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studog12

studog12

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  1. Thanks, Ruby. I appreciate the support!
  2. Hey Everybody, I am a new nurse working on a busy telemetry floor on the south side of Chicago. I have a couple of issues to put forth that have been bothering me for a while now. Sorry about the length, and I did try to cut it down, but I don't think I can adequately describe my situation otherwise. I would consider myself a thorough person when I do anything in life. I really try to do things the right way and do a good job, and I take pride at still doing them this way behind the scenes. So, when it comes to my nursing assessments, being a new grad, I try to do them as I was taught, which is, obviously, assessing everything from head-to-toe. So, as I do them, I try to actually think about what I am hearing with the heart and lung sounds, to take about 15 seconds for each quadrant when I listen to bowel sounds (I mean, who seriously has 5 minutes per quadrant like they say in the books??), check skin, pulses, edema, actually assess their orientation status, etc. I also take their vital signs. This, on average, with normal verbal interaction with the patient, takes probably 7-10 minutes. On nights, we have 5 patients, so on average for my initial assessments and vitals, I would say it takes anywhere from 40 to 55 minutes (give or take) to assess all five patients. Let me also mention that I am more of a slow-paced guy, meaning in general I don't like to have to rush through things. I prefer to take my time, slow down, process what is in front of me, and not do things as if I have to meet some sort of deadline all the time. I'm also much more people-oriented than task-oriented. And with this in mind, I try to be consciously aware of time so I can pace myself and not get too caught up with one task. But, even with this mentality, I still find that most other nurses around me (newer and experienced both) seem to get things done significantly faster than I do. This makes me wonder what I am doing wrong. Am I still going too slow? Am I being too detailed? Are they cutting corners? I am not in any way intending to be accusatory here, but I honestly don't know how others can do thorough assessments on their patients and still be that fast, you know? I know with experience that it becomes easier to recognize certain things and to know what to pay attention to with greater detail, but, isn't there still a minimal standard of thoroughness that everyone is required to meet? Again, I don't want to inappropriately imply that others are cutting corners because God knows maybe it's just me, but for the life of me I just can't understand it, given that objectively, with the time noted above, I think I am being efficient. But I am afraid that if I move any faster, I will start missing important details that I would otherwise notice. And, honestly, doing it any other way, I think, would require me to take short-cuts, which I can't in good conscience do and honestly have no idea how to do (I mean, are there safe short-cuts?). Side note: I realize that the detail nurses are taught to go into in nursing school with assessments is completely unrealistic in the real world, so just for clarity, I do understand that a healthy compromise is necessary (i.e., listening to the lungs in 2-3 places for each one, not 6, etc.). Lastly, to give a little insight into the OCD part, when I do my reassessments (we do 3 assessments total on our floor), I take vital signs and listen to the heart and lungs, and only chart on what I actually did, which in these cases, is the heart and lungs and other things like skin/edema and things you visualize without realizing it when you go into the room. Although, sometimes I question whether or not I should chart on these things, too, because I never actually consciously look at them (i.e., is the patient's edema still severe, or has it decreased to moderate or mild now? You know what I mean?). This was just suggested to me by one of my preceptors because, I presume, it looked like I wasn't charting on enough things for my reassessments. Anyway, all we ever hear is, "Don't chart on things you don't assess," and instructors and managers alike are VERY strict about this (for good reason), and yet, when I actually try to apply it, it seems like I am charting too little (as suggested to me by some of my preceptors). So, I recognize what seems to be like a gray area, and I chart a little more (such as the skin/edema example above), to which I have had other nurses ask me, "Did you REALLY look at that edema?" (or fill in the blank). It just feels like I am damned if I do and damned if I don't. Even though I am on my own now, this has been an issue I recognized in school that has still not settled for me, mainly because of the inconsistency in feedback I have received. Which makes me wonder why other (particularly new) nurses don't have this same struggle, which makes me ask myself, "Am I crazy, or is this OCD-like?" By the way, I do have Pure-O OCD, but I recognize it and have been able to control it well. At any rate, though, this issue seems like one that would be more common to every nurse, given that nursing standards claim to be so black and white when it comes to charting. Anyway, I would really appreciate thoughtful answers/encouragement. I've racked my brain a ton over this and can't seem to figure it out, which is why I am questioning and doubting myself and thinking that maybe it really is just me, in which case I would love advice about how I can be better and improve because that is ultimately what I want. Thanks so much for your time, everyone. Best wishes, Ethan
  3. studog12

