4th day as an RN on my own

[november17]

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.

[CarVsTree]

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.

[Sisukas]

Where was the charge nurse in the area? When people come in extra for me, I'm there following them around on my knees thanking them for the first 10 minutes of their shift. I can truly say that in my facility you would not have had that kind of night because the CNS and/or house supervisor would have been up there making sure that folks who get out of bed on their day off to help have a good shift.

[november17, ASN, RN]

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

I like that, I'm going to steal it from you. I definitely need to work on prioritization. I can do it well on paper, but in practice it is a lot harder. I used to be a nurse aide and it is very hard for me to resist answering call lights (even if they're not my own), or asking a patient to wait a minute if they need to use the bathroom6

Where was the charge nurse in the area? When people come in extra for me, I'm there following them around on my knees thanking them for the first 10 minutes of their shift.

The charge was very thankful. In retrospect I think everyone was having a bad shift though. Honestly I guess I didn't do too horribly. I need to work on leaving work at work.

In comparison to the night I just had (my fifth day as an RN on my own), the night that I originally posted about was a cakewalk. I had a patient slowly "go bad" last night, and got shipped to the ICU. I know I shouldn't beat myself up about it, and I won't go into too much detail. This patient's BP dropped from 100s/60s to low 70s/high 30s. with a HGb of 6.7. Her output over 10 hours was 100, and I feel terrible that I didn't catch that earlier but I was working with 6 patients without an aide or LPN and I'm lucky I even got all my data collection done. I had to call the physician like 4 times and nothing I did helped at all. Then to top it off the patient refused a blood transfusion despite me, the charge nurse, the shift administrator, AND an ICU nurse all going in to talk to her about the procedure and the risks/benefits of having a HGB that low. There is a floating ICU nurse that will respond to situations like mine and she got pissy for not contacting her earlier. I understand where she was coming from, but no one ever told me that sort of support was available (except very fleetingly during my orientation). To top it off all my kids were late for school because I got out so late. And one of the oncoming nurse's eyes popped out of his head like "I CANT BELIEVE IT!!" when I told him I hadn't gotten the blood glucose of one of his patients yet ((completely asymptomatic of either hypo/hyperglycemia). No sympathy at all from the day shift, not that I expect any. I might as well put on a bulletproof vest. I just keep telling myself that as long as my patients are alive, breathing, circulating blood, conscious, and safe, then I'm not doing too horrible of a job.

I remember how hard it was at first when I started working as a CNA, but once I got past the learning curve it got a lot better. I orientated for a long time as an RN, but at the same time orientation isn't always what it is cracked up to be (especially when you're oriented on the day shift and then only get 2 days on the night shift). I've heard the first year is the hardest, so I'm just trying to keep that in mind.

I still look forward to going to work though I'm actually kind of bored sitting around the house tonight!

[NTPinky]

Think about it, to be a peds nurse and survive, you have to truly be a kind and compassionate person to handle sick babies.

One would hope that would always be the case, but I have a couple of friends who work at a peds hospital (on the same unit) and they constantly complain about their "mean" mgr. Another friend at a different hospital has similar complaints about co-workers who "eat their young" on her peds floor.

Also, I have type I diabetes and was in the hospital several times as a child, and unfortunately, most of the RNs were NOT nice to me at all. My parents couldn't be with me all the time because they worked, and I had two younger siblings at home, and I think the mean RNs took advantage of the fact that I was without my parents most of the time, and treated me like crap. I was a shy kid who never questioned authority and never told anyone, but I'll never forget the crappy way they used to talk to me and made me feel.

I had a nursing professor in school who always used to say thought peds nurses were "more evolved" than other RNs, and I cringed every time she said that.

Sorry to get off topic with my post, but I had to get that off my chest! :)

[treysdaddy08]

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'm sure you did fine. Being as morphine is a narc, I'm sure they just wanted to triple check as the night before was so hectic. Don't let it get you down. Remember, they wouldn't have called you in if they didn't think you were doing a great job to begin with!