Well, had my first shift as an HHC nurse...

[arabstarRN]

This was my first shift of my first nursing job (I am also hired with a SNF/LTC but awaiting orientation day) and was also hired part time with a home care agency on an as needed basis due to my other job I will be starting. They had a nurse leave the agency and so they were in need for a nurse to go out on saturdays to this patient I was with tonight. Of course I was nervous seeing as this is my first nursing job and I am still unsure about the home healthcare. I am awkward being in someone else's home like that, especially since I am not used to doing so and was provided two hours orientation to the client and barely had any hands on training regarding the client's care.

It's not a difficult case, mostly just monitoring and passing meds, but its the little things that I missed that I am upset with myself about. For example, I did not know this man wore glasses, I assisted him to his wheelchair and he went into the living room and started watching TV, and stated he was ok when I asked him. As it started getting dark, I turned the dining room light on, went into the living room and asked him if he was ok and he said yes, and kept watching TV, I asked if he needed anything and he said no. His wife came home and said I should have lights on in the living room with him and he should have his glasses on - I didnt even know he wore glasses and I thought he didnt want the light on because he didnt say he wanted me to turn it on when I asked him if he needed anything (I realize that this was probably a severe lack of communication and I should have asked if he wanted a light on, and I am kicking myself for not seeing that).

This man wears a brief and I had been checking his behind for a bowel movement, and he was clean and dry every time I checked and he indicated he was ok and didn't need to be changed (I know better than to go on their report, especially if they have some cognitive impairments) BUT, and this is maybe my lack of experience, my lack of not having kids and changing lots of diapers on kids, and my lack of not having a lot of elderly in briefs, I missed that he was wet. His wife caught it right away when she got home and I felt horrible, because I have no lidea how long this man had been wet and I thought I had done my job in checking him thoroughly. I feel so bad about that. He didnt seem upset and I immediately cleaned him and changed him, but it still bothers me that I apparently missed this. I know I wont miss it next time, but I feel I shouldn't have missed it this one time either! I triple checked meds and tube feeding schedules and cath schedules (he is straight cathed 3 times a day for urinary retention) and missed the little things, the things that shouldnt be missed!

I really want to be a great nurse and missing these few things (the man being wet is NOT a small thing, that is a huge issue in my book and I am so upset that I missed that!) bothers me. Yes, I will remember his glasses next time, yes I will turn lights on, and yes I will DEFINITELY assess his brief all over to ensure he is dry and clean, but that doesn't fix the issue that it happened tonight. Honestly, am I just being hard on myself, or do I need more guidance/orientation/training before being on my own?

[caliotter3]

You are being hard on yourself and most of your discomfort is attributable to this being entirely new to you. You will relax and do better with each passing shift. Try to spend a little of your off time to think of things to look for and improve on. Ask for input from the family. There is nothing wrong with that. Good luck with your orientation to the other job.

[nola1202]

Oh my gosh, don't be so mean to yourself! This is part of having a new patient. Family knows them better than you do, so of course they pick up on the little things. I wouldn't sweat the light or the glasses. He may not care if he can see the TV perfectly. The brief, well, that's something you learn by doing. Now you know. Often family feels guilty for not being able to be there 100% of the time and they can be very nitpicky. I also have learned that the 1st cases I got with Home Care were the the very worst ones. Other nurses had tried and moved on

because the family was so difficult to get along with. Most families get more comfortable and more trusting with each passing shift. If they don't, it may be time to move on. Good for you for trying something new and different. You did really well for the first time in the home.

[Mandy LVN]

Don't be so hard on yourself!!! It's your first day as a nurse!! You have to give yourself a little bit of a break. Yes, you missed a couple things, but the patient was not harmed in any way. Relax, breath and just remember you are still learning. Even the best nurses with years and years of experience miss things from time to time.