November 06, 2011

"Never trust doctors"

Me: Doctor, my patients heart rate has been consistently greater than 110.

Doctor: Ok, lets try metoprolol 12.5mg IV every 6 hours. We give that, right?

Me: Ummm, yeah? Metoprolol 12.5mg IV every 6 hours, correct?

Doctor: Yes.

Me: Ok, thank you.

*hangs up phone and shows my preceptor the order as I had jotted it down*

Preceptor: OH MY GOD! You can't give this! You'll kill someone!!! Are you sure this is what the doctor ordered??

Me: Yes, I'm sure. I read the order back to him. He asked me if we could give this. I didn't really know without looking it up.

Preceptor: We have to get this changed. Call him back and tell him we can give 5mg IV. 12.5mg is a PO dose.

Me: *feeling very stupid and unsure of myself*   Umm, Can you call him please?

*medical director peeks head around from the other side of  computer monitor where he was sitting about 4 feet away from me*

Medical Director: *in a kind voice*   This is your lesson for the day. Never trust doctors. We depend on you to keep us from killing patients.

I think it's time to be scared now.

November 01, 2011

IV Starts

I can change the trachs of 3 month old babies. When I say "change the trach", most people assume that I mean changing the inner cannula. If you are not a pediatric nurse, you may not realize that pediatric trachs don't have an inner cannula. The entire trach is removed and a replaced with a new one approximately once per week. This is scary for pretty much every nurse until you gain confidence in your ability to manage emergencies (such as being unable to insert the new trach). I've had lots of experience. Doing this routine procedure does not bother me in the least.

I can insert foley's and straight cath patients of all ages and sizes. Again, doesn't bother me in the least.

I can give injections. No problem.

I can insert nasogastric tubes. No biggy.

I can pack stage IV decub ulcers down to the bone. I enjoy wound care.

So why in the hell can't I start IVs?!? I get nervous as all get out. I psych myself out before I even start. My hands shake scaring my patient half to death. I know I certainly wouldn't want to see me coming at me with a needle in my state! Why does this seemingly simple procedure get me so nervous? I just don't get it. I've done a lot of things much more difficult than this.

I got to spend a day with the IV nurse doing nothing but IV starts all day. I thought this would cure me. Big Fat NO. Out of about 7 attempts, I managed to get 3 in all by myself. The others I either missed entirely, blew the vein, or had to step aside to allow the IV nurse finish what I started because for some reason that I can't figure out, I couldn't advance the catheter!

It's not the actual IV stick that gets me so worked up. It's the thought of failure. Of missing that IV, of having to tell the patient I need to stick them again, then, when I miss for the second time, of telling the patient that I will get another nurse to try because I'm a big fat failure that has tortured you enough for one day. I get wound up just attempting to look for a suitable vein, especially when I can't seem to find any!

I know I'm psyching myself out. What I need to figure out is how to get outside of my own head.