    Mistakes

    @Susie 2310, thank you for your reply. To kind of respond to your response point by point, yes, I definitely check to make sure that I am giving the correct medication and taking the time to look up what I am giving and why it is being given to the patient. In fact, pharmacology is a subject that fades fast if you don't constantly refresh your memory and learn new things. Scanning medications through the computer is a way to make the process a little faster, but I still make sure the computer order matches what I am giving. In regards to the IV medications, I always check compatibility, too. I would say even at the time I felt comfortable with basic IV skills; this was a blunder I made because, well, I guess I lacked the awareness/knowledge in this instance. So technically I wasn't fully competent. Perhaps you might think that I am not completely competent with these skills, but as far as what I know now, I am competent, and should something come up in the future I will certainly not hesitate to ask about it. I know the "not knowing what you don't know" phenomenon applies here, but IV skills are not complex (not to belittle their importance), and I really do think I know what I need to in order to administer IV medications safely each time I do it. As far as slowing down is concerned, you're right. I am in no rush when giving medications, but there is always a time constraint in nursing, and I think there should be a healthy incentive to pace oneself overall. But in certain situations, such as administering medications, it is crucial to make sure one gets it right rather than try to do to much and compromise patient safety. Probably the number one issue I had with one of my day preceptors was she pushed me to the point where I didn't feel like I could take my time with things because she was always on my tail to be faster. And, quite frankly, it was a miserable learning experience because of it. With regards to the breathing trial, I confess I did not look up the policy, but I did have it taught to me and I should have asked my preceptor to explain it to me again and to stay nearby should I have needed him. I am working my way to being autonomous, so there is an element of space between us; but I should have asked and made sure he was close by. The magnesium administration follows along the same lines--I just should have consulted with my preceptor when I realized that I had not worked with those pumps before and had her there with me while I hung the mag. Again, thank you for your feedback and your wisdom. It sounds like you are a detail oriented and very competent nurse. Ethan
  4. studog12

    Mistakes

    You are probably right, and I have been able to let that go with time. Like I said, recent events have just resurrected past feelings, you know? Thank you.
  5. studog12

    Mistakes

    @Been there, done that, thank you for your reply. Well, for the magnesium instance my preceptor asked if I was comfortable hanging it, and I told her I was, and I really meant it. I had hung enough IV meds to be comfortable enough doing it on my own, and I would never do something I wasn't comfortable with without help present. I was just unfamiliar with the pump, was working my way through the process, and then when I was having difficulty then proceeded to ask for help. The lesson there was I should have had her come in with me once I realized I was unfamiliar with the pump. For the potassium/heparin instance, my preceptor was in the room with me, and to be honest I don't remember if I started to hang it and then she informed me of the error, or if it had been hanging for a short time and then she noticed it and informed me. The reason I don't remember was because it was brought up after the fact and not by her, but my supervisor who had solicited her feedback. For the breathing trial instance, my preceptor should have been in there with me. I think he basically said something along the lines of, "Ok, so you need to do this, this, and this" and included in that to-do list was a breathing trial. He didn't ask if I had done one before. And don't get me wrong, I am not averting my own accountability. But I do think it was appropriate for him to make sure I knew the correct protocol and routine, etc. He is a young nurse, though (and a good one), so I can't act as if he has the experience of a seasoned nurse. Also, in regards to the IVs, going through the process of hanging an IV med was never explained in detail while in school; we just practiced doing it. There was never any critical thinking-type questions like, say, "Why wouldn't you want to hang a secondary with certain primary infusions, such as insulin, heparin, or Levophed?" or "What should you always make sure to do before you hook up an IV line to a patient?" Etc.
  6. studog12

