New RN, first med error. I need advice!

  1. 0 Hi everyone! I'm a new grad (May '12) with no prior medical experience who took a full time position on a busy med surg floor 4 weeks ago. The NM keeps trying wean me off orientation but I keep saying I'm not ready yet. My preceptor, as well as other nurses continuously tell me how I'm too slow and yesterday my going too fast bit me really, really hard.

    Normally my preceptor and I do all of our care together. I assess, pass meds, chart, and everything else, but she's always there to back me up, check over me, and just make sure I'm doing everything correctly. Well yesterday when I got to work, they told me there was no tech, my preceptor was going to be the tech, and I was on my own.

    The day started off great. I did my assessments, checked vitals, passed meds, changed linens, got labs, brought them to the lab, hunted down my pt's missing tray, everything. I thought I was really on top of everything. But, around noon one of my pts returned from dialysis. I went and assessed her, she was doing great but I never did vitals on her! In report they told me her BP was 120/85 but with all that was going on, for some reason I didn't do VS. I ended up giving her scheduled BP meds w/o thinking about rechecking her BP, so last night/this morning when she bottomed out, it looks like I gave her catapress and clonidine (and maybe some others) with a BP of 94/50. To make it worse, I didn't chart how the pt was when she came back from dialysis.

    My preceptor just called me at home to tell me what happened and I feel absolutely horrible! I've been crying for about 2 hours now, because I could've caused someone's death. Not to mention the nurse from night shift and my preceptor had to be chewed out by the dr for my mistake. Yesterday the charge nurse pulled me aside and said I needed to pick it up because I go too slow, but this is exactly what I was trying to prevent. I feel like I was given the short end of the stick yesterday, but I COMPLETELY take responsibility for my mistake and the fact that I didn't catch it! I was trying to go a bit faster, and messed up something that is so basic. I know had I not been so busy, or my preceptor was there, it wouldn't have happened. I just told my preceptor I was overwhelmed and she said she didn't even realize (she was running around all day too).

    So, I really don't even know how to go to work on Monday. I'm so embarrassed! On top of that, yesterday I had a pt pull out his IV (blood was everywhere!!), almost pull out his foley, etc. 2 weeks ago, my preceptor and I returned an open dilaudid instead of wasting it (hello drug test for the whole unit). It's just one thing after another. I feel like the staff will think I'm incompetent now. I just feel so horrible I don't know what to do!

    Oh, and did I mention JCHAO is there today.
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  3. Visit  jordana888 profile page

    About jordana888

    Joined Sep '12; Posts: 1.

    11 Comments so far...

  4. Visit  Mully profile page
    5
    After reading all of that, my only comment is to say guess what? You're normal!

    Every-freaking-body makes mistakes, and believe me, much worse than the mistake you made. As a new grad, you're focussing on so many things at once that you forget the basics (like taking vitals). As you get more experienced, you don't have to focus on tasks like priming iv tubing, because it's become second nature. That's when your brain will keep track of the things it needs to.

    It's okay to feel terrible for this happening. That's your body's way of making you remember it so you don't ever do it again. I will never forget the day I gave 100 of lantus instead of 18. Thank God I caught it because the little old lady'd pry be in heaven right now if I didn't. Then again, maybe she'd be happier there...

    One thing I'm realizing, (I'm a new grad as well, on Stepdown) is that being a new-grad nurse is probably harder than my entire nursing school experience. Again, this is normal. Normal, normal, normal. So stick it out! I PROMISE it gets better. You get better. You become the nurse you want to be. It just takes practice, which unfortunately, at times, involves errors.

    If you feel like they're pushing you along too quickly, keep speaking up for yourself. And if they keep doing it, then go somewhere else! Every one of them has made errors before whether they told someone or not and they may have forgotten that. I'm on I believe my 10th week of orientation, and the end still isn't in sight, but that's because they understand the capacity of a new grad. (And it's because I'm on stepdown, but our med/surg nurses get 8 weeks and more if they request it).

    All in all, don't feel like a bad nurse. You're not. You're just new. It really does take time to become a good nurse. You'll make it, just don't give up. Buck up!
    CrufflerJJ, itsmejuli, RRWilson,RN2, and 2 others like this.
  5. Visit  NurseOnAMotorcycle profile page
    2
    Quote from jordana888
    ... I ended up giving her scheduled BP meds w/o thinking about rechecking her BP, so last night/this morning when she bottomed out, it looks like I gave her catapress and clonidine (and maybe some others) with a BP of 94/50. ....
    Med errors will always feel awful. I'm glad that you took this as seriously as you did, though, because if you came in and said "It's not my fault, someone else did blah blah.." then I would worry about you being in nursing.

