Ever get that sickening feeling that something just went very, very wrong? This month, we will be identifying and discussing worst nightmare scenarios in the lives of nurses. Some of these scenarios have been experienced first-hand, and others are “war stories” nurses have shared with me over the years (details have been altered to protect privacy).
Obviously, scenarios involving war/mass casualty, widespread weather destruction and abuse are the worst of the worst nightmares, but I chose scenarios similar to what you may experience in daily practice. Here’s my advice on these real-life scenarios in case you find yourself in any similar situations.
Your worst nightmare scenarios, part 1: Student/new grad edition
1. The sun shining brightly in your window wakes you. You realize with a jolt that you are already an hour late for your 7 am clinical at the local hospital. What should you do?
I hope you have your instructor’s cell number: Call him/her with an ETA on your arrival as soon as possible. Alternatively, call the assigned unit and leave a message with the charge nurse if you are unable to reach your instructor. Penalties for late clinical arrivals vary with each school, and you risk failing the clinical class if tardiness occurs too often. Take precautionary measures with multiple alarm clocks around the bedroom if you are a sound sleeper.
2. While shadowing a staff nurse in the OR, you witness the scrub nurse break sterile technique. No one else seems to notice, and your instructor is not currently with you. What should you do?
This is tricky. Staff will question your ability to determine what sterile technique is, since you are still a student. Your best option is to quietly describe to the staff nurse what you saw, and ask “Is that okay?” Depending on the response, you may need to discuss the situation more with your instructor to see if anything else should be done.
3. You get home after a long day at clinical, where you witnessed an unexpected code 30 minutes before the end of clinical. You suddenly remember that you charted giving an oral medication on your school paperwork, but in all the chaos, you forgot to document the medication on the official record and forgot to report this to the patient’s nurse. What should you do?
The nursing staff on the unit needs to know you gave that medication right away, but most schools prefer you contact your instructor first if any problems arise. If you are unable to reach your instructor, call the unit and request to speak directly to the nurse taking care of that patient.
It is a good idea to jot notes down of what occurred for your own records (do not use patient ID information in your narrative), just in case you need to jog your memory about the incident later on. Inform your instructor(s) what happened when you are able to reach them. If you will be in clinical on that same unit the following day, make a late charting entry on the previous day’s MAR as directed by your instructor.
4. You have been off new grad orientation for two weeks, and are assigned to critical care bay in the ER today. You finish doing a brief assessment on Mr. F, who is complaining of chest pain and nausea. He states, “I don’t feel so good,” vomits, then loses consciousness. Monitor shows ventricular tachycardia in the three leads on the display. What should you do?
Give a hard precordial thump on the chest while calling for help (loudly, so your coworkers will know you mean business!), then brace yourself for a mad rush of interventions. Even if you managed to become CPR/ACLS certified during your orientation, you may not be comfortable participating past the initial interventions. Do not take offense if experienced coworkers push you aside and take over. Use the opportunity to watch and learn. You may gain valuable experience by becoming the “documentation” person, writing down everything as it happens.
What situations as a student or new grad have made you cringe? Tell us all about them in the comments!