NursingZen

I finally have some time to journal…last week was the toughest week for me since school started. I had my first back-to-back 12-hour shifts that went something like this:

Wednesday: Went to hospital to “pre-lab” a patient, meaning pick a patient to work with during your shift on Thursday. I chose an elderly man admitted for dehydration and a UTI. Upon being treated for dehydration, he became overloaded with fluid and developed acute renal failure. I asked his current nurse if the patient was very complex or was he someone that I could take care of on my own. She said, “Oh, he’s fine. He’s really easy!” Went home and researched everything about the patient’s condition and all his medications.

Thursday: Woke up at 5:30 a.m., biked to the hospital, and had a busy morning putting together all the meds and assessments my patient needed. I thoroughly understood his condition and had pieced together his whole history, complete with lab values to back up the history. At 7 p.m. I reported about the patient to the on-coming night nurse, and left the hospital feeling light as air because I thought I had done my job as well as I could.

Friday: Woke up at 5:30 a.m., biked to the hospital, and started preparing my meds again.

8:00 a.m.: My nurse and I helped the pt. avert a diarrhea disaster in his bed.

8:30 a.m.: I asked my clinical instructor to watch me give the medications. She said: “Sure! Now, tell me about this one. And this one. And what kind of anti-hypertensive drug is this? And is that the right dose? What’s the therapeutic range? What blood pressure is considered hypertension? What are the side effects of this one? And that one? And this one?”

Yesterday I had the details, today I had only the general idea. It wasn’t good enough.

“You’re not ready to give these meds.”

My confidence imploded. She was right. Shame flooded over me. If only she knew how many hours I spent preparing for this patient. If only she saw how prepared I was…yesterday—but that doesn’t matter. What mattered was that I had gotten sloppy already.

I sniffed back tears while I assessed my patient. When I noticed how sick he was–sicker than the day before–my shame grew. When I couldn’t choke back the tears, I snuck into his bathroom to talk myself down.

12 noon: My patient is looking worse. My nurse gives me no guidance, takes no initiative.

3 p.m.: The doctors order an EKG stat because his potassium level is too high.

5 p.m.: He may be transferred to palliative care. We tell his family. They burst out crying. I try to console them.

7 p.m.: I go home mentally and physically exhausted. It boggles my mind how nurses can take care of 4 to 6 patients at a time. I go home and make all sorts of worksheets to help me organize and learn my medications.

I found out later that my patient died the following day.

Lessons Learned: Don’t rely on busy RNs to see things from your perspective. Don’t get overconfident. Don’t be too hard on yourself.