I just made my first mistake out of orientation! Freaking out!

Ruby Vee, BSN · Nov 9, 2017

I left a post cardiac cath bandage on the patients arm too long and her arm became edematous. I'm so upset and feel so guilty!!! I was trying to be cautious and not remove it too soon. The patient didnt complain of pain, but im worried something bad will happen and then i will get a call from my boss or coworkers. How bad is this for a mistake?? I feel just awful!!

It's good that you feel awful. I'd worry about someone who didn't feel awful about making a mistake that caused or potentially could cause harm to a patient. That said, everyone makes mistakes. Everyone. The difference between a good nurse and a bad one is what they do AFTER the mistake.

First, recognize that you made a mistake -- do not try to deny it, even to yourself. Down that road no good comes.

Second, admit that you've made a mistake -- to your instructor or preceptor, to the provider, to any ancillary services that have a stake in this. Made a drug error -- contact the pharmacist and find out if there are any antidotes or treatments, if you should hold the next dose or give an extra dose, etc.

Immediately set about mitigating the harm or possible harm to the patient. That may mean getting an order for and giving Narcan (for an opioid overdose) or sugar (for an insulin overdose), etc. It may mean monitoring more closely, getting tests such as a bronchoscopy (for intubated patient who was given chewing gum) or X-rays (after a fall), etc. Whatever it takes.

Inform your manager -- and you want to be the first person to inform her. Call her, text her, email her or walk into her office and inform her face to face, but tell her and tell her first. You want to make sure she knows how sorry you are, how you're worried about the patient, that you realize the possible harm to the patient and are horrified, and how you think the error happened and what you will do to ensure you never make that kind of a mistake again. Take full responsibility for the error, even if you own only a small portion of it. (For example, I made a HUGE error that had a profoundly negative outcome for the patient. I made is due to a miscommunication that was passed down through SIX layers of report. If any one of the six people before me had passed on the correct information, I would have had the information necessary NOT to make the mistake. But they didn't, and *I* made the mistake. I took full responsibility and accountability. It was my mistake.) You don't want anyone -- your boss, your charge, the providers or your colleagues -- to believe that you're defensive, justifying the unjustifiable or trying to avoid responsibility or accountability for the error.

Lastly -- and this is very important -- forgive yourself. This is probably the hardest part of the whole process, but if you don't forgive yourself you will be so anxious about making mistakes that you will continue to make them. Mistakes are inevitable; everyone makes them. There are no perfect people. So treat yourself well and forgive yourself. Journaling helps, exercise, sometimes praying about it. Forgive yourself and treat yourself well. If you've gone through the steps above, you're a good nurse.

I hope this helps.

MinneNurse, BSN, RN · Nov 9, 2017

Everyone makes mistakes, so don't beat yourself up over it! It sounds like you are owning your mistake and thats what is most important. Use this as an opportunity to learn and grow. I would reach out to somebody, whether it be your manager/former preceptor/charge/unit educator and ask for more information on caring for these types of patients. Ask for specific policies or look them up if you are able to yourself. Your facility or the provider should provide specific orders indicating how long the bandage is to be left on/etc. When in doubt, ask! I have called providers even after they have gone home for clarification when adequate orders were not provided, they may not like it but I need to do what is best for OUR patient. I would always advise checking with your charge first though. Best of luck to you!!

LibertarianNurse · Nov 15, 2017

First of all, breathe. Don't beat yourself up. Every mistake made is a learning opportunity, and you will remember it forever and never make the same mistake again. Everyone makes mistakes, whether small or large at some point in their career, and the key is to recognize it as soon as you can, try to mitigate any potential harm that might come to the patient(s), and inform your chain of command/resources. After all that, then I would advise you to do some introspection. Did the mistake happen because of an unclear policy or procedure? Maybe you need to speak up to your manager that the policy was unclear or missing. Did it happen because you were afraid to ask questions? Often in nursing, we don't know what we don't know and that's difficult to overcome, certainly. It may be good to find a trusted experienced co-worker or charge nurse that you can bounce ideas off. I often will ask my coworkers something like, "Hey, here's what I was thinking of doing in this situation for my patient. What do you think?" or "Here's my plan for this patient. Does that sound reasonable?" A lot of times they will give helpful advice or suggestions that I had not thought of and I am truly grateful, since it means I can take care of my patients that much better. The other factor to consider might be, was it truly your fault only or did some one else prior make mistakes that led to your mistake? Or did the healthcare system you are employed by fail you so that you were not successful? Defining the reasoning or problem can be helpful in making sure this doesn't happen again. In my experience, nursing is one of the most humbling jobs I have ever had and I am constantly learning new things. I wish you the best. Try to move forward, and not dwell on the past. You sound like you have a great attitude about it so far!