First Day at work did not go well--please advise!

Nurses New Nurse

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I am a new grad RN/BSN..I was a LPN for years before that. I have never worked in a hospital before and am now working on a Cardiac Stepdown Unit. On my first day with my preceptor she handed me the MAR for one of our patients and asked me to pass those meds. She pointed to a one time order for 30 meq K+ and told me to be sure not to forget that..the patient had a low K+. There were no initials in the box beside the order. So i gave it. Well..turns out the med had already been given..no harm came to the patient..Doc notified and all that...but did she say a word about telling me not to forget that order? No...I had to call the med error hotline and report it. Yes I know I am responsible and accountable...but I feel like she should have at least acknowledged to me that she told me not to forget that order. So now I am bummed and somewhat scared. The rest of the day went better and I am getting another preceptor who told me that she loces to teach. The floor was so busy.....and I feel that I have so much to learn. I hope I can do this.:o

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I am currently stationed in Iraq and wen I got in nursing school i got deployed and added 18 months to my nursing school basically. Prior to this I have worked as a firefighter/emt, nursing assistant icu and cadiac cath lab. Let me share something with you " I have seen a lot worse"!! don't give up, some nurses are cranky and dont want to teach. but that is in no way a reflection on you. Every nurses that taught me about their MAR and flowsheet said to writ e it as soon as you do it. So good luck and keep pushing.

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Specializes in ICUs, Tele, etc..

Sorry, but you're not responsible for this med error. Whoever gave it and did not sign it off that's their fault, and not yours....Now who gave it? Your preceptor, or the last shift that's the question. But if it's not signed and it falls within your time frame then you did what you were supposed to do. Administer the medication. This is of course if the med was not dispensed by a pyxis machine where it would have told you if it was taken out already out of the pyxis.

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I am a new grad RN/BSN..I was a LPN for years before that. I have never worked in a hospital before and am now working on a Cardiac Stepdown Unit. On my first day with my preceptor she handed me the MAR for one of our patients and asked me to pass those meds. She pointed to a one time order for 30 meq K+ and told me to be sure not to forget that..the patient had a low K+. There were no initials in the box beside the order. So i gave it. Well..turns out the med had already been given..no harm came to the patient..Doc notified and all that...but did she say a word about telling me not to forget that order? No...I had to call the med error hotline and report it. Yes I know I am responsible and accountable...but I feel like she should have at least acknowledged to me that she told me not to forget that order. So now I am bummed and somewhat scared. The rest of the day went better and I am getting another preceptor who told me that she loces to teach. The floor was so busy.....and I feel that I have so much to learn. I hope I can do this.:o

I feel bad for you...what a way to start a new job. Please don't be discouraged. It was a mistake, and certainly wasn't done on purpose. If your charge nurse is wise, this becomes a learning experience for the entire unit...signing off meds as they are given is important! I am in no way minimizing the error. But I do believe that errors are learning experiences, and not occurrences that should be displayed for blame to be attached.

Yes, you do have much to learn, but you are a new grad...that is what good new grads do. You can do this.

Identifying that you have much to learn is the first step in the process. As a new grad, you don't know what you don't know. Over the next while you will begin to learn what you don't know. Keep your eyes and ears open. Ask questions! As you gain experience your confidence will grow.

The best of luck to you!

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Specializes in Trauma ICU, MICU/SICU.

I agree with the other posters. This is not your fault. All preceptorships are not the same. At my institution, we are not allowed to give meds until we pass a pharma & calc test. Then you can ONLY pass under the direct supervision of an EXPERIENCED RN. After med validation by unit educator, than you're on your own. I'm currently passing WITH my preceptor and am so happy. We also have barcoding which kept me from giving an expired med on my first day. I scanned it and it took it. But we had to re-scan all the meds againg (long story) and the second time it was gone. Taught me to always look for the order expration.

Anyway, I digress. I would talk to your educator/manager whoever about getting a preceptor that actually teaches/supervises you until you're familiar with the system. Although, familiarity would not have fixed a previous nurses's error of not signing out a given med.

You're doing great!!!

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Specializes in ICU, telemetry, LTAC.

We don't have a hotline where I work, but we fill out these "variance" forms. And if a nurse not writing a thing on the MAR caused me to double dose the patient, yes I'd write a variance. New nurse or not, if potential harm was done, I'd write it up. If I did not double dose the patient but managed to catch the mistake before doing so, I probably wouldn't write that up.

It's especially important if anyone else is going to help you, or you are helping anyone else, to sign off that meds are given prettymuch immediately afterwards. The "dot" method works for reminding me to do this. Place a dot by the time on the MAR when pulling the med. Keep going till all meds for that time are pulled and they have little dots by 'em. Give meds. I usually have my MAR binder with me when I do this (makes a handy snack tray too). If a patient refuses a med I can go ahead and circle it and write that down. It doesn't happen often but you never know. When I'm done go back to station and sign off dotted meds. Sometimes if I need to stay in the room a while I'll sign them off right there.

So... if you and your preceptor work together, for the patients that are "yours", you need to be handling the MAR's in your own binder, clipboard, whatever it is you use. That way you won't be picking up a MAR that's handed to you, possibly before someone else has signed off a med.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Chaulk it up as a learning experience and move on. I'm sorry you got such a bad start. Bummer.

Good luck to you!

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Specializes in Med Surg, Specialty.

If you had to do the day all over again, what could you have done differently? I agree with the other posters in that giving the med was not your fault. You did what any normal nurse would do. It is not reasonable to think that you should be able to read minds and somehow know that the med was already given ;) try not to beat yourself up over this because I really can't see how this was your fault.

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!

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Specializes in OB, M/S, HH, Medical Imaging RN.

I agree that you were "not" at fault. Your preceptor was not behaving knowledgeable, or IMO ethically, by letting you take all the blame. It's important to own up to what you do even if it was a mistake. I'm sorry you had a bad day. You did right to report it, I hope you explained that the MAR had not been signed. This is exactly why I'm so glad were scanning!

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