Next time faster.

9 Sep

I had a another one of those self esteem bashing last three shifts. One of my goals as a new nurse is to try and utilize my resources and start pulling together the knowledge that  I know I have into my assessment and judgements to act faster. Now that I am home I see the situations in a different light. My first patient was lethargic and just really sleepy. The family member was insisiting that it was from the anti-emetic that was given to the patient earlier, the pulmonary MD was sure it was from the allergy medication that the patient was taking, and the attending was sure that the patient was just tired. I let it go even though in my gut I felt that something was not right, but I just did not pull the judgment or the knowledge together. Finally when I could no longer let this lethargy continue I asked the attending for ABGs–sure enough it was bad news. The patient was severely acidotic and retaining CO2. He needed to go to ICU and be intubated I was sure! However the pulmonary MD wanted her to stay and have bipap and ABGs again in one hour. I just knew it was not going to be right, but I said ok. A half hour later on bipap she was completely unresponsive even to pain and a rapid response had to be initiated. That got him to the unit in time.  Next time I think I will be faster.

Another patient that week came from the emergency department to telemetry when I just knew inside that the patient should of went to critical care. The patient had all kinds of issues going on–one problem was coagulopathy–the patient was on 2 different types of blood thinners for some reason and came in with hematomas everywhere. The other problem was acute renal failure–the patient got to the floor bleeding from where the central line that was placed in the ER. It took me a half an hour to stop the bleeding and then I could not get a blood pressure on the patient I could not even palpate a radial or brachial pulse! I had no way of knowing how the man was oxygenating because the pulse oximeter could not pick up a reading! I had to get ABGs and found out the patient was in severe metabolic alkalosis. So again I transfered another patient to the ICU which is where the patient should of went the from the first place. I mean even before knowing the ABG result the patient was severely sick. I made an attempt to plead the case to the nursing supervisor right after I got report to try and stop the wheels of this inappropriate transfer before it happened…to no result. It was just a delay in care for the patient.

The lesson I learned this week is to stand up for my patients better, louder even, faster.

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One Response to “Next time faster.”

  1. Michelle Leonard September 10, 2008 at 11:59 #

    I am a new nurse in Georgia who stumbled across your website some time ago. This post stood out to me because I know exactly how you feel. The funny thing is that we have the primal instinct to know when something is not right even if we dont know exactly what it is. Every day we get the experience and guts to back ourselves up. This is all a learning experience that you can use next time to better care for your patients. So, dont be bummed out because they did not die and in the end they got the care they needed. We are truly better than we give ourselves credit for.

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