Hello to all on this site!
I very often lurk here to find support and understanding, but don't often post because I don't have much to say. Right now I am going through some things and I think I need the advice of the group to put my best foot forward.
I am an ADN student who graduates in May 2007. My school is on a trimester system, so I had three weeks of school before the Christmas break and have the remaining seven weeks now. I will have another ten week term and then graduate.
I am one of the best students in lecture. My GPA is 3.989. I love patho. I always got "exceeds expectations" in clinical. I am excited to be a nurse. However, I've made some mistakes.
The first week of last term I did not know that my client needed two prednisone instead of one. I had pulled the meds from the drawer, waited for my teacher, and learned from the computer that I needed two. In practice, I feel I would have had the drawer and pulled two when the computer told me to, but this was called a potential med error. I accepted it and tried to move on.
The next week got worse. I have never spiked a bag of IV fluid in my life. We had just learned it in lab and my client needed a new bag of 0.9% NS. I pulled a 1000cc bag that said 0.9% NS, but, unfortunately, I didn't know and didn't notice that it also said 5% dextrose. My instructor was in a hurry. We did not scan the bag like we were supposed to and the wrong bag got hung. Fortunately, the client was not diabetic and his piggyback was mixed in D5, so it was compatible. No harm to the patient, but I felt like I was going to die. I didn't as yet get written up for this one because the instructor takes part of the blame for the mistake.
The next day I was crushing the meds for the same patient. My fellow student asked me in front of the instructor what I was giving. I said "hydrocodone". I even looked at the package and said "hydrocodone", but it wasn't. It was hydrocortisol. Of course, I knew in my head what it was, but I said the wrong thing. I got written up for that.
I was also supposed to go back and get my instructor after my client had not vomited for an hour. For some reason, I didn't. At this point, this far removed, I can't remember why I didn't actually go and tell her. The co-assigned nurse came in and turned the pump back on. I got written up for that, too.
Now I have been put on clinical probation. :uhoh21: I feel like I have been kicked in the stomach! After so much work and effort and WANTING to be there and being GOOD at it, I am now one step closer to possibly being kicked out of the program. I am told that this is just a way for the instructors to work with me, but I am terrified now of making a mistake and being booted. I feel like I have always BEEN careful. Now I'm not really too sure how to be more careful.
I also question whether or not I can do this, whether or not I will make it, and how this could happen to someone who has been such a good student. I'm still fairly in shock, to be honest. It's like learning someone died.
So, I ask of you all out there how I can approach these situations and NOT make the mistakes that I have made this term. Does anyone have any advice or routines they go through to prevent making med errors? How do you make the 6 rights part of your med pass? How do you move quickly yet carefully and without any mistakes?
I have quite a bit riding on this program, but it is also something that I feel deep down will make me happy. Yes, I know that it can be a tremendously difficult job, but I think it is the job for me. Actually, I would like to work critical care some day, but I feel like my dreams are evaporating.
I do have problems with depression and anxiety. I'm trying to deal with those, too.
So, any advice out there? Any wisdom from nurses in the trenches?
PS If this post belongs in another forum, please let me know how to move it around.
Jan 7, '07
I would say if your instructor is in a huge rush to help another student then tell them to go help that student and come back...then you can prepare and settle yourself and not everyone will feel rushed!! When we try to hurry too much is when we get into trouble!!! GL!!!
Last edit by NeosynephRN on Jan 7, '07
Jan 7, '07
here's a very good piece of practical advice that you can do when pouring any medication. put the finger of one hand on the page of the medication sheet so you kind of "highlight" the name of the medication. use your other hand to hold or point out the name of the medication you are about to open up and pour. ask yourself "do these names match?", "do the doses match?" you have to make a conscious effort to do this. and, these can't be quick glances. spell out the names of each in your mind if you have to. the actual time you lose in doing this is only a few seconds, not minutes. do the same with bags of iv fluids. use a finger and trace the printing as you are reading along. it only takes a few seconds longer. doing this is very important. it can mean the difference between being a safe practitioner and committing malpractice. there is no in between.
as for remembering things to follow up on, there is such a thing called a to do list. normally, i mention them when students ask for information about prioritizing. in short, a to do list is a list of the things you need to do during your day at work (clinicals). the most important things should be at the top of the list. as things are completed you cross them off. now, when you are new to nursing it is helpful to actually write these lists out. that way you don't forget anything. you put something down on the list immediately as it is known. as you get experienced, you can run the list in your head. i would recommend that you carry some kind of little pocket notebook with a list like this that you set up for every single clinical. it will help you organize your time as well as prevent you from making the same kind of mistake you mentioned in your op--that is, assuming you remember to put the task on the list and remember to refer to the list periodically. i will also tell you, that when i was working on a busy stepdown unit i would circle a couple of times in red ink those things that i needed to remember to do so they jumped out at me every time i looked at my "brains". you can do the same by using a yellow highlighter if you don't have a multi-colored ink pen. here is a copy of my "brains". Attachment 5032
i often put things i needed to chart or follow up on on the back of this piece of paper as well. it was folded up and i kept it in my pocket or on my clipboard during my work shift.
- setting priorities
- how to make a todo list
to-do lists from mind tools - learn how to plan your time intelligently. free template!
- to do lists
Last edit by Daytonite on Jan 7, '07