Feeling inadequate....

:frustrated: I am 60 years old and have been travel nursing for 3 years. I love it. I have 30 years of nursing and feel very confident in everything that I do. This job was to be a med-surg position. Not once was telemetry mentioned in the interview. My skills check list and resume reflect that my telemetry skills are 8 years old as is my ACLS. I do not want the responsibility anymore. I am sliding in to home base with chocolate in one hand and a glass of wine in the other with lots of wonderful memories. After orientation-no telementry mention- I get on the floor and it has 4 halls telemetry, med/surg. I know my basic arrhythmias and I know when to call an MD. The telemetry is a separate room and thery call you if there is an irregularity but it stops there because that's all they know. I mentioned this to my preceptor who stated --we need to get you in a class. I said that was OK. My patient nthat I received apprently had some tachy/brady arrhythminment. My rehis assigas during the night shift and the Dr. ordered Digoxin 0.25 mg IF Q4hours x 4 does. I gave the last dose at 8 AM that morning..Apical pulse was 82 and regular. Around 10 AM they called from the tele room. Pt's pulse had slowed down. I went to room--patient had been having diarrhea ( a mass in her lower colon- NPO for colonoscopy but no prep had been started. I got her off the commode-placed in bed. A-pulse was at 84, she was asymptomatic. I thought a vagal reponse and left her and checked on her frequently. She continued with diarrhea and N/V all morning. Her general intern arrived ranting and raving--"She could have flatlined" "Why didn't you call me?" Continued on with his ravings to other nurses, charge nurses and Manager. Bottom line is they have asked me not to take the extension that they presented me with a week ago but by all means to finish with this assignment. My agency has been very supportive in informed the Manager that they misrepresented there need and I was honest on my applications. The patient was transferred to the unit and the first thing the CCU nurse said was Why did they give her Digoxin. I wish I knbew more but I"m hurt and embarrassed. I know s____t rolls down hill but this has been my first. If you are on a floor like that..should you give cardiac drugs IV? I did look it put and gave it correctly and she had already been given 3 does before by another nurse. Her dig level showned 3.6 that afternoon. This is keeping me up at night.:endof:

I don't see what you did wrong- you checked the heart rate before giving the dig, she was on tele, and even though you said her rate slowed for a brief moment, it came right back up & you continued to monitor it. I agree- probably vaso-vagal. I wouldn't have called the doc unless the rate went down & stayed down for more than a couple of minutes.

0.25mg iv digoxin...seems like a lot, especially if the patient even had a brief period of bradycardia, and already had 3 doses--especially if it was long enough for the tele nurse to have mentioned it to you. i've seen 0.25mg given as first dose and then following doses tapered. i don't think that you did anything wrong, but considering the dose, and that brady episode, i may have held it until md had time to do rounds and r/a. i know we can think for ourselves as nurses and it seems so easy in hindsight. i remember i had a tele patient i gave dig to after taking apical/radial pulse >80 but the tele nurse who was covering for breaks forgot to mention to me about a brady period earlier. i was really upset, because if i had known that beforehand i would have definitely held the dose until seen the md on rounds. oral dig is given at 14:00 so that would have given me lots of time to check with md. (i've even held meds, even when the doctor say to go ahead and give it--ie., atenolol or sotalol with hr 58-60) i was lucky in my case the patient went brady but was asymptomatic. unfortunately in your case they had to go to the unit. take it easy on yourself. sounds like the unit isnt very well coordinated with poor communication between tele nurse and floor nurse.

Geez!

I know this post is old but what a terrible way to treat the traveler. I agree that this hospital has a serious problem with how they monitor patients and hand off communication. This writer indicated that the patient remained asymptomatic and the bradycardia wasn't significant nor was it sustained. No specific mention was made about the blood pressure but I'm sure it was adequate given the rest of the reported findings. This patient sounds fragile and would require close monitoring anywhere. I think the traveler was very vigilent and did nothing wrong. I'm sure that were the telemetry history to be researched, it would be discovered that those brady episodes were occurring all along with or without Dig. As was suggested by another reader, due to the GI symptoms, the patient was likely experiencing vaso-vagal stimulation which would account for an increase in the frequency of bradycardia irrespective of the Dig. I wonder if the ICU nurse assessed the patient and reviewed the meds and telemetry history before making the derisive Dig. comment. Finally, the doctor's behavior was ridiculous and transferring the patient to the unit seemed punitive. How was this action to benefit the patient? Was there a change in her treatment plan that could only be carried out in the unit? Is there some prophylactic paint on the walls there that prevents flatlining? Give me a break!

Joperry, if you're still out there, I'd advise you to dust off your heels, take your Bordeaux and chocolate and go to another place where your diligent nursing care would be appreciated.

R