Archive for January 2010
I know this is going to be the way it will be for me for a while. I’ll have hours or maybe even days where I feel like the nurse I dream of being. I am compassionate and accurate with my care of my patients, their stay in the ER is as short as it can be while providing them the services they need, and I am thorough and current in my charting as well as helpful and cheerful as I go about my work. I had one of those days this week.
I started working with a new preceptor this week on the 11am to 11pm shift. First of all this shift fits my body clock much better. I get up at the reasonable hour of 8 or 8:30, I get a nice breakfast and a few chores done before work. And I am alert through the entire day especially after dinner which is my most productive time of day. My nurse kept feeding me patients so that I always had four, but let me work pretty much on my own to care for them. I was able to keep up, I had hardworking CNAs that shift that didn’t disappear when I needed help with something, the unit clerk was in a good mood. The day went smoothly and at one point I thought to myself, “I kinda feel like a real nurse with some confidence, I can do this! and I love my job!”
Then came the day that I stumbled so often that I realize I need knee pads and thicker skin. I started the day with 3 patients; one that had been boarding in the ER already for 16 hours. He came in for a cough/COPD exacerbation and his chest xray had shown suspicious spots, (he had had previous lung CA) and possibly pneumonia. The ER doc admitted him but there were no beds so he was boarded with us until one was available. That day we had 8 admitted patients waiting for rooms. He was started on IV antibiotics, and needed a CT scan. His floor orders were numerous and he was grouchy. He demanded so much of my attention for so much of the day that I had a hard time focusing on my other patients. He wanted to go home, but did not want to leave AMA. I listened and talked to him, I got the admitting resident to come talk to him several times, the ER docs came by and talked to him and he remained uncooperative. He refused to sign consent to get his records from another facility. When his room was finally ready a little after 3pm, I called report but he refused to go to the floor.
All through this I ended up being delayed getting things done for my other patients. We were quite busy that day, I had a steady stream of other patients too including a 5150 hold patient beginning alcohol withdrawal. I constantly had the ER docs coming to me to ask me why I hadn’t done this or that yet. Sometimes they were legit, sometimes I was waiting on pharmacy or lab or someone else. I was kept needing to do two or three things at once and probably making the wrong choice about which came first. And of course the CNA’s were always vanishing.
Then I had the resident who had added on to the floor orders for my boarded patient earlier in the day reprimand me for not ordering a scan she had written an order for. I was totally confused and I felt all the self confidence drain from me as I stood there listening to her right there in the middle of the ER. My preceptor was gone from the floor she had a meeting for an hour and then went to the staff meeting (that I missed) so when she got back I talked to her about all that had been going on. I hadn’t realized that while our ER docs put the orders in for scans themselves, the docs for the rest of the hospital do not, she was expecting me to put that scan in the computer. I had gone through and taken care of all the rest of the orders, medications, O2 parameters, trying to get consent for records (which he refused) etc.. I caused a delay of this diagnostic. The funny thing was, that I had been calling CT all afternoon to get him in and they never mentioned that they didn’t have the order, they just kept telling me they were backed up and they would call, or they didn’t pick up the phone at all. The patient was also arguing with the docs all afternoon about not wanting to stay and have the scan at our facility, he wanted to go somewhere else. In the end with his family’s help we convinced him to get the scan and stay for one more dose of antibiotics, then he left AMA.
I was drained. There were so many times during his care that in hindsight I could have handled better. As well as handling the rest of my patient load while I had such a demanding patient. I see my mistakes, and I will be more attentive to those particular things in the future, but I can’t help thinking about how many more mistakes I have to make. I am so afraid of causing someone harm rather than inconvenience or delay in their care. And I just don’t like the feeling of not being on top of my game. In the meantime, I’m standing back up, brushing off my bum, putting on a confident smile and showing up.
I have always been quick to learn, especially when I am really interested in something. I read everything I can find, I talk to people and ask questions, and I study stuff until I conquer it. I don’t know if it is the enormity of this field or the fact that I am into my sixth decade that makes me feel so inadequate. I am just not used to feeling so slow minded. Particularly at my age, I have lots and lots of experience in lots and lots of areas, just not nursing. This worries me, since I only have about a month left of my orientation before I am on my own. I just don’t want to cause any harm to my patients. I can’t see that one more month is going to give me any more confidence than I have now.
Some days I come home and ruminate over the mistakes I have made and wonder if I’ll ever get it together. Mind you, I haven’t caused any harm to a patient, just delayed their stay in the ER or made the MD frustrated. I do things like set up for a pelvic and forget to get the vag light out of the Omnicell, or assist with an LP and not have extra saline flushes in my pocket, or not notice a discharge up for my patient and stop to ask the MD what their plan is for the patient. It would do my spirit better to think about the things that I have done that made my patient’s experience better, like listen to their story and reassure their fears, like bugging the doc to take their pain seriously and give them some medication, like spending time with them at discharge answering every last question they have.
This job is challenging, hard, frustrating and most rewarding. I just hope I didn’t start too late in my life to make it all the way up the learning curve.