No Good, Very Bad Day

Saturday was my worst day ever at work. Allow me to share with you a partial list of what I did during the course of my 12-hour shift.

• I hung a liter of D5 1/2 NS instead of the ordered D5NS (that's all abbreviations for types of replacement fluids, by the way--water with 5 of dextrose and 0.45% sodium chloride, instead of water with 5 of dextrose and 0.9% of sodium chloride) and didn't notice, but my preceptor did, after 300 mL had already run in. (Incidentally, this was a non-big-deal clinically but went a long way toward making me feel like an incomptent boob.)
• I spilled a patient's ginger ale all over the floor. I wiped it up, and then should have called housekeeping to come mop it to get rid of the stickiness, but I never did.
• I grabbed the sprayer for cleaning out bedpans and somehow depressed the lever prematurely, and got one whole side of the bathroom wet, including the toilet paper.
• I forgot to get morning vital signs on the guy in Room 28, and didn't get any until noon.
• I totally missed the 10am dose of oral Lopressor for the guy in Room 38. Just somehow didn't see it on the med sheet. Fortunately (?) they were deciding to go up on his Lopressor dose, anyway, so he did get the new higher dose around noon.
• I somehow decided that 24 divided by 8 was 4, and so pulled 4 tablets of Zofran to pre-medicate the guy in Room 28 for chemo, instead of the needed 3, and my preceptor noticed it before I did.
• I didn't know that you throw away cyclosporine tubing after each use, and spent 5 minutes trying to get the damned locking adapter off the end of the tube, where it was stuck (because cyclosporine is hellaciously sticky stuff--just another little vastly useful tidbit of knowledge for you).
• I put on the ID bracelet for a new admission too loosely, so it could slip off her wrist, and I had to ask the unit secretary to print me out another one.
• I had a hard time taking an apical pulse on the guy in Room 38. Who can't find a damned apical pulse? (That essentially means I couldn't consistently hear the boomp-boomp, boomp-boomp when I tried to listen to the guy's heart to count the beats in a minute, which I was doing because the pulse in his wrist was all erratic. Gold-standard for pulse, especially when the heartbeat is irregular, is listening to the heart with a stethoscope for a full 60 seconds.)
• I repeatedly forgot to get more saline flushes for Room 28, and he was on MRSA precautions, so I had to keep gowning and gloving and then de-gowning and de-gloving as I went in and out and in and out of his room.
• I started crying in Room 38 while the patient was in the bathroom, and didn't get my face wiped off in time, and he probably noticed.
• As I was leaving around 9:00, 2 hours after my shift was supposedly over, I got all the way downstairs before I remembered that I had left my jacket, with my car keys in the pocket, back up in the break room, and had to go all the way back up and get it.

As you can probably tell, it was one of those days where things start out badly and then just get progressively worse as one loses all faith in one's own abilities, all ability to think clearly, and all concentration for anything but self-recrimination. I am very grateful that none of my little disasters actually had much of an impact on patient care, and shudder to think that they might have.

I've been trying to figure out just what went wrong. I really, really, really don't want to live through another day like that one. Part of it, I think, was that I had been frantic and flustered and rushed the day before. Both at work (a rare 8-hour shift) and then at home, I was running to try to get things done and feeling very frayed pretty much all day. And then I rushed to go to sleep, so I could be rested enough for a 12-hour shift, and then I got up and rushed to work, and so by the time I got there, I was already all jangled. I started out the day without enough calm and attention to sit down and really take in and process a whole bunch of new information about two somewhat complicated patients. I started feeling anxious and overwhelmed almost immediately, and I just never was able to catch up after that.

The other problem was Julie, my preceptor. She's the nice one, the one who always knows just what to say and just how to handle me. Saturday, though, she seemed suddenly to have lost faith in me. Instead of responding to my being scattered and freaked out with her usual relaxed confidence, for some reason she started looking at me like I was really Not Okay. She gave her usual little pep talks about doing what I needed to do to recover, and to try to put things into perspective, and to realize that things were not actually as out of control as they felt like they were. But for some reason, her tone and her facial expression belied her chill-out message. Her nonverbal attitude was one of Grave Concern.

As the day wore on, and I tried to take some opportunities myself to lighten up and get a grip and snap out of my tragic-screw-up mindset, she seemed to make a point of pulling me back down. It was weird. Once I spent a minute, or maybe two, joking around with an old favorite patient, and came back to where she was sitting at a computer with a smilier, more confident manner than I'd had all day. She started in immediately talking very seriously to me, at length, about the things I hadn't done yet (including some that weren't even due for another hour or two). It was the same story after lunch, when I was feeling refreshed and cheered up by sitting around for a few minutes with other nurses in the break room, talking and laughing about dumb things. This time she even managed to mention that it was Week 7 of my orientation, the implication apparently being that I was alarmingly behind where I ought to be. And then, toward the end of the day, I came out of the room of the new admission, having just done the 6-page admission assessment questionnaire (Have you had any changes in your bowel habits? Have you fallen recently? What is your religious affiliation?) as I was supposed to, and remarked to Julie that it was so nice to get to really have a conversation with a patient, that it helped me remember what this was all about, that it was most fundamentally about the people and not about the tasks, and that was the thing about the work that really fed me. She agreed (half-heartedly?), and then a minute or two later gave me another little lecture about how it was very nice to talk with patients and all, but at this stage, I really needed to concentrate on the tasks. As in, I may tell you to try and put things in perspective and that this is just all part of the process, but you need to know that I don't really mean it, and you'd better not think for a moment that you're doing fine and things are okay, because you're not, and they're not, and you sure as hell better wipe that smile off your face, missy.

Sigh. I don't know. We'll see how it goes tomorrow. It's funny. Now I'm even wishing I had Jessica as my preceptor instead of Julie. But maybe we can come to an understanding somehow. If it's bad again, I might even have to say something kind of direct. Bleah.