September 6, 2014 at 3:51 PM #16051
I am fresh out of nursing school. I have my BSN and almost immediately was hired at a med/surg unit. My passion in psych nursing. I study psych nursing every chance I get with the hopes of someday being a psych RN. Right now however, I am working in the med/surg unit to fine tune my basic nursing skills.
Most of the time I feel because of my newness, I feel inadequate, slow and just all around not good enough but everyday gets easier with the help of my co workers and I know that soon I will be rocking it. This story is about how I gain a world of confidence when I finally spoke up and made my first own call about a patient and got praised for it.
I work in post surgical, a patient came back from a spinal fusion. When I got report on this patient I was told that her morphine PCA was being held overnight due to hand tremors that had started in the afternoon. Before I did my assessment I took a look at her medications and saw that she was on lithium. Since I had studied psych nursing and psych meds so much I remembered that not only does lithium have an extremely narrow therapeutic range but that toxic levels can cause hand tremors, lethargy and profuse sweating.
Upon returning the room I saw that this patient not only had the hand tremors but she was lethargic and a little sweaty. I took her arms and bent them back and forth and they were doing something called “ratcheting.” A psych doctor told me toxic levels of some drugs will cause the arms to jerk with passive movement. When I looked in the computer I saw that she hadn’t had a lithium screen done in 5 months!
I promptly explained to the hospitalist on call for the night shift that I thought the lithium could possibly be contributing to the hand tremors and that it wouldn’t hurt to get a tox screen, he agreed and had me order it. The lithium levels came back at 2.0! with therapeutic levels being 0.6-1.2! I was so glad we caught it before she got another hefty morning dose of lithium!! I was about to report the result to the doctor when he walked into the nursing station after his rounds. He had already seen it and was sitting down to hold the lithium and to start the lithium toxicity therapy. He saw me put his hand firmly on my should and said: “Good catch.”
Good catch. Two words from a respected doctor at my hospital was all it took to shout my confidence through the roof. I did it. I am a new nurse that actively put my knowledge out there and applied it to a real life situation. I know I am on my way, and getting that pat on the back for that doctor was a nice confidence boost I needed.
Just wondering if any of you follow nurse have gotten praised for something you said or did for a patient that would have otherwise gone unnoticed? I know it is a great feeling.September 18, 2014 at 10:43 AM #16185
Wow! That is a great catch. You are already a great nurse, keeping working at it and everyday things will come easier. You rock!
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