Feeling guilty about poor practice

  1. I was going to write "bad habits" instead of poor practice in the title line, but I thought better of it. A little backstory. I recently moved from the southeast to the northwest and started a staff RN position on a surgical unit. The hospital that I am working at now has received multiple awards for clinical excellence and tries to use established best practices whenever possible. In the last few days I have been through several orientation type inservices, reviewing basic things like central line dressing changes and chest tube assessment. In the process of learning the policies and procedures I have become aware of how lax my practice had become, especially in the last six months at my previous job, when I was working night shift. To my knowledge, I did not cause harm to any patients, but I am feeling incredibly guilty about how sloppy I was. I didn't check my IV sites often enough, I let my tubing get out of date, I pushed IV meds too fast, didn't do very complete assessments if the patient "seemed" ok. I don't want to make excuses for myself, but I think that the above "habits" and others developed over time from being overwhelmed and overloaded with my workload. Subconciously I thought, "well nothing bad has come of it, and I just have too much to do." I am realizing now that I was saving time in completely the wrong ways. I have made a commitment to myself to change my practice for the better, and to beware of cutting corners. I am just feeling really crappy about it. It would be really helpful if anyone can share how they have dealt with this kind of thing before, or if they can share any tips on how to save time, and still get things done the right way.
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  2. 10 Comments

  3. by   SouthernLPN2RN
    I applaud you for realizing this and attempting to remedy it. I would just start doing everything like it should be done, all the time. Practice is about the only thing to do to make it faster. One tip I do have is to do your assessment thoroughly, and include the IV site and tubing in your assessment. It also only takes a second to glance at an IV site and ask if the pt has any probs with it. If waking a pt up is a concern, use your penlight to check it. On pushing the meds, take the time required, no matter what. If the time frame is too long, see if it's a med that could possibly be mixed in a 50mL bag and PB'd. Again, I applaud you!!!
  4. by   TypicalFish
    Hurray for you for having the courage to hold yourself to higher standards! Don't feel bad about what you USED to do; feel good about what you are improving on now. And, I don't think a day goes by where I don't think of something that I could of done better, or more efficiently.
  5. by   nursemike
    When my Dad was teaching me to be a carpenter, one very good lesson he taught me was that if you start off doing quality work, you'll get faster with practice, but if you start off working as fast as you can, your quality won't improve over time.

    He was absolutely right, and I try hard to bring that wisdom to becoming a nurse. But I have to admit, I do feel the pressure to try to get everything done on time, and it's awfully tempting to cut a corner here and there. I have reached the conclusion that it's better to occassionally give my last 2200 meds by 2245 and be sure the right meds get to the right patients, especially if the late ones are pepcid or colace. Still, I sure look forward to the day when starting an IV doesn't take half an hour and a dressing change doesn't require three trips to the utility room. Maybe then I'll be done charting before my manager comes in at 0800.
  6. by   Tweety
    I think it's all too common to get a little "sloppy" because of the amount of work we have, the pressure we're under, and the high ratios. Also, sometimes you have to realize you can't do it 100% the way the book says.

    It's tough when I precept "Now you're going to see it done this way........but I want you to get into the good habit of............". My mantra is get and use good habits until they become good habits.

    I'm glad that you've made a commitment to quality. Good luck.
  7. by   bethin
    Good for you for noticing this. From your post you sound like a caring nurse who wants realizes past mistakes.
    I'm a CNA. I rec'd my certification from a LTC facility. When I went to work in a hospital I thought the same thing you did. I felt bad for giving bad care but I realize now that it was the best care that I knew. I never abused pts. or anything like that but I probably didn't spend enough time with each one. I don't think too much about the care I gave in my previous job but I know without a doubt that I learned something. I learned how to slow down and think through everything I do. I've come a long way.
    Since you recognize this you can do something about it. Good Luck!
  8. by   pricklypear
    Good for you!! Would you come be the manager of my unit? I am overwhelmed with examples of poor practice every day. Stupid things that can and have caused problems. I have done everything short of submitting them to the DON (in the process of compiling a list) and have gotten nowhere fast. It's unbelievable. I wish there were more nurses like you!
  9. by   JBudd
    You can't change the past. We all wish we could back and change things, but working on just consistently getting better and letting go of the past is what you need to do. It isn't easy to let go, but try looking at it as "this was before, this is how to do it better". If you think of all of it as just a comparison for improving instead of obsessing over not having been perfect the first time, your mental approach will be less of guilt.
  10. by   fronter
    Med/Surg nursing is very hard work and most of the time you'll have admission, fresh post-op, MD returning phone call and bunch of family members asking questions, all at the same time. Now you realized, well this is not my best performance! I've started cutting corners where I really shoudn't! This isn't my best? Now you just need to find out is it really just you or is it nature of the unit? Go to your manager and tell her/him how you feel.Talk to your team in the staff meeting about it. Maybe you'll get extra help and whole unit will benefit, patients and staff as well. If nothing happens and you still have to cut corners, move on! PCU, 4-5 patients, CSU 3-4-5, ICU 1-2-3 or CVI 1-2 patients. Maybe you'll like it better there and you'll find your job more enjoyable before you burn out and start to hate your job.

    I admire people like you very much! Thanks for sharing your feelings and beeing honest about it! You are an great nurse!
  11. by   SheriLynnRN
    Thanks for all of the encouraging words. It's good to hear from others who have felt this way before. Tomorrow will be my first day actually orienting on the unit. I'm nervous, I will have to start all over, developing a new routine for myself. I'm going to give it my best shot. I am feeling some pressure to be perfect though, because the manager said that the unit doesn't get the opportunity to hire nurses with surgical experience very often. I feel like they are expecting me to show up and hit the floor running, with everything under control. They did offer me 4-5 weeks of preceptorship, so I guess they are giving me time to get everything straight.
  12. by   fronter
    Way to go girl! Rock on! You'll feel better in the unit! There are days where you can, actually, sit down!

    Good luck...

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