    Mistakes

    Thank you so much for your kind reply. It really means a lot. I wish this were not such a taboo topic and that everyone would be more empowered to be more open and honest. And yes, I can tell you I will never make the same mistakes again. I have had a step-wise routine for hooking up IV lines ever since, look through all of my IVs to see which ones can have secondaries (and if none can I grab an extra pump or channel), and I will most certainly be at the bedside the next time I do a breathing trial.
  7. studog12

    Mistakes

    Hi All, I know that there are already other threads about this topic, but I decided to start one just so I could get some direct feedback. So, I am on orientation in an ICU at a nationally known hospital, and I am also a new grad. Recently (but not too recently), I made a couple of mistakes and I guess I just need to vent, as I have been discouraged and a bit worried. My first mistake (while on my current orientation) involved turning one of my patient's sedation off to do a breathing trial, and instead of staying at the bedside and monitoring how he did, I left to go check on my other patient, for some reason not thinking that I needed to stay at the bedside. I had never done a breathing trial by myself, just been shown one by one of my day preceptors. The patient had restraints and couldn't pull out his breathing tube or any lines, but I still felt bad because it certainly would have made him uncomfortable had my night preceptor not caught it. My other mistake was I hung potassium as a secondary line with heparin, not thinking that, duh, if I hang the potassium with heparin, the heparin infusion will stop, which is a big deal, as this is a high risk med. Another mistake I made while in school was during preceptorship, and I am embarrassed to even talk about this one. I went to hang some magnesium, as I had hung many IV medications before and felt comfortable doing so. However, I had not worked with these particular IV pumps before, and as I was setting up the line and priming it, I didn't realize that I had not installed it in the pump, and I had already hooked it up to the patient. I began to program the pump and kept wondering why it wasn't working, so I checked the roller clamp to make sure there wasn't an issue there, and eventually I just went to get my preceptor for help, trying to be safe and do the right thing. However, by the time we returned to the room, the magnesium had already infused into the patient as a bolus...I guess when I adjusted the roller clamp I either didn't check the drip chamber or I did and it wasn't dripping--but then started to after I walked away. Talk about almost having a heart attack. The patient ended up being fine, and I honestly have no idea why I didn't think in that moment, "Duh, you have to install the line into the pump." I was tired and working the day shift, which is common, but something that one just has to work through. Anyway, I have to be brutally honest about all of this because I just want some honest and candid feedback about it. The thing is, I am a VERY, VERY conscientious person, even to a fault and to the point of perfectionism. I would NEVER want to harm a patient, and I make patient safety my number one priority. I have caught safety hazards from other nurses as I began to care for my patient after report, and yet, I still screwed up, and I just feel so stupid. How could I make such a mistake, particularly the one with the mag bolus? I mean, why did I just not "think" in that moment? I have gone over it in my head a thousand times and still can't come up with an explanation, other than I was sleep deprived, or I was rushed and felt intimidated working with a tough preceptor (referring to my most recent mistakes) and got too ahead of myself. Anyway, that mistake with the mag happened while I was in school, and I have moved on. But my recent mistakes have resurrected anxious feelings, and I am just uneasy because I don't want to make another serious mistake in the future, especially if I am not realizing I am doing it, you know? I will be the first to admit that I have a tendency to space out in terms of my attention span, but I recognize this and am ALWAYS present in the moment when at my job, ESPECIALLY when right in the middle of patient care. To wrap up, if it came down to it I would quit my job in a heartbeat if I knew that my personality or way of doing things or whatever was going to be a liability to any of my patients. I was drawn to nursing and ICU nursing for all the right reasons, I still think--I enjoy continuous and in depth learning, am very detail oriented, enjoy quality nurse-patient interaction with 1-3 patients, and, though cliche, am driven by helping people, particularly on such an intimate level. I guess I just need some encouragement or some honest input about whether I am cut out for this profession. I still believe in myself, as I know and have read about other nurses making mistakes, even serious ones that have had major, even fatal repercussions for patients. But I just needed to put my thoughts and feelings out there and get some feedback. Thank you so much for taking the time to read this. I know it is a repetitive topic but very important nonetheless. Yours, E-Stu
  8. studog12

