking his lasix or other meds for quite some time. No PCP. + drug screen. He c/o SOB and edema. He was 97% on RA always. Lungs diminished but moving air. Labs came back- first lactic was 10.4. BNP almost 8,000. Trop slightly elevated. So MD orders fluids.
He went to CT and I guess his IV came apart at the hub, but didn’t come out. So CT didn’t restart his fluids because it was a blood bath. When he got back, my preceptor came in and asked me which IV bag was the bolus and I said the liter, when it was really the 500cc bag also hanging. The doctor put in two different orders for a 500cc bolus and then for maintenance fluids at 100cc/hr. i assumes they were both boluses. So my preceptor ran the bolus of 100 Cc/hr.
I came back into his room a little later and the charge RN, my preceptor and the MD were all in there. I walked in the room and the charge told me the mistake we made and told me he was in heart failure now. The MD used to be a nurse and was SO nice and looked at me and said “I messed up too. It’s okay. I didn’t notice his edema. We’ll just give him some lasix and it’ll be fine.” My preceptor also Said it was okay and that he was already in failure. She’d seen worse mistakes. Rechecked his respiratory status- RA, lungs still just diminished. Took him to ICU as already planned and ordered bipap just in case. Came back and filed an incident report.
I think part of it was me taking the “pick up the pace” comments and just rushing, but it’s not excuse. And I hate that it partly falls on my preceptor for taking my word for it and thinking I was competent enough to be able to read an order. I just feel like an awful nurse. I also knew he had edema and CHF and questioned why all the fluids, but never spoke up and asked. Which could have prevented all of it. I’ve never had something like that happen.