1st nursing job, new grad LPN, 1st shift, already a serious error!!

[NHCVTturnedLPN]

I apologize in advance if this is long. There were a lot of details that played into the whole event.

Hi, I graduated from a LPN school in Dec 08. Took my boards, was all ready to get a job and get going with my new career. I have worked in the medical field, only my patients were the kind that walk on 4 legs and generally have fur, hair, feathers, or scales. However, the general medical/nursing practices are still the same. It bleeds, you bandage, its broken, it hurts! I was very highly skilled in my field after having been in for 16 years, but 2 young kids, the increase in costs, caused me to change direction a couple of years ago. So after getting my LNA, EMT, and then LPN. I figured I would at least know something.

And then I did the dumbest medication error in the world. Four different licenses, all 4 had the same rule. the 5 rights, and I missed them all, wrong patient, wrong medication etc. The medication I was supposed to give was to the person in Room A, not Room B. And of course that is what I did, only 1 1/2 hours into the shift. I immediately realized it when the woman said " I don't get this kind of medication" After checking into WHO it was, I could have smacked myself in the head! How could I not follow what was taught? what I knew? what I preach in my other field to new vet techs. NEVER give medications to any pet unless you know what it is and who/why it is for! So why would I do it for Ms Smith? Anyway, my agency "boss" screamed at me over the phone as I called for suggestions. She wasnt having any immediate reaction to the medication, no adverse reactions, nothing on her chart (allergies, other meds etc) would cause her to have a problem with the med/dose I gave (which is not what I determined on my own- I called her primary care Dr.--He determined that for me) The Dr said "Dont worry about, why are you calling me?" -I thought" Well, lets see, I just gave 90 year old ms. smith miss jane's Morphine SubL and she does have an allergy to codeine, my boss said I am out of the nursing field I might as well tear up my license and find a new career because I am done here! The Dr. told me there was no co-relation to the 2 drugs and basically "to get over it and stop bothering him". The resident had no adverse effects, VS remained normal throughout the entire night THANK GOD. Of course the rest of my first (and only? ) shift as a LPN was horrendous. The following 6AM had me racing around to try and medicate 22 out of 30 of the residents in my care, and that did not include any of the vitals, dressing, misc. things that needed to be done with them. I did have 2 very good LNAs who were regular staff and I had to have them ID all the patients for me the rest of the night. There was no ID on the resident (no wrist braclets etc) no door tags, most people had pictures, but that was about it.

So besides not following basic Nursing 101, I dont know what else I could have done at the time. There was no one else for me to ask general questions. The nurse who I changed shifts with was an agency nurse and the one coming in at 7am was too. Even the aides didnt know who to call. I was working for the agency I was hired for. There is nothing "sneaky or tricky" in resume. I am very open and honest with my past experiences, and my lack of new experience. I figured when they called and offered me a shift in a 30 bed "assisted living" (I didnt know assisted living took hospice, and those who needed skilled nursing-- I thought most of assisted living were up and about- and just needed 'assistance') A LOT TO LEARN I figured working for an agency would get me great experience (I did agency work as a LNA and loved it) and the hours would be varied. I guess what I didn't realize was that once you get there, you are on you OWN. I thought at least the nurse who would have been there would have been a regular, and gave me a brief introduction, orientate around-even if for only 15 minutes. Maybe I should have taken the hint when my boss slipped in "btw, you might not want to mention you are brand new). However, I think the nurse picked up the hint when she said "Lets do count" and I said "ok, how do we do it?" she said I was pretty calm for someone new as this particular place has had her and many others in tears. And just how long have you been a nurse? She had 15 years, at that point I was going on 15 minutes. OK another red flag.

Anyway, any suggestions. My boss was all nicey-nicey after he found out later that I hadnt done any serious harm to the woman and by the AM she had no complaints, if anything she was more then understanding, (at least I had that on my side), he just says "have a nice weekend, come in monday with a write up of what happened and why"

My question after this long winded essay is do many nurses lose their licenses over a med error involving a narcotic? I told him I would come in for a urine test, I have nothing to hide. do I have to report it to the board. any insight on this or suggestions for a better start at a 2nd attempt if I can still find a job after all this. I dont know if you get an offical write up by the board. any advise ANY at all, would be greatly appreciated. Thank you.

Barb

[makes needs known]

Did you get any orientation? It is difficult when you are new, and you don't know the pts. Everyone makes errors and everyone make a narcotic error occasionally. Do the pts wear name bands? Are there pictures of the pts in their medex's? These are some of the tools used to help identify the right patient if you don't know them. Relax.

[lamazeteacher]

You got off to a bad start, which is largely because the agency hired you, knowing you're a new grad who needs supervision and orientation at first. The boss ignored the requirements for agency hires, when he told you not to reveal the extent of your inexperience, at the worksite.

Please take this in the way I mean it, which is great concern for your future nursing career. The errors you made were possibly due to nervousness, being launched into a situation for which you weren't ready. You did the right thing informing the patient's physician when you gave her someone else's medication.

There was the potential for harm, and you didn't exactly luck out by reaching a doctor who just wanted to be left alone. You were able to keep it to yourself, and weren't disciplined appropriately, which may derail the application of the things you were taught. You must be bruised everywhere from the kicking yourself you've done, though.

