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Discussion

4th day as an RN on my own

Warning: Just a vent. I need to vent.

I got a phone call from work and decided to go in. I got there at 11:30pm (shift is normally 7p-7a). Basically nothing had really gotten done for the patients except for the scheduled medications and initial assessments. So I tried to get a handle on the situations by going through the charts and trying to see what was going on, because the reports I got weren't super great.

At 11:45pm a cardio doc rounded. He walked up to me acting cranky because the patient was on tele, but the tele monitor had run out of batteries. I started to explain that I had just gotten there and would take care of it, but he gave me a look like, "yea right", spun on his heels while I was talking mid-sentence and walked off. Great way to start my night off.

At 12:30am the secretary handed me the results from an APTT for a new heparin drip. I noticed the physician that ordered it had written out this super long protocol that made absolutely no sense. I tried looking at it sideways, upside down, in a mirror. It was contradictory and I couldn't figure out what I was supposed to do. So I ended up paging him to clarify what exactly I was supposed to do to adjust the heparin. He called back (obviously half-asleep), and was cool about answering the questions I had, but I spent about 30 minutes trying to figure it all out and completely missed my break time in the interim. I wasn't going to take a full lunch but it would have been nice to grab a bite to eat.

Then of course, the nurse I was working with went on her hour long lunch break. Leaving me to handle her patients as well as my own.

So I rushed rushed rushed to get all the paperwork caught up. But call lights were going off like crazy. The nurse I was working with on our end of the unit was monopolizing the aide's time, so our shared aide was mostly tied up with her patients. And most of my patients were the type that if they'd even hear footsteps in the hall, they'd ding their call light for help to the bathroom/reach their boxes of tissue. When I went in to pass meds, change IV fluid bags, or anything they'd want to go to the bathroom. One of them even asked to go and said, "I'm not really sure if I have to go or not but I better just in case." Then proceeded to void about 50ccs. Don't get me wrong, there's nothing wrong with that, but it is very time consuming.

At 5:00am I got an admit from the ER, which was okay but all the paperwork started getting me pretty far behind with the rest of what I was trying to do.

At 6am, CT called. I had a patient that was going for a CT, and the person on the other end was saying, "Why do they need another CT? They just had one two days ago for the same exact reason. Does this really need to be done?" I couldn't really answer the question except there was an order. So I was flipping through the physician progress notes and the person on the other line said, "Maybe you can contact the physician and ask them about it?" And I said, "Okay." I figured the person on the other end was a professional and knew what they were doing, why else would they question it? So I got off the phone and continued reading through the notes, and thinking about why the patient was there in the first place. Then I realized that the patient indeed needed the CT. So I tried to call the CT office back and they didn't answer the phone!!! The secretary tried to call and they didn't answer. I tried again 45 minutes later and they still didn't answer. Of course at this point I was so tied up I couldn't sit there calling over and over so I made a note of it and passed it on to the next shift. This entire thing took up another 20 minutes of my time, and I was already running pretty far behind.

At 7am I realized that my admit had not peed yet. So I bladder scanned her for 500+, put her on a bedpan, and she could not go. So I had to call a physician and get an order for a foley.

In the meantime, at 7am, one of the oncoming nurses was all pissed off because I had only gotten half of my written reports completed. I'd never done a written report in my life, the floor I work on used to do taped reports, and I did oral reports throughout my clinical experiences. However over the weekend we magically switched to written report (I never heard anything about a switch). So I muddled through that and I feel like I did a crappy job at them.

The nurse who got the aforementioned CT patient got really ticked and was saying, "I walked into a huge MESS. I can't believe this. What a mess." It didn't really make me feel very good because short of personally walking across campus to the CT lab I feel like I did all I could do. We do these pain sheets where we have to fill them in every 4 hours. What pain meds we give, what the patient's pain levels are, etc. I missed the 4am spot for that patient, and she put a big fat line through it so I couldn't go back and fill it in. Then I overheard her say she was going to write me up for not filling in the pain sheet q4 like I'm supposed to. It wasn't that I wasn't assessing his pain or medicating it, because I was literally in his room every hour helping him to the bathroom.

Now I'm home, and I feel like a huge moron. It's 9:30am and I just realized that I forgot to hang one of my patient's 0700 antibiotics. There was so much happening right then that I had crossed it off my hourly to do list and then didn't do it. I'm sure the oncoming nurse caught it, since the antibiotic was sitting right on top of the med cart, but still, I feel dumb.

