I have had the most horrible two days in Clinical Rotation…all you nurses reading, please advise! Here is my scenario, and for the sake of privacy, I will be switching up my stories!
The hospital I am at has med/surg floors that deal with specific illnesses, like most hospitals do. The type of floor I am on is not relevant I suppose, but the following information is. My MAR indicated an IVPB of Penicillin G Potassium to be hung at 1000. Already flowing in the primary was 20 meq potassium in NS with magnesium sulfate. I was told by my instructor to be ready at 1000 to dispense medications. Now keep in mind that 5 other students in my group are administering medications. In what we call the “IDEAL” world, there is a 30 minute window to give meds. Our instructor expects this to happen. So here is the dialogue, listed in times incremements:
Me 1000: Meds ready, brain ready.
Her 10-1115: With other students giving meds.
Me 1116: ???
Her 1117: Ok tell me about your medications (standing in the nurses station)
Me 1117: “Ok I have this and that…and Penicillin G Potassium 100 ml/per hour, the fluids are compatible because I looked it up in the IV Compatibility book”
Her 1118: “Really? Are you sure about that?”
Me: “Yes, because I looked in this book and there seems to be no interactions according to it.”
Her: “You sound like you are second guessing yourself. You really aren’t sure are you? Do you realize that you are almost 2 hours late giving this medication? Do you understand what this means? And now, you aren’t even sure that these medications are compatible after I have given you all this time to look them up?”
Me 1119: <about to pass out>
Her: “You need to get on the phone with a pharmacist right now and determine if these are compatible.”
Me: I scurry to the phone trying to look as confident as I possibly can, because after all, I HAVE just second-guessed myself. So I call Pharmacy and get put on hold. She is getting even more angered by the second. She sees a Pharmacist sitting across the nurse’s station. Tells me to hang up and go ask him. I do. I tell him the situation. He writes it down and says he will get to it. I go back and tell her. She says “No, you need to go ask him again.” So I go ask him again and he says that he is in the middle of writing orders and will look at it in a bit. She is fuming!! Tells me to get back on the phone with Pharmacy. I call. I hold. Someone calls back and says the Pharmacist is unavailable because he is assisting with Chemo meds. During this time, another nurse hears our debacle. She shows the instructor an intranet website the hospital uses to check for compatibility. And golly gee darn, the meds ARE compatible. Guess what time it is? 1155. So we head to the med box to gather the medications that should have been given almost two hours earlier. Guess what? The meds have already been given by the nurse who is over that room.
I felt so cruddy about myself. In post-conference she mentioned the situation to the group. Said she was very disappointed in the way we prepare meds and how we do not know our drugs. So last night I came home and was DETERMINED not to let her defeat me. I made my own patient “brain” which is a sheet that I write all my Vitals on, medications, allergies, etc. Basically all of the pertinent information that you really need to know at all times. I had a plan to be very organized and informed and show her that I could rebound from the day before (which really wasn’t my fault, right??).
Wednesday:
Pre Conference begins. She advises us that we really need to be “on it” today and know what we are doing. Meds need to be given in a 30-minute window. She should not have to do anything but walk up to us, and without saying anything, we need to start spouting off everything she needs to know (side effects, interactions, indications, etc.)
Remember that I had a plan to have ALL my ducks in a row. I was giving a Beta Blocker, I need to know the Blood Pressure and Heartrate prior to administering. Did that. I had lab values. I had side effects.
Her 1045 (after giving her all this premeditated knowledge): “Really? Hmm. What is her diagnosis?”
Me: “She has ABC, XYZ, and JKL. She was prescribed the blocker because of consistently high BP’s and HR for the last few days.”
Her: “No, what is her Medical History? What is the reason she was here for before?”
Me: <Sweating, about to die>: Umm, well, this is a blank floor, so she has been treated previously for blank. But now she is being treated for ABC, XYZ, and JKL.
Her: <Long stare, too long IMO>: “Really? You really don’t know what she is here for do you? You have no idea.” She says to classmate: “Jane, do you think you could help her find out why her patient is in the hospital?” To me: “This is what we discussed in pre-conference. I have given you all this time and you STILL are not ready.
I am on the verge of tears. I have become resentful. How is it that I shouldn’t be feeling some resentment?
The weirdest part: I come home and take a nap. I am physically and emotionally drained. I sleep for three hours and when I wake up I realize what I have been dreaming about. People dressed in Wendy’s costume (from the Wendy’s Commercial) who I had caught stealing medications and they tried to have them filled at the pharmacy. I dream I am involved in a lawsuit involving those medications. I dream of an old, dear friend who had a blow up mannequin to travel with. There is way more, but I should save some for later.
