Third week off orientation and getting the hardest patients in the unit

Published

Lately I have been feeling really flustered with the whole nursing career. I just got off orientation less than three weeks ago and I have had the HARDEST patients. I work in the ICU and spankin' new off orientation, I came in thinking that the charge nurses were going to take it easy on me at least for the first month. But to my dismay, I was wrong. My third day was a nightmare! I had two patients. The first was a renal patient with NOOOO veins. He had a vascular access that was being used during the day shift, but when the Nephrologists came in at 2 pm, he wasn't happy that we had been using his site. So when I came in at 7 pm, the patient had no IV access (this is the point when the day nurse finally figured that it was time to get IV access, but left it up to me). To make a long story short, the only reason the guy was in the unit was that he was on an insulin drip that had been turned off earlier in the day. Just as I was about to transfer him to the floor, his blood sugar shot back up (400 at 10 and 350 at 2 am) I had been talking to a resident all night long and when she didn't know what else to do, she told me to call another doctor, who proceeded to yell at me for the patient being in the unit with no IV access. I explained to her that I had been trying (as well as more experienced nurses) to get an IV in him all night long and was asking if I could call ER to put an EJ in him. She snapped at me saying that ER was too busy and to just to cover him with regular insulin. A while later, I went into his room and he said he felt his BS getting low, so I checked his BS again and it was 50!!!! As I ran to get him his glucose tablets, I happened to look into my other patient's room....

My second patient was on a vent and had become agitated. I gave a bath at 4 am and after we got him situated, his heart rate decreased to 35!!! It went back up, but I called the doctor, who gave me no new orders. The respiratory therapist had been trying to wean him off the vent. I knew something wasn't quite right and when I told her that he might not be tolerating it, she told me that everything was fine because his SPO2 was okay and yada yada yada. Well guess what, the guy bit a hole in his tube (but we didn't know it yet) so as I was walking to get the glucose tablets, I noticed my vent patient had a low BP. I asked another nurse to watch him because his BP hadn't been that low while I went to get the glucose tablets. A few seconds later, his heart rate dropped again and we ended up coding him :crying2:

All of this is my third day off orientation...but it gets better. Since then, I have had two GI bleeders, an aortic aneurysm train wreck, and a liver failure patient on three drips with fluid overload and no urine output. Someone tell me it gets better!! I know the reason that I feel like I hate it is because I don't have experience. And the nurses on my unit are really helpful. I'm not saying that I don't want these patients because I need to learn, but when does it get easier?!?!?!?

And to top it off, I spoke to one of the charge nurses as I was leaving yesterday, and she says "I've been trying to give you the good patients and not the boring ones!!" :angryfire

Up Vote Up Vote ×
Specializes in Nursing Professional Development.

Try to see the positive side of these assignments. Yes, it's stressful. However as a new nurse, people are "keeping an eye on you" in a positive way. They are looking to help you as they know you may need the help. If you were to go a month or two with "easy" assignments, you would probably relax a bit and you would be in danger of having your rate of learning slow down. By the time you got these difficult patients, the staff support might be less available as they stop thinking of you as being new. I've seen that happen many times.

The new nurse gets the easy assignments and she reaches a premature plateau in her learning. As time passes, she gets comfortable with the more stable patients -- but may become increasingly afraid of the really scary ones. Six months later, the staff doesn't see her as "the newbie" anymore and is not paying as much attention to her learning needs. They have moved their attention to the newer nurses. More time passes and our nurse now feels she is expected to be able to handle the really tough cases -- but she is very afraid of them -- and the staff doesn't seem to be focusing on meeting her learning needs anymore! They expect her to know her stuff by now! The situation goes down hill from there.

As long as you have to the support of your colleagues ... it's best to keep stretching yourself a little at this point of your career. You should start feeling more comfortable somewhere around the 6-9 month mark. You should feel even more comfortable at the 1 year mark.

Up Vote Up Vote ×
Specializes in Peds Hem, Onc, Med/Surg.

And to top it off, I spoke to one of the charge nurses as I was leaving yesterday, and she says "I've been trying to give you the good patients and not the boring ones!!" :angryfire

That is when you say, please don't do me any favors!

