What do we do with an "Imperfect" nurse?

  1. 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 regular. Yes, I made the mistake! I'll admit it. The patient was on an insulin drip that was covering at about that rate. The infusion was stopped and no negative outcome occoured to the patient.

    This happened in an ER hold area on a weekend morning. I feel terrible about this mistake and am very glad that nothing happened to the patient! A fairly common and well researched mistake using an order that was poorly written. I was placed on the do not use for that facility.

    Once I held an antibiotic. The ped had a central line that would not flush for me. I attempted to flush with a 10cc in hopes of having better luck with more pressure. The line still did not flush well. I told the student md during rounds that I was having difficulty with the line. "He said to just give it!" I held the med. On the next scheduled day of work I was fired. No harm came to the patient.

    I failed to enact a heparin protocol at a facility. There were apparently some parameters somewhere that dictated that a bolus was to be given if the PT INR form a lab fell within a certian parameter. I was unaware of the protocol and bolus necessary. The patient was fine 2 days later when I cared for him again. I am now a do not use at that facility.

    I am not perfect! I truly care about my patients! I try my best to assist them to achieve the highest level of wellness! I make the extra efforts to help the family. I feel terrible about making these mistakes!

    Should I simply quit nursing? Having posted these admissions here for peer review I hope to recieve some feed back. I also hope that the BON does not see fit to take action against me. The only thing that the BON seems to do is prosecute when a mistake is made.

    I need to know if I am just a "bad nurse" and should have never been allowed to or at least continue to pratice? Are there any other nurses in the world that have made mistakes? How did you overcome them? How did the facility handle them? Were you ever "forgiven?"

    Please help me to gain the confidence to resume pratice or get out!

    Thank you
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  2. 40 Comments

  3. by   Norbert Holz
    I've been watching this board for a while. Does anyone care to lend support or advice to leave?
  4. by   nicola
    Honestly, I can understand why no one has posted to you... You ask difficult questions! Without knowing some things, like how long you've been a nurse, the period of time between these incidents and the orientation you had at each place, it's hard to say.

    In my opinion, it sounds like the heparin thing could have been due to insufficient orientation. If they have standing orders that are used with any frequency, you should have been informed.

    As to the other things, I'm at a loss.

    If your confidence is down but you want to continue in nursing, there are many areas that dont' include direct care which you might want to consider.

    I'm at a loss...
  5. by   Norbert Holz
    I've been an RN for 7 years.
    The incidents happened:
    this year heparin, no orientation to the facility or unit.
    antibiotic in 1997 "full "hospital orientation
    insulin in 97 no orientation

    Thanks for responding !!!!!!!!!!
  6. by   fiestynurse
    First of all, you are implying that there is such a thing as a "perfect" nurse. All of us must come to terms with our strengths and weaknesses. It sounds like medication administration is an area that you need work on. There are many things that you can do with a nursing degree and areas of nursing where you don't give medications or give few meds. How are your other skills? How did you do in nursing school? What kinds of things have you already done to remedy this issue?
    Last edit by fiestynurse on Nov 26, '01
  7. by   Norbert Holz
    My idea for the title "imperfect nurse" comes through my observations. I hardly ever see nurses being fired or put on do not use lists. I feel that this is unique to me because there is no discussion on the subject.

    We all know that nursing is in a sad condition today. I believe that this may be considered when handing out disipline to nurses who have made mistakes. My experience is that I am a disposable and easily replaced by some one else.

    I did have quite a tough time while in nursing school. It seems that my gender and up beat personality were misintrepreted.

    Imagine failing a blood pressure assessment! I can not even begin to fathom how an instructor can fail a student on "improper" assessment of a blood pressure. That was my first evaluation in nursing. It was also stated that winking will not be tollerated! Imagine that for a grading criteria!


    I have been an RN for over 7 years. My other skills? Great!

    To remedy the situation I've learned from each of my mistakes. I have continued to pratice. I have asked for full and complete orientations wherever I work.

    I have even left nursing going to work for Bisk publishing, the "on line" marketing company that offers the BSN program shown on this site.

    Thank you for responding!

    How do other places handle nurses that are less than perfect?
  8. by   Teshiee
    I understand what you mean sometimes. No nurse is perfect I have made errors and use techniques to not make the same mistake. I use my own cheat sheet so when I have to administer the med it is there in bold print. I have witness other nurses making errors and being literally crucified for them it is not right. We all have different situations. It sounds like to me you have to believe in yourself. I am not good on taking major patient load I freak out. I know this and I work in NICU. Yes it is a stressful area but with less patients. I tend to focus on better with less patient load. Just find your niche and you will see that you are not the imperfect nurse you thought. Good luck to you. I also admire your courage in posting this. Trust me you are not alone.
  9. by   P_RN
    Here in SC it is pretty much standard to have two nurses check ALL heparin and insulin preps to avoid just such problems.