I didn't get any of the dressing changes done that I was supposed to except for one. So that probably looked terrible on my part too. Everyone's dressings were dry and they were all post op day 3+'s, but it still bothers me.

I'm scheduled to work tonight but now I don't even want to go back in. I generally look forward to going to work, but I don't feel good about last night at all. I'm usually very well organized but literally every time I would open a chart or get on the phone last night I would get interrupted by something happening. I can't figure out where I screwed up time-wise, because I literally was working my butt off all night long.Even when I walked out I stopped in the restroom and took a 90 second pee because I had been holding it for so long.

Bleh.

Featured Replies

  • Expert

Here's a hug! (((HUG))) :icon_hug:

I am so sorry that your night progressed so terribly! Personally, I've learned to never come into work for an overtime shift that has already begun, because I tend to fall behind before I've even arrived. For example, if the shift began at 6 o'clock, and I am called to show up at 9 o'clock, I now know better than to accept the shift.

Anyhow, you deserve some much needed rest (and venting).

It's amazing how much they expect one person to do, isn't it? And I'm QUITE TIRED of ending my shift with the oncoming shift being hostile toward me. Hang in there...you were starting off behind and some nights the patients are just sitting on the calllights. We don't even have an aide a lot of time on night shift at my hospital, so I know what you mean about how time consuming the toileting is. I think the expectations for new nurses are entirely unrealistic. I usually have 6 VERY sick patients on my floor and to think I can do total patient care on them is ridiculous. Anyway, don't be hard on yourself...you did all you could humanly do.

Emily

I think Commuter is right, you were behind before you ever started. It sounds like you were trying to cram 12 hours' worth of work into 8 hours (not that you had any choice).

It comes under the category "no good deed goes unpunished." I wouldn't be in any hurry to "help out" next time.

  • Author

I just took a phone call from today's charge nurse. I had pulled up some morphine in a syringe for a patient requesting pain medication, but then didn't give it because I judged them as being way too sedated to handle more morphine at the time. I had another RN witness me waste it into the sink. When I went into the omni to waste the dose, the computer wouldn't let me access that dose of morphine. I marked it as not given on the med sheet and had the other nurse initial it. But according to the omni it wasn't wasted. She was asking me if I was sure if I wasted it and didn't give it to someone else on accident. Now they think I'm doing med errors! Gad

what a horrible night.

I think Commuter is right, you were behind before you ever started. It sounds like you were trying to cram 12 hours' worth of work into 8 hours (not that you had any choice).

It comes under the category "no good deed goes unpunished." I wouldn't be in any hurry to "help out" next time.

To the OP, I start on my own as an RN in mid September. Ready, but still scared as hell. Everything the OP mentioned, I could see myself going through. I can tell she worked in geriatrics. Heart problems and having to get up every time you turn around to pee. Of course it takes forever and a day to get them oob!! Spent 18 months as a tech on a post CABG unit. Looking back on it now, I don't know how I ever took care of these geriatric pt's. SOOOOOOOOO much much much more happier as a pediatric RN. Everyone on the floor works together and you don't get a lot of BS. Think about it, to be a peds nurse and survive, you have to truly be a kind and compassionate person to handle sick babies. People say kids whine too much, noway that is the adults, calling for their 35 meds/day they take to add another 3 years to their life. One thing that drives me crazy with med-surg geriatric care, is the lack of quality of life, and denial of pt's that should so be in hospice. How many 91 y/o do you see still taking Lipitor, c'mon people, really gimme a friggin' break.

  • Author
To the OP, I start on my own as an RN in mid September. Ready, but still scared as hell. Everything the OP mentioned, I could see myself going through. I can tell she worked in geriatrics. Heart problems and having to get up every time you turn around to pee. Of course it takes forever and a day to get them oob!! Spent 18 months as a tech on a post CABG unit. Looking back on it now, I don't know how I ever took care of these geriatric pt's.

Actually heheh I'm a guy and I work on an ortho/neuro med-surg floor. Lots of knees, hips, and lamis. For some reason I did have a disproportionate amount of older patients last night though.