    The few days after you get back will be hard, but get through it and everything will return to normal. Honestly, they know you are a new grad, they know you are in orientation, and there is completely too much going on each day for them to dwell on it. You'll never forget it, though, and that's good. You'll even be able to help someone else out when they make their first med error.

    If you get written up then accept it and do better. If not, then just do better.

    In the meantime, take a lot of deep slow breaths and be happy that someone caught it so the patient is ok.
    CrufflerJJ and RRWilson,RN2 like this.
  6. Visit  Sun0408 profile page
    4
    Pts will pull out IV's, NG tubes, foleys, pegs, piccs etc.. Not your fault, it happens. As far as returning the med instead of wasting; how is that your fault, your preceptor was right there too.

    You will never make this same mistake again, always check bp before giving BP meds, HD pts can crash rather quickly, assess them as soon as they get back with a full set of vitals We learn, we grow but we will still make mistakes, we all just hope those mistakes don't kill anyone.. Go to work, do your job and keep at it. Ask questions when you are unsure and ask for help if you need it. Soon this will be a thing in the past.

    The first year of nursing is the hardest
    cljbrn, CrufflerJJ, Hygiene Queen, and 1 other like this.
  7. Visit  dirtyhippiegirl profile page
    7
    Aw. It's posts like these that I wish I could have taped the conversation I had with a loooooong-time nurse the other night.

    Had a nurse who floated up to our unit to do ICU stuffs. She's been a nurse for 40+ years, with the last 25 years in our high acuity SICU. We chat a bit. I open up about my latest mistake -- snipping right through a patient's much needed PICC line -- and she just looks at me and goes in a certain tone of voice that you had to be there to appreciate, "Oh, honey, stay at the bedside long enough and wait until you really make your first mistake."
    rachstept, mitral, sharpeimom, and 4 others like this.
  8. Visit  samadams8 profile page
    2
    Too err is human; to not learn from it and move on would be the real crime.

    We've all been there. Remember the safety basics, and you will be fine.
    People aren't going to always be around to help you with your checks and balances--with meds the exception would be peds--or things like giving blood and chemo, etc. Nursing is time-consuming, b/c it can be a lot about checking, re-checking, and then checking again. It can make you OCDish.

    Because you had a strong emotional response to it, I am relatively certain you will be fine and a better nurse; b/c it's there in your psyche and emotions.

    Now if you didn't care that much or didn't have a conscience or if you blew it off and didn't see the potential danger that could have ensued, then I would worry.

    It's done. Grow and move on. We all have had to do it. It's easy to get too busy and frazzled or to become overly tired in this line of work.

    Go into work. Own up to thing, but show that you are more careful. Don't talk about it too much, b/c some folks just feed on this kind of thing--like gossip--even though they know darn well that they have made med errors.
    rachstept and CrufflerJJ like this.
  9. Visit  eatmysoxRN profile page
    0
    Your pace will pick up with time. It seems like you've learned from your mistake, so let it go. I always be sure that any BP med/diuretic is accompanied by a blood pressure and hr check. IV narcs I check bp, hr, and esp RR. Don't rush for anyone because it puts your patient in danger.
  10. Visit  Esme12 profile page
    3
    Quote from dirtyhippiegirl
    Aw. It's posts like these that I wish I could have taped the conversation I had with a loooooong-time nurse the other night.

    Had a nurse who floated up to our unit to do ICU stuffs. She's been a nurse for 40+ years, with the last 25 years in our high acuity SICU. We chat a bit. I open up about my latest mistake -- snipping right through a patient's much needed PICC line -- and she just looks at me and goes in a certain tone of voice that you had to be there to appreciate, "Oh, honey, stay at the bedside long enough and wait until you really make your first mistake."
    Ha! She's right....I remember on a particular difficult intubation requiring endoscopic guidance and consideration for a trache......I was happily cleaning up the patient's bloody mouth, lips and tape and decided to "fix that horrible tape job and bloody ETT tape" when I snipped the pilot of the ETT tube....that was not a pleasant phone call to the MD...thank goodness he liked me.

    Only four weeks of orientation for a new grad? Shame on that manager. Most new grad orientations are at least 12 to 16 weeks with classroom in between for policies and how to's classroom time...how to start a blood transfusion, how to use the PCA pump, How to.....etc. It will take you up to a year to feel better about being on the floor...don't despair.

