9 Newbie Nurse Mistakes to Avoid

[Nurse Beth, MSN]

Here's some common mistakes you don't have to learn the hard way:

1. Painstakingly re-starting your patient's IV. One hour later, the MD discharges your patient. Before re-starting, consider the possibility of discharge, or if they even still need IV access.

2. Mistaking the female at your patient's bedside as his mother. Or his daughter. (It's his wife). This happens once in your career, at which point the lesson is learned. Similar to asking a woman if she's pregnant when she's not.

3. Leaving the rollerball clamped on your IV antibiotic so it doesn't infuse. Usually not noticed until the next shift. Face palm.

4. Dutifully clearing your IV pump but then instantly forgetting the totals. Now you have to calculate it all by hand. Always jot your totals down.

5. Reading tele strips upside down. Turn it around and voila! Rhythms look so much better right right side up.

6. A not-so- funny one: leaving the bed in high position and/or with side rails down. It's an easy mistake to make after transferring a patient over into the the bed from a guerney. A related mistake is not resetting the exit bed alarm when you put your patient back to bed.

7. Discharging your patient home with a saline lock. This mistake happens when you go in to discharge a patient, and they are already dressed, complete with clothing and shoes. Your brain is tricked into not checking for a saline lock under their sleeve. A related mistake: discharging your patient with pacing wires still in the chest (it happens!).

8. Forgetting to remove old transdermal patches when applying a new one (duragesic, nicotine, nitropaste). Some patients have patches stuck all over their back and arms. Be sure and do a full body check.

9. Calling the wrong doctor. Some patients have multiple specialists, and it's not always easy to know which one to call for what. Make your best guess, then consult another nurse or your charge nurse.

Another common mistake- thinking you'll never get it all down down and become organized. Not true! Trust me, you will. In a very short time, you'll no longer be the newbie, but the one new grads look up to!

What rookie mistakes have you made or witnessed? Leave a comment, I'd love to hear!

Until next time friend,

Nurse Beth

[DahliaOH]

When you go to call a doc, make sure you have the right doc on the other line. I called a dr that I didn't know was a female (my second orientation day) and a male voice answered. I got a bunch of orders from another dr and documented it with the female dr's name.

The male dr later called (he was curious about the new nurse he just talk to) and everything was straightened out. I was embarrassed though, like "Dr so and so is female?? I talked to a guy..."

[Nurse Beth, MSN]

haha That's a good one! To look back on, anyway. Not fun in the moment!

[Nalon1 RN/EMT-P, BSN, RN]

#2, I always ask "how are you related" to anyone in the room when I see a new person and introduce myself. Too many wives I thought were mothers, sisters I thought were wives, and all the other mistakes.

#3, I have done that a few times, and sure I will do it again.

#7 unfortunately happens a lot in the ER. Your discharging a patient you know nothing about and don't realize they have an IV. Most will say something, but some forget too, most come back 20-30 minutes later to have it taken out.

One to add, if you don't know how to say someones name, ask them instead of butchering it.

One way to get around directly asking it is when you come in and introduce yourself, ask them to verify their first and last name and birthdate, most are none the wiser.

[jlr820]

Wow, let's see. I've been "bizz" for 6 years. Let's see how many "craniorectal inversion" moments (think about it for a second...) I can remember.

Forgetting to "pop" the seal on an Add Vantage cartridge after it has been screwed into the top of the diluent bag, so that your patient gets 250 ml of normal saline rather than the vancomycin he/she was supposed to get...

Forgetting to unplug the crash cart from the wall outlet before sprinting it toward the room of a coding patient (it's kind of like being a dog that runs until they hit the end of their chain. Kinda jarring...).

Charting a BEAUTIFULLY THOROUGH head to toe intake assessment, and dutifully saving it only to realize, just as you click SAVE AND RETURN TO WORKLIST, that you did it on the wrong patient.

Suiting up in "full battle rattle" isolation gear for an airborne precautions, negative pressure room (complete with CAPR) to enter and do a complicated dressing change, only to realize once enclosed behind several thick panes of glass and several feet of distance, that you forgot the Medipore tape, or scissors, or whatever other seemingly insignificant piece of equipment needed to do said dressing change. Now, you either have to go through the process of exiting the room and degowning (only to return and do it all over again), or stand inside the glass and play a strange game of charades with your coworkers (who are all sitting at the station pretending not to understand what you need, and doing their best not to laugh).