    Charting/Assessment Struggles

    @Been there, done that Well, I didn't ask her, but let me explain a little bit. From the get-go she was very adamant about getting me to "move along," trying to push me to be efficient while being thorough simultaneously. That sounds good in theory, but the excess pressure she put on me was counterproductive and ended up making me worry more about my efficiency than my effectiveness (at least it seemed like I had to sacrifice one for the other). Plus, she had a difficult temperament and wasn't very inviting to me in terms of asking questions, so rather than just ask her about it I hesitated because of my intimidation. My mistake, I know, and I won't make that mistake again. The speed will come with time; I always need to focus on being safe first. Unfortunately because I didn't speak up she has concerns that I am not safe, which couldn't be further from the truth.
  9. studog12

    Charting/Assessment Struggles

    Yeah, that's a good idea. I have recently begun to write down abnormalities that I see on my sheet of paper so I will KNOW what I assessed. I guess I can also write down anything I realize I miss during my initial head-to-toe when I am charting in the complex assessment, and once I am done go back and assess those things all at once to sort of cluster my care. But it's nice to have some validation that it is easy to forget something when one has so much to remember and take care of in a patient's room at the beginning of a shift.
  10. studog12

    Charting/Assessment Struggles

    Right. That's what I would prefer to do! But word around the unit is that when you do that people think you are trying to avoid being available to help out, so it's like I can't win! However, I still think I will experiment with this once I am on my own and see if I can find a routine where I can have time to do this.
  11. studog12

    Charting/Assessment Struggles

    Hello All, So, I have some burning questions about charting. Ever since nursing school, I have noticed that there seems to be some gray around this issue, despite always being told/taught that it is black and white (i.e., if you didn't see/assess/do it, then you don't chart it). For starters, I consider myself a very cautious/careful person and nurse, and that is from charting to assessments, to medication administration to giving report--the whole shebang. In short, I really care about doing things the right way and not cutting corners, even if that means taking more time, getting behind, and having to stay later to finish up after report is given. However, despite my passion for thoroughness, I still miss things. I am a new grad in a cardiac ICU, and the learning curve is steep with tons of things to remember to do at 7 a.m. when I begin my shift. Therefore, even with the checklist I made to prevent myself from forgetting something, it still seems like there is always something I miss, mainly in the head-to-toe assessment. I especially notice this AFTER I have done my head-to-toe when I am charting the complex assessment and there was more to assess than I realized. And certain things I miss can be routine, too. For example, I might forget to check for a brachial pulse on the arm in which the patient has a radial arterial line, or I might forget to make sure the patient has a stat lock for the Foley catheter, or forget to write down whether the patient's central line/IV dressings are "clean, dry, and intact" as previous nurses have charted before, or forget to write down if there is redness/ecchymosis on the left upper extremity or down on the right lower extremity. In other words, little details that are a routine part of the charting template that unless I go back into the room and check specifically, I can't really picture in my mind's eye whether or not those things are present/not present. Consequently, I use the previous, more experienced nurse's charting as a REFERENCE (I would never copy!) just to make sure that I, as a novice, wouldn't miss anything significant but missed because, well, I guess I just missed it. I just worry that I don't remember details well enough, even though I am very detail oriented and even if I chart soon after my assessment. So, what I will sometimes do if I forget a few details is just agree with what was charted before, unless I absolutely disagree with it, which I will then chart my own perspective. And the reason I do this is because I have found that as I move through the complex assessment charting, there are several things I could go back in the room to check, but might end up making multiple trips and therefore seem like I am overthinking it, you know? I just struggle with this ambiguity. Charting is preached like it is black or white, but it just seems like there is a significant amount of gray. I mean, how can other nurses remember to assess all those details every time, especially when they are busy? It's not like there is a checklist manifesto that each nurse must universally abide by as they do their assessments. We each have our own liberty and autonomy to make choices about how thorough we want to be (even though we all should be as thorough as possible). And I want to be thorough and do my best to get it right every time (not trying to be a perfectionist--it's just important to me and for the sake of the patient)! Anyway, I just wanted to see if you all had any advice about this. The risk of using someone else's charting as a reference as a new grad is if you chart on something he or she did and you do not really understand it and then it is discontinued or no longer applicable to the patient's care, you can end up "false charting." This happened to me and my preceptor noticed and it came up in my evaluations. And I understand that "false charting" is serious, but again I am not sure what to do given the urgency to be efficient and the impracticality of going back and forth to and from the room all the time to check those certain things I missed initially. Thanks for reading the long post and for your answers. It means a lot that we can come here on this forum to ask questions and be honest. Sincerely, Studog
  12. studog12