It's not really a confidence issue, or fear, it's just getting slammed with so much stuff to do and being expected to get it all done. It's nuts. It is very frustrating when orders aren't very clear, and I'm not ballsy enough to fix an order without phoning a physician first or just flat out write one. Some of the nurses know the physicians well enough that they know what to expect and can just go ahead and write an order and have the physician sign it in the morning when they round. Or they know what the physician meant when they wrote the order in the first place. It just doesn't really make sense to me yet.

They offered me the night off today because they were overstaffed, and I took it. Except I agreed to be on call. I hope they don't call :(

WOW! And I haven't even began to persue my Nursing degree!! Sounds like this would a lot to get used too. And now I see why they say nurses are so undermanned right now around the US. You all sound like wonderful nurses and need a BIG pat on the back for handling situations as some of you mentioned. Sometimes people don't get the hand shaking or the oral reconition needed:)

((((hugs)))) i so understand what you are going through, at times i wonder what i am doing wrong that i can't even find a spare minute to pee, the demands can be relentless and i use every opportunity i can to put the patient in control of their own needs and help themselves as much as possible but it still isn't enough you did exceptional i'm sure.

Actually heheh I'm a guy and I work on an ortho/neuro med-surg floor. Lots of knees, hips, and lamis. For some reason I did have a disproportionate amount of older patients last night though.

It's not really a confidence issue, or fear, it's just getting slammed with so much stuff to do and being expected to get it all done. It's nuts. It is very frustrating when orders aren't very clear, and I'm not ballsy enough to fix an order without phoning a physician first or just flat out write one. Some of the nurses know the physicians well enough that they know what to expect and can just go ahead and write an order and have the physician sign it in the morning when they round. Or they know what the physician meant when they wrote the order in the first place. It just doesn't really make sense to me yet.

They offered me the night off today because they were overstaffed, and I took it. Except I agreed to be on call. I hope they don't call :(

Hiya! I recently got off orientation myself--and your original post reads exactly like some of my night shifts. The whole thing with coordinating with CT--oh, that's exactly what would happen to me. Reading through progress notes, asking the patient, bending over backwards to encourage SOME outcome--CT or no CT....

I know there's a reason why somewhere, but being so new, I definitely feel like I'm facilitating communication between different departments that I really don't know enough about. How many times I click "send page" for various issues not knowing if I'm actually waking up some poor resident who's trying to get a 2 hour nap on a 24 hour shift, when really it's a matter for pain service or PT, and can't be resolved till the morning....

The resident orders a portable CXR--do I have to call radiology? If I page them and they return my call but I'm in the bathroom (cause I haven't peed in 6 hours), will they still come? I don't know. Better wait to see IF they call.

I'm also on an ortho floor. your experience--both with dealing with hospital systems/bureaucracy and patient care--are very familiar. You have my sympathies. What I tell myself is "i'm doing everything i can"--don't take comments from other nurses personally (i know, easier said than done), unless someone gives you some direct feedback/constructive criticism. Don't try to make adjustments in your practice simply to stay the behind-your-back mutterings of other nurses. Their complaint is not your responsibility until they address you directly and professionally.

Good luck!

I know there's a reason why somewhere, but being so new, I definitely feel like I'm facilitating communication between different departments that I really don't know enough about. How many times I click "send page" for various issues not knowing if I'm actually waking up some poor resident who's trying to get a 2 hour nap on a 24 hour shift, when really it's a matter for pain service or PT, and can't be resolved till the morning....

The resident orders a portable CXR--do I have to call radiology? If I page them and they return my call but I'm in the bathroom (cause I haven't peed in 6 hours), will they still come? I don't know. Better wait to see IF they call.

You describe this dilemma that newbies face well! Not fun but a good description :idea:

Sorry to hear about your horrible shift.

Almost everyday I'm at work I repeat my mantra,

"I can do one thing at a time and I can be in only one place at a time."

I continuously prioritize tasks and if I can't get to something during my shift....well, repeat mantra above. I do my best and work my hiney off EVERY SINGLE SHIFT. If that's not good enough, then HEY! repeat mantra....haha. It's helped me get through tough work days.

Sorry you had such a bad night.

My only advice is NOT to do extra shifts as a brand new nurse. Especially, extra shifts that were already in progress when you arrived. You haven't fine tuned your time management skills yet so it is too hard to catch up an already behind shift.

Just do your regular hours until you are comfortable. Then go for extra shifts. Until then, just say no, you'll burn yourself out.

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