Lowering a bed before checking that none of the wires/cables/tubes/other miscellaneous stuff won't get in the way and be pulled/tugged/shifted or otherwise compromised. Example: Lowering the bed without checking that the, oh say, flush bag for your arterial line isn't in the way of the descending bed such that a side rail catches the bag spike just right and you hear a sudden loud POP followed by the sound of gushing pressurized water striking the tiled floor (followed by the sound of the RN stomping to the supply room to get another 500 ml bag of flush solution, a new art line tubing set, and several towels) :)

I'm sure I can recall more given the opportunity, but that should do for now. :)

[Donna Maheady]

Beth,

This is such an important article/discussion. We were all newbies at one time....and all make mistakes.

That's how we learn! Great piece.

[Nurse Beth, MSN]

Where's the double like button?

I love your examples! They are making me laugh and cry at the same time lol

[TheBlackDogWaits]

The other day, I had a very elderly female patient (94yo) who was just lovely! Her hair was tastefully dyed red, nails a freshly glossed deep coral.... And she was feisty! Her daughters, also just as lovely, had been at the bedside 24/7 for several days, in shifts.

Finally, one day, I step into the room and see a much older gentleman. Ahah!, I thought - the husband has finally been able to make it!

So, I walk up to him and exclaim how it's so nice to finally meet her husband...

As it turns out, though, the frail-looking gentleman was her son-in-law. I was the family's little hospital joke after that.

[Ristosix]

Duly noted, so far "Forgetting to unplug the crash cart from the wall outlet before sprinting it toward the room of a coding patient (it's kind of like being a dog that runs until they hit the end of their chain. Kinda jarring...). has been my favorite as I've done that twice.

I had once ran into a situation where there was a thermometer shoved into a male's urethra by his wife...took me about 5 min before I could listen collectively...and get the full story. I was very careful splinting it in place. Lesson learned, check your gut if there's grimace...the problem is usually where you cant see.

[slauren]

When I was doing clinicals in nursing school, I emptied a foley bag for a patient that had a TURP but I forgot to do the lock at the bottom of the bag. When I returned from lunch there was urine all over the floor. Was so embarassed. To cheer me up, my instructor told me how she had to give a lady a supository one day then was yelled at for putting it in the wrong hole. lol

[BlueDawnRN, BSN]

I know of someone who gave an injection with a retractable needle and flipped out because she thought the needle had lodged in the patient.

[cayenne06, MSN, CNM]

1. NEVER skip your 5 rights of med administration! When you get used to the common meds on your unit, it's very easy to get a little too comfortable. When you are used to giving toradol to all your post c/s moms, it becomes rote and if you aren't consciously remembering the 5 rights, you might miss the patient's anaphylactic allergy to NSAIDs, or the fact that the anesthesiologist already gave her first dose in the ER.

2. Always, always err on the side of caution and SPEAK UP if you are unsure of yourself. That being said- take responsibility for getting the info you need. If you don't know how to do a certain task, or you've never cared for a patient with a certain condition, or are giving an unfamiliar med- take the initiative to seek out facility protocols, look up the medical condition of your patient, and take the time to familiarize yourself with the drug. THEN ask for clarification/guidance/advice. Don't rely on your mentor/preceptor to "teach" you information that you can gather yourself.

3. If you work nights, prioritize your sleep. Don't let yourself fall into the pattern of interrupting/cutting down your sleep hours in order to get things done during the day. If you have young children, arranging for reliable coverage while you sleep is super important. Get black out curtains, a fan, and a sleeping mask. And IMO there's nothing like an 8am beer after a 12 hour night shift!

4. Remember that everyone on staff- from the attending to the housekeeping service- is an invaluable part of the patient care team. Treat everyone with respect, and remember that no job is "below" the scope of an RN! We can pass trays and change linens as well as any CNA . And CNAs often have valuable insight into your patient's status- respect and solicit their input when you are planning care. Show the staff you are a team player, and it will (hopefully) be reciprocated.

eta- 5. Don't forget about the incredibly important resource you (hopefully) have at your disposal- the hospital pharmacist. These people know more about meds than probably anyone else, and IMO are sorely underutilized in the hospital setting. I'd love to see pharmacists become part of morning rounds, and to have their input be a standard part of inpatient medication management and discharge planning. WHY are pharmacists so underutilized in our health care system?! Or maybe they aren't, and I am just missing something.

6. Find out your facility's rules on tablets/phones/internet access. Use this technology to your advantage however you can. I've got about half a dozen apps that I use on a regular basis for my job- the CDC STD tx guide (of course the 2015 guidelines aren't available in an app yet, argh), icontraception, lactmed, USPSTF ePSS, etc. I've got the pap guidelines bookmarked. Books are out of date before they even leave the printing presses.