    New grad struggling with receiving/giving report

    i'm in a similar situation as you, my friend. I am a new grad nurse working in a cardiac intensive care unit, and the learning curve is overwhelming, yet exciting. And you know what I probably have the most anxiety about? Giving report. I am a very detail oriented guy, and I have made my own SBAR sheet, structured the way I want it so I will be able to reference and use it in the manner which suits my brain. This means that I organize it in such a way wherr the little details of patients that are nice to know are included, too, simply because I want the next nurse to be as prepared and have as smooth of a start to his/her shift as possible. So I go through my routine...patient's name is so and so, he or she came in with this, has as history of that, etc., only to have my preceptor jump in, say I am a new grad, and start giving report. I wasn't mad at her or anything, but it perplexed me why she thought I was going about it the wrong way...doesn't one begin with the patient's name and then move to the more pertinent information such as diagnosis, history, and treatment? I guess I am just more of a step-wise person, and I don't do well with jumping from this bit of information to that bit about the patient when giving report, as I simply can't remember without looking at my cheat sheet and following my routine. My preceptor is kind of like that, and I plan on talking to her about my difficulty with report, explaining my vision for going about it, and asking for her advice on my thinking and what I could change to make it better. Anyway, I want you to know that you are not alone, my friend, and that even though giving and taking report may seem easy to some nurses, it is not as easy for those who are more inclined to detail in their communication and the more linear thinkers. Trial and error will help get us where we need to be; that and time. Let's hang in there and keep learning!
  13. studog12

    Do women find male nurses attractive?

    Respectfully, I can see from a professional standpoint that you may find his comment about women "liking" care from male nurses inappropriate, but I do not think he meant it that way. It seems to me his comment was informal and did not refer to the actual enjoyment or lack thereof of a play-by-play scenario of being cared for by a male nurse. I think the point behind his question is how a lady would view a man in terms of the attractiveness of a male caregiver, not the actual caring part itself (which is obviously very private and does not need to be discussed at any time other than for professional reasons). Like I said, I get your point. But I don't think the meaning behind his question was geared in the way you interpreted it.
  14. studog12

    Do women find male nurses attractive?

    Haha...I couldn't agree more, Wile E Coyote. I mean, the guy made himself vulnerable and shared his thoughts and heart...as if every person on the planet doesn't have insecurities...even the stereotypical "total packages" we like to envision in our minds when thinking about a significant other.
  15. So beautiful and so human, which makes it very inspiring and believable. Thank you so much for sharing!
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