Before continuing to work with any agency, it would be better if you worked on a unit in an acute care hospital, with a proper orientation and supervision, for at least a year. (Which is usually a requirement for hire with a staffing agency. Otherwise you could get into poor working habits, lack of organization, and make more and more errors until you loose the sense of responsibility you exhibit now, and/or lose more self esteem. Your reliance on staff that have less education than you do for help, could be disasterous for you.

LTC seems like an easier job, but it's not as you saw, getting more patients and responsibility than you can handle now. Agencies I've known don't much care whether they're sending someone inappropriate to an assignment, as long as they get their cut of the money. There have been so many of them going out of business due to lost law suits, it's not funny.

So please look after yourself well, get the supervised experience you need, and then choose how and where you want to work. I know getting a paycheck is important, and you will have earned yours well by doing it the right way.

I've worked almost 15 years in HH supervising experienced staff; and 10 years in hospitals' infection control and staff development programs, as well as nursing administration. Other agencies sent me into facilities such as the one to which you were assigned, to assure that their clients received appropriate care. When all shifts are staffed by different nurses from various agencies, I saw red flags all over the place. The travesties I saw being done there and lack of permanent, caring staff result in serious injuries to patients; and in cases like yours, can make a good nurse turn away from her profession in disappointment or disgrace.

Your post indicates that you care about giving proficient care, you want to perform your duties correctly, and be supportive to your patients. I'd hate to see you leave our profession. So get a new start, and be able to hold your head high with the knowledge that you can take responsibility honorably.

Lois

[rhondaa83]

Everyone makes mistakes, do not be so hard on yourself, you will make more. Just learn by your five ways of a med pass and let that be a personal lesson to you.

[anonymurse]

Hey, I made a mistake, I told the boss it was stupid, and she smiled and told me "Just don't beat yourself up in front of the wrong people." Good people appreciate absolute honesty. An untested person is an unknown. A person who has made a mistake and takes responsibility is more valuable in their eyes, OK? So do like she says and have a good weekend. You can't go back and undo it, and you are probably dealing with someone who's been there, done that, got the t-shirt!

[Jules A, MSN]

Everyone makes mistakes, do not be so hard on yourself, you will make more. Just learn by your five ways of a med pass and let that be a personal lesson to you.

I agree, unfortunately these things happen. Did the patient tell you she didn't get that med before or after you administered it? Even with my patients that I know and who's meds I feel I know if they question a pill or ask about one that isn't in their cup I always stop and double check it. Most often they are mistaken but there has been a time or two when they were right. Anyway chalk it up to a learning experience, try to avoid it in the future, and move on. Thankfully your pt. was fine and the doc wasn't a jerk about it. Hang in there.

[Midwest4me]

My heart surely goes out to you! We've all been there and made our share of mistakes. Just learn from them and move on. No harm came to the patient and that's the most important thing. Good luck in the future!

[NHCVTturnedLPN]

To all that replied a huge Thank You! I have decided to either gain employment in a hospital or LTC as a perm. staff nurse just for this reason. I need training and orientation before just starting out on my own. I do have the necessary skills to do good nursing care, assessments, give meds, triage etc. What I dont know is how to balance the work load, how to actually "run" a shift by myself, and thats where I got stuck, panicked and messed up. I thought I was up to the challenge but ended feeling more scared after a was on my own with 30 residents. I guess thats when it really sank in. I do plan to stay in the nursing and veterinary field as I love both of my patients both 2 legged and 4. And it is my passion. I will just think before I act. And no, no ID on the residents, only ID I found was some pictures in the MAR. I had no Kardexs. The rooms werent even labeled A or B, which is where I made the mistake. I had the right number just the wrong roommate. And the patient said after I gave it to her that she doesnt take liquid medications which also clued me that I messed up. A hard lesson to learn so early on but one that I will NEVER forget. Thank you all for the encouragement!!

Barb:)

[Ginger's Mom, MSN, RN]

It sounds like you learned a lesson a hard way, a new grad should not be working agency. You need a good clinical orientation, you will be paid less but you won't be put in dangerous situations.

[lamazeteacher]

Quote from "Anonymurse"

"A person who has made a mistake and takes responsibility is more valuable in their eyes,"

Not OK, as they have something oin you, and know you'll stay there or risk disclosure, later. Believe me, I know how some administrators think.

[flightnurse2b, LPN]

don't beat yourself up over it too much.

even a seasonsed nurse can make a medication error, especially in a facility they are unfamiliar with. you, especially as a new grad nurse, deserve an orientation. when i got my license i worked with another nurse for around 6 weeks until my preceptor felt that i was safe and competent to carry a patient load on my own. when i switch jobs next month, i hope for a good orientation there too--each facility has new policies and different ways of doing things.

many LTC's (and i'm assuming this was LTC) do not require their patients to wear name bands, some charts will have picture identifiers, but i remember doing my clinicals in the nursing home and double checking pictures because you just can never be too sure. the nurses that worked with them everyday knew them well, but i didn't, and if you ask a patient with dementia "are you mr. smith?", they might just tell you yes.

another good rule of thumb for nursing is... if a patient looks at the pill and says "whats this, i don't take this one"... they're probably right!

all the very best in your new nursing career.

brush yourself off and learn from your mistake... you'll be a better nurse bc of it! :)

[anononurse]

I agree- don't beat yourself up! We have ALL made med errors! As long as you're working within your scope of practice as an LPN, you have nothing to worry about as far as reporting this to the BON!! As another poster said- move on and learn from it. I think your orientation is lacking though- IMO ALL new grads, whether LPN or RN need a preceptorship in the area they're hired for.