Self sufficient???? When????

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Specializes in telemetry, med-surg, post op, ICU.

Hi, all!

I've just come off second shift and I think I need to do some typing to some people who may understand. I work on a tele unit. I graduated in May and had about 11 weeks of orientation. Today was my third day off of orientation and I had five patients all of my own.

I am always encouraged to ask questions. When I had a preceptor, I did! I always turned to them for advise or updated them about my patient to find out what to do.

The problem is that I'm still doing this. I'm calling the charge to find stuff out and I'm wondering if this is normal. I just feel like I should be doing my own job and not constantly running to someone else to ask what I should do.

For instance, my patient tonight had a fever of 101.2. Well, she has chest pain that hurts when she takes a deep breath. Most of the time for pain like that, we would make them cough and deep breathe and recheck the temp. Well, she couldn't do that. I didn't give her pain meds because she said it only hurt when she breathed. Duh, I should have given her pain meds so that she could breathe deeper! I feel like I didn't manage her pain very well at all.

So, I have an order for tylenol, but is this something I call the doc about? I mean, it is a change in condition, but I could easily solve the problem. I could give her some tylenol. I sat there thinking about it, then didn't want to mess up so I called my charge nurse to ask her what I should do. She said to call. I did and he told me to give the tylenol. *sigh*

Then I had to start an iv on a patient that was going for a ct angiogram. It had to be a 20g in the ac space. So, I go in and give it a try. Miss it, naturally. Now I don't want to try the other ac space because someone with more skill could use that site. So, up to the charge desk I go. They tell me call the iv team even though our policy is to try twice. Still feeling like a bit of a fool for not being able to get it, I page the iv team and wait. No one calls back. I page again. No one calls back. Sooooo, call the charge and let her know and she calls. No one calls back. The guy is taken for his ct. Radiology calls me complaining that they will have to reschedule for the next day if someone doesn't come and put the iv in this guy's arm. They finally get the iv team. The iv was started right next to where I tried mine.

Should I even begin to tell about my confused and combative little old lady that kept ripping her surgical dressing off and found interesting ways of getting out of her restraints tonight? I probably consulted four other nurses in the course of that because I just didn't know what to do. Actually, I could narrow the situation down to two choices, but didn't know what the best one was . . . sort of like NCLEX, I guess. :uhoh3:

Then there was the lady in pain. This is a different pain lady than the first one. Didn't ring the bell for pain meds. As all of this other crap is going on, I walk past the door and see her face all scrunched up like she's sucking a melon. I TOLD her to call me. I didn't want to give PO lortab and IV dilaudid at the same time. I wanted to see her pain control with the lortab first and the dilaudid second. I also don't know how safe it is. Now I start feeling like I'm totally mismanaging this lady's pain, too, and I feel crappy that she got into that much pain at all. It's my fault for not addressing it when I practically KNEW she would need the dilaudid, too.

I didn't go to the charge with that one. When this lady started developing uncontrollable itching, I knew to call the doc and get some benedryl. It was okay, though, I was calling him anyway to get a vest restraint for my cute lil ole lady. :lol2:

I didn't even mention the other patient I had. She had pain issues, too, but she had sense enough to ring for the dilaudid. Unfortunately, I was too busy jumping around all of the other rooms to give it too her and she had to ring several times. One of the other nurses picked it up for me.

I spent the last half hour of my shift with the aide trying to rediscover the art of tying quick release knots for my laughing lil ole lady. A girl scout I am not.

After that it was all overtime as I had to sit down and chart every single thing that had happened over the evening. I was there until 1AM. Not bad, actually. The latest I've been there is 2AM. That was the night of the lady who would not stop bleeding. Then there was the night of the lady who could not breathe.

So, is there ever going to be a time that I don't have to call up my charge and say, "alright, this is what's going on. what should I do?" They all say that this is what I am supposed to do, but I just feel so bad for doing it. I don't want them to think I'm lazy . . . or stupid. I want to be able to do my own job. That's important to me. I feel like I should know how to do these things, know the answers to the questions, but I don't.

Any thoughts? Sorry to go so long. I needed to get that all out.

Iona

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I've been off orientation for a year now. And I remember exactly how you are feeling now.

Don't worry. You aren't supposed to know everything. You're not even supposed to be good at everything. IV starts are a learned skill. You'll get better at them the more of them you do. Frankly, if you missed the guy and the IV team didn't page back, I think the charge should have got off her butt and started it for you. The charge is there to be a resource for the rest of the floor nurses. It can get hairy if the charge has a heavy assignment of her own, but I know on my floor they usually carry a really light assignment.

You'll get more confidence as you do this longer on your own.

And I just asked my charge a question 5 minutes ago. It's okay!

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Specializes in NICU, PICU, PCVICU and peds oncology.

kcalohagirl is quite right. Those sorts of judgments come with exposure and experience. If you don't have either, you can't possibly make the decision without help. I've been doing my job for more than 10 years and I ask lots of questions. I'm famous for my polls... "I'm taking a poll. This is the situation. These are my options. This is what I want to do. What would you do?" People sometimes laugh, but I always get good opinions and in a way, I'm modeling behavior for others who think they should 'know it all' the minute their orientation is done. Since I'm usually the one people bring their questions to, I can almost hear them thinking, "If Jan can ask questions, then maybe so can I."

