3 medication-related errors in 6 months. Is this a sign I should quit?

[hnnrgh]

I'm a nurse of 1 year, 8 months. I work in a medical/surgical ward where things are frequently busy and I'm often under a lot of stress. While my first year was rough, I managed to pull through somehow without especially serious errors. I really don't know what's going on with me these past few months, it feels like it's just been one mistake after another.

My first mistake was in September - a missed dose for an eyedrop that was supposed to be given at 8pm. The patient went through the bill the next day and complained that this eyedrop was never given to him. That was when they found out that I had missed it out. I only realised the next day and put up an incident report accordingly.

The rest of my months were fairly smooth (or as smooth as working in a busy, disorganized and understaffed ward can even be), but just last month, I made error #2. IV Benadryl 25mg was prescribed to the patient. As each vial contained 50mg/ml, I carelessly drew out 1ml when I was supposed to draw out 0.5ml. I got worried and reported the incident to my nurse clinician immediately. I also informed the doctor, who didn't sound very worried and said the patient would be fine (if sleepy). True enough, the patient did fall asleep, and I continued to monitor his vital signs throughout in fear that something would happen to him. He woke up, and went home completely fine in the end. A part of me regrets self-reporting, because nobody would even have known if I hadn't, but another part of me knows it was the right thing to do.

After that mistake, I vowed to be more vigilant. To my shock, I did it AGAIN, just yesterday. The doctor had prescribed IV Cefazolin 1g tds. IV Cefazolin 2g was given in the operating theatre at 8pm. Our regular timing for antibiotics are 8am, 4pm and 12 midnight. Seeing as I couldn't give the midnight dose anymore, I stupidly assumed that the next dose, as I had seen in the system, was 8am. What I should have done was give it 8 hours later STRICTLY, at 4am.

I've just been feeling so incompetent. My clinician in charge told me that with all these mistakes, I'll be getting a warning letter pretty soon. Honestly, I'm scared. Should I continue being a nurse? Does this mean I'm unsuited after all? I do think I'm unsuited to work in the inpatient ward at least, because I crumble under stress (which was likely the cause for my carelessness).

I honestly hate working in this hospital. They're so understaffed that I sometimes have to take up to 12-13 cases at night, with only 1 assistant aiding me. I'm always considering quitting, but now I'm afraid that the disciplinary action I'll be getting will hurt my chances of finding a new job.

I don't know if I should continue nursing at all. It's not that I dislike it, but I just feel like I can't do anything right. I've honestly been so depressed these few weeks that at my lowest points I've even considered self-harming (Don't worry, I always talk myself out of it). My low mood seems to be affecting my work too. I'm slower on the uptake, and even the most basic things are slipping my mind. Please, I need some advice. Is this a sign I should give up nursing? And if not nursing, what could I even do with the degree that I have?

[Wolf at the Door, BSN]

stop beating yourself up. Just slow down. Go through the 5 rights during each med pass on each patient. You know where you have messed up by now....Which is....Right amount...Right dose.

The IV Antibiotic was not an error.

[akulahawkRN, ADN, RN, EMT-P]

I would say that given your load, having only 3 (and at least one of those is marginally so) errors during that time is actually pretty good. Remember to go through all the "rights and checks" you were taught in school and this will, by itself, reduce the number of errors you will have. Generally speaking, all nurses will have med errors. Management will always want us to be 100% perfect in this area, but it will happen because we're only human. Fortunately in the US, many hospitals have switched over to an electronic MAR which can greatly help with reducing errors.

I'm an ER nurse and while it's nice to have meds that need to only be given "now" instead of on a set schedule, when you have multiple meds suddenly ordered "now" for all of your patients, it can make you run around like the proverbial "headless chicken." This can lead to errors. I may be very, very fast at my job but the one thing I slow down a bit for is when I'm administering medications. The reason I consciously slow down for this is because like a bullet that's fired from a gun, once that medication has been administered, you can't recall it. Giving the wrong med can easily kill your patient. It's also why I almost NEVER pull medications for more than one patient at a time. This way I greatly reduce the chance I could give a patient the wrong medication.

The situation you find yourself in is very dangerous for everyone. If you or your unit cannot find a way to reduce the workload, you will need to quickly find yourself a new position where your patient load is far less heavy. It's not necessarily YOU that is the problem. This is a system problem and you're taking the brunt of it and you're being put in a position that you do not want to be in. They're likely going to issue a letter of warning to you because they expect 100% accuracy in medication administration. Trust me in this: you will not likely be able to make it through the terms of the warning letter. The environment you're in basically makes it impossible for this to occur barring a miracle. Once you have this warning letter, they can (and will) scrutinize every medication administration you do and they will find more errors, even if they're "minor" errors. They will keep accumulating those "error" records until at some point they will decide you cannot meet the terms of the warning letter and then they'll proceed to the next step, which will be outlined in the warning letter, probably termination of employment due to excessive medication errors continuing after the issuance of a warning letter.

My advice is simple. Get out. Soon.

[K9lover, ASN, RN]

Try not to beat yourself up too badly, we have all made mistakes. You mentioned working night shift which may exacerbate the problem if you are tired. It sounds as if your self-confidence is suffering and feeling stressed all of the time will not help AND 13 patients? I don't know how hospitals justify doing this, in California we went to safe staffing guidelines >10 years ago but not seeing other states follow suit which is a shame.

Do they have electronic scanning? That would have alerted you to both the missed eye-drops and Benadryl. As for hospital nursing I am quite happy to be away from that and, God willing, will never return to bedside nursing. With over a year experience you can likely look for jobs outside the hospital setting which may allow you more breathing room to focus.

[fezz]

Think about the hundreds of time you did everything right. These are not serious cases. If they overwork you and then make you feel this bad about 3 non serious issues in 1 year and 8 months I understand why you might want to look for another job. I have worked in various busy settings for years and mistakes like yours happens more often than you might think. And great nurses and doctors makes them too. Not just inexperienced ones. Not everybody reports it so good for you for being so particular. You are obviously very trustworthy and conscientious.

[K9lover, ASN, RN]

Too true in that it is a system problem but as we all know they will throw the nurse under the bus every time.