What To Do After You've Made A Mistake
by Ruby Vee
Everyone makes mistakes. It's what you do afterward that makes you an honorable human being and a good nurse . . . or not.
- 72 Published Feb 8, '11nursing school doesn’t really teach you how to be a nurse, it just gives you a glimpse into the world of nursing and the nclex gives you a license to learn. if you’re smart, you’ll learn something new every day of your career. if you’re very smart, you’ll learn how to handle those moments when you’re very, very stupid.
everyone makes mistakes. everyone. there are no perfect people, and anyone who would have you believe they are perfect is a damn liar. so know from the very first moment you put on that name badge that says “rn” or “lpn” or “cna” that you, too will make a mistake. mistakes are an inevitable part of life and an inevitable part of nursing. what matters isn’t that you’re perfect; what matters is what you do after you’ve made that mistake.
recognize your mistakes. i’ve known a few people who were so convinced of their own perfection they couldn’t recognize their imperfections. if they did it, it must be right. if you’re not willing to admit the possibility that you might make a mistake, you’re unlikely to realize when you’ve made one. the very first thing to do when you’ve made a mistake is to recognize it. the second thing to do is to admit it -- to yourself, to your charge nurse, to the provider, to your manager and ultimately to the patient.
it’s amazing how few mistakes actually kill patients or even cause them permanent injury. some do, we all know that. but if you recognize your mistake, admit it and immediately set about to minimize the damage, most mistakes are merely a bump in the road rather than a career ending or life ending catastrophe.
i worked with a nurse i’ll call maria. maria was a lovely person -- beautiful, funny and smart. she also lacked integrity. we worked in sicu together years ago, and one day i was in her room with her, helping her to turn her fresh-from-the-or cardiac surgery patient. as we turned him, the monitor started to alarm and we looked up in horror to see his heart rate slowing down and passing 30 on the way south. the surgery resident was just outside the room and responded instantly to my involuntary utterance of “oh, s%&#!” there were many interventions, but the one i’m talking about was the order to give “point one milligram of epinephrine.” maria grabbed up the amp of epi i handed her and pushed the entire thing -- one milligram.
suddenly we had the opposite problem. the patient’s heart rate picked up -- slowly at first, but rapidly gathering steam and the rate on the monitor was over 15o when i looked up from the code cart. from no blood pressure and a flat art line, we suddenly had a pressure of over 250 systolic. and climbing. “how much epi did you give?” shouted the resident.
“what you said,” replied maria, hiding the empty syringe from view. “i gave what you said.”
“how much was that?” countered the resident.
“i have what you said,” maria insisted, despite clear evidence to the contrary. and she never budged from her story. never. the chest tubes were suddenly full of blood and the pleurevac overflowing. as we whisked the patient back to the or, there was a trail of bright red blood in his path. maria’s mistake didn’t kill the patient because of the quick thinking and quicker actions of that surgery resident, but i never trusted her again. neither did the resident, who is now head of cardiac surgery at the hospital where maria still works.
as soon as you recognize that you’ve made a mistake, tell the appropriate person. it’s not enough that you recognize your mistake, you have to do everything you can to prevent, minimize or mitigate the damage. if you’ve made a medication error, tell the physician. there may be -- usually is -- something that can be done. narcan can reverse a narcotic overdose , protomine reverses a heparin overdose and if you’ve given too much insulin you can follow it with sugar whether it be a can of real coke or an amp of d50. you’ll need a doctor’s input and a doctor’s order.
once you’ve done what you can to help the patient, take a moment to think through the process that led to your error. were you moving too quickly? distracted by family members? couldn’t read someone’s handwriting? whatever it was, you need a firm understanding of how and why you made your error and an idea of what you’re going to do differently next time to keep it from happening again.
then tell your manager. there are right ways and wrong ways to tell your manager, but whatever you do, tell her before she finds out from someone else, especially if it’s a big mistake. call her at home, email her or whatever. there’s nothing worse from a manager’s perspective than being blindsided by the person who comes to confront her about some mistake made by a member of her staff.