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Specializes in Telemetry/Med Surg.

I've been an RN for a little over a year now and work an extremely busy Tele unit. I feel that I've gotten up to speed without any problem but I'm still asking questions about things I'm not totally sure about want someone elses opinion on something etc. etc. All the nurses tell me that they would rather someone ask questions than guess and do something wrong and I feel comfortable with that. Chin up...it gets better.

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Specializes in ER, NICU.

Agree with others. Keep chin up, you will be very surprised that one day very soon you will have some very unsure "nurseling" come to you and ask YOU questions and you'll rattle it all off as if you were born doing it.

Being a first year nurse is like "two steps forward one step back...."

Charge nurses are there for you to "bug" - they get paid more.:lol2:

(Please don't flame me, Charge Nurses!)

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Specializes in Pediatrics Only.

I agree with the above posts.

Also, this is how you learn. You say you didnt control the pts pain very well. Next time, you'll control pain better. Everything is an opportunity to learn, and with each learning experience you become better and better. You'll understand how to better care for patients by "mistakes" you have made in caring for previous patients.

Just take a deep breath and remember, its never wrong to ask for help. Everyone needs help once in a while.

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Definitely go to the charge nurse if you have any questions. That is wha t they are there for. Don't try to do something if you are unsure. It is always better to be safe than sorry. And trust me one day it will be like a light bulb turned on in your head. Everything will just click and you will feel confident and feel like you finally know what you are doing. I remember the first time I felt confident in my abilities. It was a really great feeling. I love my co-workers also. They are soooo supportive of the newbies and they are always available to help with anything. Without them I would of never made it.

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Specializes in telemetry, med-surg, post op, ICU.

Thank you for all the replys! I was pretty upset that night. I felt so not confident, so out of control. The thing for me is that I don't want others to think -- and I don't want to feel! -- as if I am being lazy or stupid. I am understanding betternow, though. My unit is very supportive and I feel that I can go up to any rn on the floor and ask them for help and they will give it to me. I guess I just sort of felt that I should be independent now that I am off orientation. I know now that this is not the case. I talked to my preceptor, some level three nurses, and a nurse who has been there for a year and they all reassured me that I am *expected* to go to another nurse quite frequently. I guess that's why they all keep asking me if I'm okay. :)

It's just a tough transition. School was tough, then orientation was tough. I got used to them both. This is like the last transition and I'm still trying to learn the rules. I have high expectations of myself and I value integrity, hard work, and "getting my job done". It's odd to be expected to rely so heavily on others. It is odd to not be expected to make my own choices. It's odd to be in a situation where I am encouraged to bug people 50 times a shift if that keeps the patient safe. It's odd but I'm trying to get used to it. :)

Thanks for all of the replies. What a journey this is!

Iona

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Glad to hear you are feeling better about things. Just remember.

Any nurse who says she has never felt like you is either. . . .

1. lying

or

2. So out of touch with her own limitations she is scary.

A true sign of maturity is being able to know WHAT you do NOT know, and be smart enough to know where to go to find the answers. Nobody in the world knows everything.

*hugs*:balloons:

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Specializes in Emergency.

Hello!

I am a new grad that is off orientation for about a month now. I feel a lot like you sometimes. Luckily, I have a great experienced crew who I work with regularly! I do often have questions that I will try to answer myself, and then I will "run it by" another nurse. I never have felt like they thought I should not be bothering them. There are nurses there who have years of experience, who will go to our ClinII with a question. Most of the time, I know what to do, and will be confident in my decision. Sometimes we all need help.Especially in difficult situations. Never be afraid to ask...After all, it's your patients safety at risk.

Amy

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Specializes in Utilization Management.

Iona honey, I got halfway through your post and I'm laughing too hard to continue. Please, please, please get a Journal going. I love your writing style.

Now, I'll go finish reading and try to give you some real assistance. :D But I had to say thanks for the giggle. I totally understand.

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Specializes in Utilization Management.

OK, finished. (And still giggling. I have my share of battle scars from those helpless-looking little Houdinis too.)

The one thing that kinda leapt out at me was the patient with the 101.2 temp. I'd be asking the doc for blood cultures followed by an antibiotic, a chest Xray, a CBC, (maybe even a D-dimer), possible neb treatments, and then an antipyretic and pain medication of some kind.

Sounds like she might have pneumonia or something going on in her lungs. A PE is also a possibility. Blood cultures are pretty standard for a fever, the CXR would be diagnostic, the CBC would clue you in with a WBC count, the neb treatments might help break up the congestion that could be causing the discomfort, and of course, the anti-fever and pain medication until everything else started working. Maybe a little O2 @ 2L with a Nasal cannula and positioning the patient with the head of the bed up might help too.

The point is, treat the pain, yes, but try to get to the bottom of why the patient is having pain and fix that, then the patient won't have the pain.

These are all things that I would not have known to do straight off orientation either, and if you didn't ask, how would you learn? Being a nurse is partly knowledge and mostly experience.

Until then, if I was your coworker, I'd welcome your questions and concerns.

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