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. 
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. 
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