as an example of the wrong way to tell your boss about a mistake, david once defibrillated a patient in normal sinus rhythm because he mistook artifact for a lethal arrhythmia. he was new to icu, and some artifact looks like v tach, v fib or even asystole. david shocked his patient in full view of an entire team of doctors and a couple of nurses who were all yelling at him to stop. “oops,” he said with a laugh. “i shouldn’t have done that.”
no one else was amused.
you want to make it abundantly clear to your boss that you realize you’ve made a mistake, that you understand the consequences were or could have been enormous and that you’re profoundly sorry. you also want her to know that you’ve thought about how it happened and how you’re going to make sure it doesn’t happen again. few bosses would tolerate david’s responses to a mistake, but i can tell you from personal experience that you can survive the second with your job and your license intact.
lastly, forgive yourself and move on. that’s often the most difficult part of the whole process. but not moving on condemns you to relive your mistake over and over and over again. it undermines your confidence, destroys your sleep and makes it more likely you’ll make more mistakes. that’s a vicious cycle.
i won’t say i’ve completely forgiven myself and moved on . . . yet . . . but i’m working on it.
Last edit by Silverdragon102 on Feb 9, '11 : Reason: changed to all symbols
About Ruby Vee
Ruby Vee freely admits she is not a perfect person or a perfect nurse. Hopefully, she learns from her mistakes and hopefully you will, too.
Ruby Vee joined Jun '02 - from 'the Midwest'. Ruby Vee has '38' year(s) of experience and specializes in 'ICU/CCU'. Posts: 8,120 Likes: 27,786; Learn more about Ruby Vee by visiting their allnursesPage
5Feb 10, '11 by DedHedRNDo you think it is possible that she was panicking and was substituting 1 milligram for 1 milliliter in her mind when she pushed the meds and never even realized that she made a mistake?
And laughter is a nervous response of some people when they know that they have done something wrong, its doesn't always mean that they think the situation is funny, or that they are not sorry.5Feb 11, '11 by silverbatWhat bothers me the most is the mistakes we don't realize we made..........
I had a nurse once walk down a hall hanging IVPB's a she went, which was fine, as it were, until I answered a beeping IV and found she had hung the wrong meds on almost everyone 7-8 pts.... Thank goodness no one was harmed...but........
I still remember my first med error as a CMT, and practically all my others, because, yes, I have made errors, I am human, I have learned. DO NOT trust the nurse who says she has NEVER made an error, She hasn't admitted to it, yet.4Feb 11, '11 by cherryames1949Best advice ever. Sometimes people are reluctant to own up because a manager or the health care facility can be punitive. Nobody wants to make a mistake. It can be devastating. Management could have appropriate education following an error. The institution could have a review of errors, in a non punitive environment, so everyone could benefit. This could improve employee morale and patient care.3Feb 15, '11 by dudette10I also want to add something to Ruby Vee's excellent post.
Never forget to learn from your "almost" mistakes, too. You know the ones...where you almost make a mistake, but catch it just in time. As a student, I've made a more "almost" mistakes than actual mistakes because I have someone watching over my shoulder, and those are very important to reflect on also.1Feb 18, '11 by joanapril_18It's ethically correct to admit the mistake that occurred, and it also gives a chance to quickly correct the problem. I just think it's difficult to be completely truthful about the mistake if you know that your superiors will never forget the mistake you've done. It's hard to move on when they keep on reminding you of the mistake you did. Even if there was no harm that beset the patient or it didn't kill the patient they would still remember it and bash it in your face right after you've made another mistake of a different kind.
The honesty is the easy part, but its the moving-on which is the part of the cycle that is most difficult. Specially, when the one's that you've confided the truth are also not in support of your efforts to move on.
I also agree that not moving on will predispose you to more mistakes in the future..
Thanks you for the post.