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

  1. 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?
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  2. 16 Comments

  3. by   nrsang97
    Breathe. We all make mistakes. The key here is that you took the steps accordingly when you did make the mistakes. It can be especially difficult in the first 2 years. Since you used the term "operating theatre" I will assume that you aren't in the US, but rather in the UK, Ireland, Australia, or New Zealand. Are you working in a post operative unit? 12 to 13 patients is a LOT. I was overwhelmed working med surg with 10-11 patients when I was first a nurse.

    Always double check medication concentration and dosage. You are correct that the antibiotic should have been given 8 hours after the first. You know better now and can correct yourself.

    I saw you said that you have contemplated self harm. Please talk to a professional. I know you said you talk yourself out of it, but the fact you have these thoughts is concernong. Please talk to a counselour. I have had to talk to a professional as well a few times just to sort things out. It really helped. Please do not harm yourself.

    I say do not give up. You have recognized that you are depressed, and seeking a counselour would be the way to go.
  4. by   Cowboyardee
    To be honest, it seems like your facility may have fewer checks and fail-safes than most with respect to medication errors. None of your errors were particularly serious (in terms of causing harm to a patient) but easily could have been if the same errors were made with more dangerous or critical drugs. I'd look into your system for administering medications before second-guessing your career path. Perhaps some tweaks or just better organization on your part would prevent errors in the future.
  5. by   MunoRN
    To start with, "TID" and "q 8 hours" are not the same thing, if a patient got a dose rescheduled to coincide with surgery then the next dose would be according to the TID schedule, not 8 hours from the OR dose, so that's not actually an error.

    I would say that even with super-nurse, having 12-13 hospitalized patients makes bedtime eyedrops a roll of the dice, consider yourself lucky if you get them.

    I'd say with your workload, your errors don't represent a practice that falls clearly below typical abilities.
  6. by   TriciaJ
    I don't think you're necessarily unsuited for nursing. For starters, 13 acute med-surg patients is ridiculous. There is no way they can be getting more than marginal care, no matter how good the nurse. You really should start to look for another job. This one's killing you and of course you don't want to kill anyone else.

    But a couple of other things jumped out from your post. You described your errors as "careless". There are a lot of reasons med errors can happen, but there's never an excuse for carelessness. You also had second thoughts about self-reporting an error. Do not have second thoughts ever. Errors need to be reported. You never know when an unreported error will come back to bite you, so even though it feels like you're hanging yourself out to dry, you could well be saving your own skin.

    I really do think you should get out of that brutal environment before deciding nursing isn't for you. A saner workplace with some mentorship might be all you need to thrive and flourish. Good luck to you and please keep us posted.
  7. by   HeySis
    Wow!!! Where I work, had a drawn out a vial, the computer would have alerted me that the vial was more then the ordered dose. There are so many more checks in place with the computerized system then there use to be, and I am grateful for that, it has saved me errors in the past.

    I wouldn't give up on nursing, I would find a new place of employment if that was my work load, that's crazy to have that many patients on a med/surg unit.

    If you feel like there is going to be disciplinary action you could be pre-emptive and complete a medication administration review course and then take the completion certificate into your employees and let them know you re-educated yourself in order to prevent more errors. If you feel like this will follow you in a looking for a new job you could do the same thing and if asked about a time you made a mistake (they love to ask that in interviews) be honest and say, I had a medication error and it bothered me enough that I took a review course so I could strengthen that skill (be more comfortable, make less errors..... whatever feels right to say).

    Please don't hurt yourself and make sure you are talking to someone you can trust and seek professional help, too often these feelings don't go away on their own. {{hugs}}.
  8. by   SunnyPupRN
    You are working under unreasonable conditions [not unusual but still unreasonable.] The environment in which you work has become the harbinger of floor nursing. Hospitals will throw you under the bus while ignoring that there needs to be a RCA [root cause analysis] of safety and staffing.The chaotic and undue burden of taking on that many patients practically begs for mistakes to happen. In my opinion, detrimental events like repeated medication errors happen under detrimental environments.
    I don't know you as a nurse, but I would not base your capabilities on your performance in such a situation. Administration more and more expects nurses to be perfect while disregarding the fact they ask us to work in an atmosphere that has us swimming upstream from the second we clock in. This is a wide-spread practice and the status quo in many places. It cannot continue to function this way without mistakes.
    That said, you express a desire to leave, and the system is not flexible or accommodating to change. Leave while you are still 'eligible for re-hire,' and practice what you enjoy in setting that makes it possible for nurses to succeed without risking safety. Good luck!
  9. by   ItsThatJenGirl
    1-800-273-8255 if you feel like you want to hurt yourself.
  10. by   blackvans1234
    Missing eye drops as a med error?
    That's comical. Maybe the patient was off the unit, refused them, not available from pharmacy.

    Also sounds like you're using a paper MAR -
    Electronic MAR would show you (until you left) that the medicine was overdue.

    Giving 1mL (whole vial) vs .5mL (half vial) is a good learning experience. Again, many electronic MARs will alert you that the barcode (whole vial) is too much medication, and that is your reminder that you should only give half.

    Antibiotic timing is something that I don't have experience with- our OR sends their abx record to the pharmacy who then profiles the timing for the subsequent dosage - again this would show up continuously on my electronic MAR when it is due / overdue.
  11. by   BSNbeDONE
    Quote from MunoRN
    To start with, "TID" and "q 8 hours" are not the same thing, if a patient got a dose rescheduled to coincide with surgery then the next dose would be according to the TID schedule, not 8 hours from the OR dose, so that's not actually an error.

    I would say that even with super-nurse, having 12-13 hospitalized patients makes bedtime eyedrops a roll of the dice, consider yourself lucky if you get them.

    I'd say with your workload, your errors don't represent a practice that falls clearly below typical abilities.
    (Standing at the door) Here, catch this and drop a couple in your eyes for me! (Door closes).
  12. by   BSNbeDONE
    Medication errors begin to occur long before they reach the patient; and I must say that your errors began with accepting, responsibility for 12-13 cases with only one person to help you. This is a system failure by design. Time to put one for in front of the other especially if a written warning is in the works.

    As a previous poster stated, it sounds like you're not in the US. So, I can't say how things are done wherever you are. But around these parts here, that crap definitely wouldn't fly. But, we here with 5-7 patients are not error-free. We are so busy most times that it's an error if we never get around to giving a particular medication (better late than never)...forget the specified times.

    We can only work with what we have, although I'd never try to work with 12-13 cases, patients, whatever, with only one other person who is not even a nurse. I'd strongly request at least one other nurse and a tech, or else I'd develop a sudden case of the bubble guts and couldn't make it. I would never knowingly walk into those conditions.
  13. by   MedSurgRN14
    At my hospital in US, our ratio is 1:5 ideally, 1:7 at max. I find ratios of 1:6+ to be insane, as I also only have one PCT helping me. I am running into one room, then running into the next. It is nonstop. You are more prone to errors when you are understaffed and also patient safety is at risk, eg falling. I would consider looking for another job with better staffing and ratios. The medication errors you made are minor, but depending on your work situation, it could set you up for further problems down the road, esp if management is not supportive of nurses. You could be fired, which will make finding another job very difficult. But then again if they are understaffed, they may not fire you. You always have to COVER YOUR ASS. Additionally, you do not want to be caught in the middle of a lawsuit or patient complaint.
  14. by   Wolf at the Door
    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.

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