I'm sorry its so rough for you! I don't really know what to tell you except to hang in there and my thinking is that they are thinking highly of you because they know you are capable of handling that type of patient. Or so I think.

Up Vote Up Vote ×
Specializes in Family Practice, Mental Health.

Sorry to hear about your troubles.

Next time you get a patient with no IV access dumped in your lap and you're unable to get a PIV started, call the doc for an order for a PICC line and prepare to alter some meds for either a later start time or holding off all together until the PICC line is ready to use. (Of course, this does NOT excuse the Dr's behavior!! You are NOT a whipping post for someone's personal frustrations. I would have informed the Doc that he/she needs to take it up with the Nephrologist who left you in the lurch without some kind of line. The Nephrologist usually knows how poor of viens a dialysis patient has - What a big old MEANIE!!)

Next time you get a vented patient who is struggling and you're not sure what's going on, draw an ABG and go from there.

Airway comes before low blood sugar....

When you get report on a patient who has been on an insulin drip - check the labs first thing to make sure the Anion Gap is closed. If the anion gap is open, this is a good predictor of someone who may spike their blood sugars again. :)

Hang in there.....

Up Vote Up Vote ×
Specializes in Post Anesthesia.

It gets easier- the patients don't get less hard, you just get better at handling the day to day hurdles. In 6mos you will be able to head off most problems before they derail your shift. Ask yourself when you finish a night like those you describe- Is there anything you could have done differently to forsee the problem or better resolve the crisis. A patient in ICU with no IV access is a problem, but it isn't YOUR problem- the doctor wants IV access they you have a reasonable responsibility to try an attempt or two and if unable- notify the doc that nursing access isn't possible and a central line is required. You can't grow new veins for the patient and the doc should understand that-If they get "blame centered" then maybe it's time to talk to your manager about improving the docs attitude. As far as the ER docs being too busy- could be true- that dosen't change the fact that the patient dosen't have nursing accessable veins. Don't beat yourself up about things you have no control of. Learn to control the things you can and don't let anyone make you responsible for things that aren't your problem.

Up Vote Up Vote ×

When you get report on a patient who has been on an insulin drip - check the labs first thing to make sure the Anion Gap is closed. If the anion gap is open, this is a good predictor of someone who may spike their blood sugars again.

The doctor asked me to draw the labs and his anion gap was closing, so that's why we were going to transfer him to the floor. But man were we wrong!! And we only have one picc nurse that doesn't come in on the weekends or nights...*sigh* And you should have seen this guy's neck. It looked like someone had tried and tried to get lines on him without success.

Thanks everone for responding. It makes me feel better to know that things will get better. Like I said, I don't mind getting these patients because I know that's how I'll learn, but MAN I need a break because sometimes I feel like I don't want to go to work because I don't know what Im going to get. I do feel like my skills are better than they were two months ago, but I still can't see the light at the end of the tunnel :-( Hopefully it's coming..

Up Vote Up Vote ×
Specializes in Post Anesthesia.

....Thanks everone for responding. It makes me feel better to know that things will get better. Like I said, I don't mind getting these patients because I know that's how I'll learn, but MAN I need a break because sometimes I feel like I don't want to go to work because I don't know what Im going to get. I do feel like my skills are better than they were two months ago, but I still can't see the light at the end of the tunnel :-( Hopefully it's coming..

It may be best not to see the light at the end of the tunnel- Often it's a train comming at you!

Up Vote Up Vote ×
Specializes in IMCU.

When you get report on a patient who has been on an insulin drip - check the labs first thing to make sure the Anion Gap is closed. If the anion gap is open, this is a good predictor of someone who may spike their blood sugars again. :)

Hang in there.....

Please explain this. I probably should know but I don't. Thanks

Mahage

Up Vote Up Vote ×
Specializes in NICU Level III.

New nurses to my unit whether experienced or new grads get the hardest patients and most of the admits. I honestly hate it because it leads to burnout (been there, done that and got a new job...) and I think admits should be rotated. Being super busy every shift in a row = fatigue = mistakes. If this starts to happen to me, I have no problem letting someone know how I feel about it.

Up Vote Up Vote ×
+ Join the Discussion