What do we do with an "Imperfect" nurse? - page 2
Me, that is? I seem to make mistakes ! Nothing that has ever caused any injury, harm, or negative outcome for a patient. I remember well the 10U of regular insulin that looked like 100 of... Read More
Nov 27, '01Certainly, nobody is perfect, but maybe you should not be doing agency until you are more experienced.
Why not try to get a permanent placement and get comfortable with something?
Nov 27, '01granted, there is some substantial issues that need to be looked at/resolved....but i do think it is intresting that i've only read one or two posts saying "good for you for admitting your mistakes and trying to become a better nurse"...i think that is sad...
norbert--good for you for bravely and publicly admitting your mistakes and making an attempt to figure out thier roots and resolve them
Nov 27, '01I think that it is safe to say that EVERY NURSe, at least once in thier career, has made a med error. I know I have and luckily no harm came to the patient. If one hasn't then they are lying or just "perfect". As Fiesty nurse said there is no such thing as a "perfect nurse". Don't be so hard on yourself. It is customary to have two RN"S check insulin and heparin drips. Always remember the five rights of medication administration:
1. The RIGHT DRUG
2. The RIGHT DOSE
3. The RIGHT Patient
4. The RIGHT ROUTE
5. THe RIGHT TIME
and the 6th .....the RIGHT DOCUMENTATION
It is imperative that each and every time a nurse gives a med that these "rights" are followed. I think that there are more med errors than actually reported because a nurse is afraid of being reprimanded.
Keep your head up! Good Luck!
Nov 27, '01Perhaps you need more structure than agency nursing allows you. Consider going back on staff somewhere to get a thorough orientation with a mentor. I sense you are feeling a bit underconfident. Agency nursing is not the place for underconfidence. No one is perfect, we all make mistakes, but agency nursing is not suitable for every RN.
Nov 27, '01Originally posted by kaycee
Only you know whether you are competent. There are no perfect nurses as has been stated. We all make mistakes at different times in our careers. We learn from our mistakes.
I agree with thisnurse. Agency is not for you. You need to work in a steady environment with a good orientation. Jumping around from place to place is not for nurses that are unsure of themselves.
Also why do you feel the do not use lists are unique to you? Sounds like you're down on yourself. Maybe this comes across to your co-workers. Somehow to be put on the do not use lists constantly without discussion means there needs to be discussion. Talk to the head of your agency. One med error doesn't usually get anyone fired or on the do not use list. There must be more Norbert.
After reading this message, I did question this nurse's ability to give safe care. We all do make mistakes, but serious mistakes such as these are different. Med errors that were listed above with an agency nurse would certainly give the facility reason not to request this person back. A nurse who would give a 100 units of R insulin without question would send up red flags to me.
Nurses, who make consistent errors or do not change their pattern of making mistakes with giving meds are not giving safe care to patients. We must adhere to policies that ensure meds are given safely with the six rules of safe medication administration and knowing all the information of the medication which includes dosages.
Nothing was written in the orginal message that question were ask of other staff members or that this nurse looked up the medicaton prior to giving or not giving it to their patient? I once had a nursing instructor who stated we don't need to know everything, but we must know where to look it up.
Nov 27, '01[QUOTE]Originally posted by thisnurse
[B]we all make mistakes. i made the same insulin mistake when i was in school. i misread 2U as 20 units. after i pushed the insulin i realized that was an awful big dose so i questioned it. i should have done that BEFORE i gave it. no harm came to the patient, thank god, but i learned a lot from that. i always write out units now. ]
Where was your nursing instructors and most hospitals and nursing homes, you will be required to have insulin dosages drawn up checked by a second nurses.
Nov 27, '01[QUOTE]Originally posted by leia
[B]I don't think tthat there is a perfect nurse and we all do make mistakes-you just get caught doing them.
So nurses are out there making these same mistakes, they just haven't been caught?