    What you need is good brain sheet to help you get organized.......here are a few.

    mtpmedsurg.doc 1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    I made some for nursing students and some other an members have made these for others (Daytonite).....adapt them way you want. I hope they help
    mitral, samadams8, and cardiacrocks like this.
  11. Visit  samadams8 profile page
    0
    Quote from Esme12
    Ha! She's right....I remember on a particular difficult intubation requiring endoscopic guidance and consideration for a trache......I was happily cleaning up the patient's bloody mouth, lips and tape and decided to "fix that horrible tape job and bloody ETT tape" when I snipped the pilot of the ETT tube....that was not a pleasant phone call to the MD...thank goodness he liked me.

    Only four weeks of orientation for a new grad? Shame on that manager. Most new grad orientations are at least 12 to 16 weeks with classroom in between for policies and how to's classroom time...how to start a blood transfusion, how to use the PCA pump, How to.....etc. It will take you up to a year to feel better about being on the floor...don't despair.

    What you need is good brain sheet to help you get organized.......here are a few.

    mtpmedsurg.doc 1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    I made some for nursing students and some other an members have made these for others (Daytonite).....adapt them way you want. I hope they help

    Esme, Wow, you are the kind of nurse I'd hire everyday and twice on Sundays! This is EXACTLY what we need more of in nursing!!!!

    You are awesome. Keep it up!

    Are you a clinical instructor or professor of nursing? If not, you should be!!!!
  12. Visit  cljbrn profile page
    0
    Thanks for the words of encouragement.
  13. Visit  Esme12 profile page
    1
    Quote from samadams8
    Esme, Wow, you are the kind of nurse I'd hire everyday and twice on Sundays! This is EXACTLY what we need more of in nursing!!!!

    You are awesome. Keep it up!

    Are you a clinical instructor or professor of nursing? If not, you should be!!!!
    Thanks.......I have always felt if you have knowledge it's easy to share it with others.....it's the ones who don't really possess it that have difficulty in giving it away........but alas no.......I don't teach anymore "professionally". I have a rare neuro-musclar disorder and no one wants/will hire a disabled nurse in a wheelchair and to make matters worse, I don't have a Masters. So, as I search for a cure and remission........I feed my addiction to teach and share here on AN!
    sharpeimom likes this.
  14. Visit  FurBabyMom profile page
    0
    Relax! The first year out of school is so difficult for so many reasons! I didn't have med errors but there were numerous times some of my meds were passed 'late'. And you know what? Oh well. It's better late than never and better late than when someone should not have gotten something. It got better with time but wasn't until much later that I became comfortable. I was just becoming comfortable when I left my job on a med surg unit for the OR. But the OR is something I could not pass the opportunity up.

    I am sure that had things been different, or had I worked long enough I would have made a mistake like that or perhaps worse. I am OCD about everything and will recheck vitals myself if it's been more than an hour since my tech took them. It is important to check and recheck and check again whether it's orders, vitals, meds to give or documentation. There's times I have caught a doctors error before it could affect the patient. It happens. You learned something. Move on and it will get better. I will say this - I came awful close to making an error on a few occasions. I can easily see how I could have not caught something and therefore made an error. This is a learning experience. It really will get better.

    Also, like others have said, four weeks is too short for orientation. I'm sorry, it is. Six weeks was too short at my first job and I got an extra two weeks (even with those extra days it was rough being on my own). They reluctantly gave it to me, and guilted me about it relentlessly. My manager and my educator just kept saying 'The first year is so hard, it'll get better you're doing fine.' It's easy to want to say that, but really hard to hear it as a new nurse. I felt like they brushed my concerns off without much consideration. It's hard to work through the role adjustment to being independent when you're concerned about whether you got proper orientation or if it's just a confidence issue. It doesn't help if (as was the case in my first job) your coworkers treated you like you were stuck on stupid for asking questions or voicing concerns about anything. My second job I got six weeks but had much better preceptors who knew and followed policy...and I'd been on my own a while at my first job.

    Do you have an educator that works with your unit that you can speak with and discuss your concerns? Maybe they can help you assess your strengths and weaknesses and determine if you're really ready to come off orientation. They may help you articulate your concerns better to your manager. I know you said your preceptors and charge said you were slow... It's easy to say 'Oh, you're slow' But what are their suggestions to help you become more efficient? Can you ask them for suggestions? It's a hard transition but it will get better.


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