When does this get better?

[brittany_micah]

I graduated in May of this year and was a Student Nurse Associate on a pulmonary unit all through nursing school. But I had my heart set on working in cardiac or ER. So you can imagine how stoked I was in June when I got an offer on the Cardiac floor!! My orientation was rather eventful, my 2nd week my preceptor was out sick so I tagged along with another new nurse. I found my patient unresponsive and had to start CPR on him (which I had never done in real life), the ER dr was really unimpressed with me for not knowing what had happened to him. I knew I hadnt given him any meds, he was fine earlier, come to find out he had a seizure and had aspirated on his lunch I cried for days! I did learn a lot in orientation but of course you cant learn everything.

Now I am in week 2 of being on my own and I feel completely stupid! Our patients are very sick, not just cardiac reasons but respiratory failure, etc. We team nurse so I usually have an LPN with me and a CNA, but ultimately I am responsible for 10 lives! SCARY! I'm finding it difficult to keep up with everything, to make sure everything has been done. While some of our LPN's are great about giving meds on time and telling me new info some aren't. I get nervous around the chest tubes and pacing wires. My pt yesterday come up from the unit with an epidural, the bag was empty so I just quietly asked the unit nurse how to change it. She looked at me and said "you dont know how to change it?" I really didnt want to announce to my pt and his family that yes I am a new grad and no I dont know how to work it. :/ At this same time I had two others having chest pain, one who had had a heart cath and his site was bleeding, one in respiratory failure and was getting ready to call a QRS (rapid response) on. In all the craziness, after my pts were stable I look at a pt's potassium level and see 5.4, I confirm with my LPN call the dr and realize that it's 4.5, he proceeds to ask me what the normal potassium level is and what I want him to do about it? :/ talk about embarrassed! Trying to recover from that, staffing is trying to give me 1-2 more patients. WHAT? I explained to my manager that I was not trying to be a problem, but with all of my other pts having so many issues I couldnt take anymore pts. She agreed and said that they could hold them in the other places til I had a discharge. I feel like I am constantly second guessing myself, forgetting stuff, and running like a chicken with my head cut off.

I know that I am not alone. I'm wondering if I made the right choice going straight to a cardiac floor. When does it get easier? better?

[HouTx, BSN, MSN, EdD]

From your description, it would seem you are pretty much on track for a new grad. You are asking for clarification when needed & seeking assistance when you're faced with tasks you are not familiar with (epidural).... I'd be happy to work with you.

This is a time when you're dealing with a major learning curve. As an educator, I have a much more positive frame of reference for all of the "mistakes" you cited. From your post, it seems that each time something happens that makes you uncomfortable, you are reflecting on it and analyzing what you should have done instead. As a result, you are rapidly building your expertise. Hey, I'll bet you no longer call a doc about a lab result without double-checking it, right? You now know how to deal with the epidural infusion, right?

I know that sometimes it's very difficult to see the big picture but I encourage you to take a step back and compare your practice today to what it was back in May.... you have undoubtedly made a lot of progress.

BTW, when you work with an LPN, you are supervising but not really accountable for their work. Anyone with a license is accountable for their own practice. You are not responsible for anything that you were not aware of or could have reasonably foreseen. Just make sure to validate your LPN's level of competency prior to the assignment - this can be as simple as asking "have you done this before?" or "are you comfortable with this procedure?". Touch base frequently enough to maintain awareness of what is going on.... it'll be fine.