Nov 27, '01I agree with what everyone is saying. I think your first oversight is not having a solid base of nursing to go by. I would advise you to go to a med-surg floor. LEARN THE NORMALS!!!! Be straight up with them and let them know that even though you have been a nurse for 7 years, you want an orientation--a good one(seeing as you may have never worked in one consistant place before) as far as the ped's patient with the central line I wouldn't have given the med either, however, I would have notified the attending physician. The he11 with the med student. And most importantly....DOCUMENT. The insulin issue---I was trained to always have a nurse double check the insulin with the original written order. Fresh eyes are always good. At our facility, heparin protocol orders are always on the chart...always check your charts. The charge nurse may not always be able to get to them in a timely manner. If all this seems overwhelming...it is. Take a time management course, get out of agency nursing and find a home. It sounds to me like you need constants to gain back your confidence and your skills. Good luck and don't give up. Sharpen yourself up a little and be the best nurse you can be. We need you.
Nov 27, '01Norbert:
I too applaud you for bearing yourself so openly; That in itself is proof that you worthy of caring for patients because you are so willing to learn from your mistakes. I fear the nurse who is never wrong for "we" all learn something everyday.
Your confidence needs help. The other posts were right on when they mentioned a class or other sort of brusch up for your medication knowledge. I recently purchased a new Drug Book by Loeb; This book is very user friendly with large print, stays open in one hand while you use your other (wouldn't it be great to have three hands?), and colored print for alerts. I picked it up from .com for less then $ 20.00.
Find what works for you. Nursing needs commited individuals, like yourself, who are willing to go the extra mile and continually reassess themselves and get the training/education they need.
When in doubt: ask, check the policy and procedure manual, look it up, follow your gut... move forward...
Recently, I listened to a wonderful tape about Mother Teresa's book "Passages"; I learned a very helpful prayer for forgiveness. It helps me to realize that we are all forgiven the moment we ask Him for forgiveness.
You have learned from each of your mistakes. It is now time to move on and do what you need to do. Only you know what that is... follow your instincts.....
Nov 27, '01Yes, mcl4, I believe that many errors go unreported because of the punitive nature of our system. And I also want to compliment Norbert on the admission of his errors and the seeking out of help.
Nov 29, '01Originally posted by fiestynurse
Yes, mcl4, I believe that many errors go unreported because of the punitive nature of our system. And I also want to compliment Norbert on the admission of his errors and the seeking out of help.
On this board, errors have been admitted by the person, but my reading of the orginal post is that other staff nurses he was working with found these three errors. It didn't appear he had the knowledge necessary to realize he made an error?
Nov 29, '01I have some concerns. By stating them I am not implying perfection. But the words that echo in my head froma lot of years ago are these "You are the patient's last line of defense". Perhaps unfair, but I have found this to be true. It is worthy to note, this is part of our job that our patients are unaware of.
The mistake with insulin must be common. At least common enough for recommendations that the word units be written out in the order. To not question an IV infusion of 100 units per hour isn't orientation related. It is a little scary.
Holding antibiotics because an IV doesn't work? You can't do that unless the antibiotics are changed to another drug, dose, or route. It is the nurses responsibility to follow up on this. Don't force a central line to flush either. And if the medical student tries to, then stop him/her. Can cause embolus. It may be necessary to replace the central line, they are only good for so long, or obtain peripheral access. But we can't just decide what meds to give and not give based on if our IV access is working. Follow up, follow up, follow up!!!
Is IV Heparin ever given without a titration schedule?? You indicated that the heparin was to be titrated by PT/INR. This is a red flag to me that you may not be all that familiar with heparin, since it is titrated based on PTT, not PT or INR.
I guess my question would be are you working agency in care areas where you are familiar with the patient population, common diagnoses, and usual treatments? I have worked agency and you don't get a lengthy orientation. You are expected to hit the ground running. If you are unfamiliar with the care required for a particular patient group, then it is your responsibilty to say, "Sorry, I can't take that shift".
I am not perfect, but my background would not permit me to take a shift in labor and delivery.