    With the heparin protocol, was it not on the MAR? It should have been printed in the MAR! It should have also been included in the treatment orders.

    A "student doctor" is that a medical student? We cannot take orders from medical students. Did you document why you did not give the Abx? Did you notify the physician? Did you seek someone else to check the IV line? Did you notify the doctor it did not work?

    I don't think any of us is perfect, but I don't like your feeling you are imperfect either. Perhaps you would benefit from a pharmacology course as a review. You may have to take it on your own $ but it couldn't hurt to be able to say that you have done that.

    Good luck.
  10. by   canoehead
    Well, not knowing you it is hard to have an opinion.

    Perhaps you are putting responsibility off on other people too easily.

    As a nurse you need to know the usual doses and make sure the dose your pt receives is in line with their condition. With that in mind 100u of insulin is way too much for anyone.

    You need to be aware of the scope of practice and expertise of people around you- a student doc doesn't know anything, and can't legally give orders. So always go up the ladder, don't assume the student doc knows enough to inform their superior, it is actually your responsibility to get appropriate follow up for your patient. But even if you DID think that this person could give orders "give it anyway" on a nonfunctioning line is impossible, and requires some discussion on what route, how much to give. You absolutely cannot leave it in that person's hands no matter what their rank if you are a pt advocate. Why not follow up after rounds and say "so what did you all decide about that line that's not working?"

    If you have a pt on heparin protocol you are responsible for pulling out the protocol and using it. Don't wait for someone to prompt you. If you see the heparin up there must be an order for a constant drip, or a protocol, so look into it.

    As I said, if I worked with you for a shift I would have an idea of what to advise you- but from what I see maybe taking a personal interest in makng sure ALL aspects of the patient's care are coordinated would help- even if you think that someone else is handling it more often than not other depts and med students figure that nurses are double checking and coordinating.

    If it was just about following rote orders a tech could do it, you are being paid for critical thinking, and questioning, so go ahead and do it.
  11. by   leia
    I don't think tthat there is a perfect nurse and we all do make mistakes-you just get caught doing them.And that you feel terrible about them just shows that you are taking responsibilities for them and ,as you said ,learn from them so you won't do them again.Other then that keep on informing yourself,books, courses etc.To me a good nurse don't have to be perfect,but has to know his/her limitations and most of all has to care about the pt's he/she is dealing with.For me it always worked to really listen to my gut-feeling,intuition is always good.
    You have a german sounding name-are you german?Just curious
    leia
  12. by   willie2001
    There is no such thing as the "perfect" nurse, although I have worked with one or two who think they are. A good, responsible nurse will admit to her mistakes. It's called being accountable for your actions. In your situation, why did you agree to work in an area/facility where you received little or no orientation? That is just setting yourself up for mistakes. And why, if the insulin order was unclear, did you not clarify it with the physician? It also seems that the problem with the pediatric line should have been called to the attention of the attending physcian, not a medical student. Surely something could have been done to make sure the patient didn't miss a dose. I'm probably coming across as harsh, but using a little common sense can go a long way in a lot of situations. And don't be afraid to ask questions if you don't know something about the policies and procedures of your facility. It is ultimately your butt on the line.
  13. by   thisnurse
    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. I never abbreviate that word. i check check and double check my meds before i give them.
    i have to be honest here, 100 units of insulin is an unusual doseage. i certainly would have looked at that more than once. you have been an RN for 7 years, i dont understand why you didnt.

    only you can say whether you should stay in nursing or not. only you know if you are unsafe. if you have your heart set on staying, i suggest you get some kind of remediation before you cause harm to someone.

    from what i gather, although i dont really know, it sounds like you are an agency nurse with no solid orientation. i remember when i graduated 5 years ago the only place you could get a job was in LTC or agency. one of my friends went with agency. she did home care at first and was put on assignments she was not qualified for
    such as trach patients. she never had one. got to the clients house and found out she had a trach that required care. the office walked her through it over the phone. it was her last day. she quit.
    another friend went to a LTC facility. her first night on duty she had 35 patients and she was to be the ONLY rn in the facility. her supervisor told her if she had any problems she could call her at home. she refused the assignment and went home.

    these nurses were smart. they refused to be put in an situation they could not handle. they realized their limitations due to their inexperience. how many nurses that graduated around that time just stuck with it, knowing they were never properly trained to be a nurse, just skating by on what they learned in school. is this what happened to you?

    maybe agency isnt a good fit for you. perhaps you should take a job at a hospital or LTC facility that offers at the LEAST a six week orientation. see if things improve after that.
    making mistakes makes you human, unfortuanately, in our profession we are not afforded the luxury of mistakes.

    good luck to you.
  14. by   kaycee
    Norbert,

    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.

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