I had a BAD day... very bad. - page 3

Today was our last day in clinicals. I made my first med error! Before giving ferrous sulfate, lovenex and effexor I failed to take vitals. I was bordering on giving them late for several other... Read More

  1. by   peaceful2100
    (((VAL)))))) Hang in there, it will get better. You have been offered great advice and I can't offer you anymore but juts hang in there.
  2. by   NurseGirlKaren
    Ditto all the above. I'm sorry that you have to be dinged for stuff like that. Glad you made it through!!
  3. by   Kayzee
    Keep your empathy.....their wrong.
  4. by   nurseleigh
    I understand all the above posts about "living in the real world" and so on, but you guys need to remeber that things that wouldn't be a very big deal if you-a licensed nurse-did are a HUGE deal when we-the student-do them!!!

    I know in my program you are only allowed 2 med errors total, not per semester, but for all of your semesters. And the late meds that are late because you couldn't get to the instructor to check them off still count against YOU.

    Anyways, I have a few questions. Did you report to your instructor when the armband was missing or that you needed a consent form signed? I doubt that anyone from my class would have been written up for the med being given late under the circumstances IF we kept the instructor informed all morning of the problems. However, if I went to her 5 minutes before the meds were late and she had no idea what had been going on all morning, she would have.


    And lastly, here in illinois we have an hour before or after to give the med, not 30 minutes. Just an FYI.

    Leigh
  5. by   Vsummer1
    Originally posted by nurseleigh
    I understand all the above posts about "living in the real world" and so on, but you guys need to remeber that things that wouldn't be a very big deal if you-a licensed nurse-did are a HUGE deal when we-the student-do them!!!

    I know in my program you are only allowed 2 med errors total, not per semester, but for all of your semesters. And the late meds that are late because you couldn't get to the instructor to check them off still count against YOU.

    Anyways, I have a few questions. Did you report to your instructor when the armband was missing or that you needed a consent form signed? I doubt that anyone from my class would have been written up for the med being given late under the circumstances IF we kept the instructor informed all morning of the problems. However, if I went to her 5 minutes before the meds were late and she had no idea what had been going on all morning, she would have.

    And lastly, here in illinois we have an hour before or after to give the med, not 30 minutes. Just an FYI.

    Leigh
    Yes, she was aware of the armband and the consent. If I had your hour before or after to not be late, I would have been just fine. I asked her if my CATCHING these previous errors could in some way justify my error, and she said nope, but that she would take it into consideration on my final evaluation.

    I think a previous poster summed it up: She wanted my TOTAL assessment, including vitals, done before any meds. Which means that instead of reading the patients chart and looking up my meds (letting the patient sleep) -- I will in the future wake my patient, do assessment, then while they are eating look up only those meds needed for the first med pass. I can read the chart to try to figure out why the patient is hospitalized (I kind of like knowing the med dx before I approach a patient, and we don't get our assignments until we show up for clinical!) after all of that is done. Had I done it this way, I would have noticed the cathetor leak and the armband earlier, and gotten the consent earlier. I just wouldn't have been able to read up on anything not given in report along with all the meds the patient was on.

    I have thought long and hard about how I could have done it differently for a different outcome, and that is my solution. And isn't all this about critical thinking anyhow? So, in the end, I have learned from it.
    Last edit by Vsummer1 on Dec 12, '02
  6. by   nurseleigh
    by the way, HAPPY BIRTHDAY!!!

    Leigh
  7. by   Agnus
    Could have would have should have. Stop beating yourself up. You did fine. I'm an RN. In the real world the CNA would get your vitals.
    Ya done good kid. I do not take vitals for those particular meds.
    Suff happens. Let me tell you about the day I just had.

    4 incident reports. 2 incident reports the day before.

    Looks bad huh?

    Yesterday I was charge with 4 patients. And admitted another. So I had 5.
    One of my nurses had a patient fall.
    A CNA was injured. I'm vague about it but seems she cut her hand and was exposed to a patient's bedding or something?
    I lost the keys to the pharmacy.
    I gave cumadin to a patient without an order. Someone else transcribed the order to the MAR but it was the wrong patient.

    The day before, I wrote an extensive incident report on the night nurse for multipe errors. The patient was not harmed as the errors were caught by me in time but the potential was real.

    I also had to write one for something else that day. I forgot what it was.

    Most of those things I had absolutely no contol over.
    The cumadin was because I did not check behind the UC after she transcribed. I do spot check. However, I was very bussy and didn't really have the time that day. I know the UC is very good about transcribing and I have faith in her. This was a very human error. I share responsibility as I ideally should have checked. Untimately the responsibility is mine.
    I gave the keys to someone and they did not return them and went home with them by mistake. I was bussy and she probably couldn't find me to return them and then forgot just as I forgot that I gave them to her.
    The falling pt and the CNA injury I had no control over. It was a hectic day. Sure ideally the Charge nurse is suposed to know everything that is going on and make rounds. Sorry folks I couldn't be in 6 places at once. So two people got hurt. I am sad for them but it was not within my control.

    Stuff happens. In the real world meds are late, vitals are missed, assessments are not by the book.

    You are learning the ideal right now and that is as it should be. But forgive yourself on this one learn what you can but let it go.

    I have to smile about the waking up the patient part. That was me in nursing school.
  8. by   Furball
    Yup we all make mistakes..... I once gave a unit a blood without an order. How could THAT happen you gasp? It was my first week off orientation on a very busy post op cardiothoracic step down unit. Short staffed, off orientation early because "you are doing SO WELL" Shift from hell, no secretary, no NA's, rude, obnoxious family members. Got report which stated that one of my pts was to receive 2 units of PRBC's because her crit was 20 and she was scheduled for sx in the am. Yup, ok, faxed for the first unit, checked the consent, orders, blood unit, MR # ect with an experienced nurse, called the resident on call and obtained orders to premedicate. Like I said, shift from hell. Only transfused 1 unit reported off to the next nurse to give 2nd unit. When I get home the phone rings. It was the nurse I reported off to asking where the transfusion orders were. Huh?

    Apparently in my rush I read the orders to type and screen x 2 units and THOUGHT I read transfuse. The other nurse who checked with me also rushing swore up and down there were orders....there were none.

    Thnkfully the resident I called for premed orders came by later and wrote the orders to transfuse. The next day he thanked me for saving his butt. He was suppose to write orders for blood but got distracted by a demanding family member. My mistake was in the pts favor, thank God...but could've been disastrous.

    Don't beat yourself up. We've all been there.
  9. by   Vsummer1
    You guys really are the best! Thanks so much... it means a lot to me that you all care enough to share your experiences.

    Next up: OB.

    :kiss
  10. by   Amy W.
    Effexor is a mood altering drug and that is why (most/some) facilities require written consent before administration of such meds. If the facility did not require it that is probably why the instructor required the consent.

    Taking V/S is part of patient assessment and that is probably why you got a ding in the assessment area.

    Remember before giving any meds you need to assess the patient for problems or atleast a baseline...under the assessment part of Nursing Considerations in my drug book you should assess pulse and B/P. If this was not done prior to administration how would you know if something changes.

    Just a little constructive critisism...Keep up the good work, you will do fine.

    Remember...you have to be able to evaluate the effects of the medication.

    Even though it is not a B/P med or require some lab work ALWAYS look in you drug book under nursing considerations for assessment guidelines.

    Also remeber your instructors are teaching you "How things should be done" not how they really are done somtimes "in the real world." You did fine and you will be a very good nurse. Clinicals are very stressful and don't beat yourself up. If you already knew everything you wouldn't be in NURSING SCHOOL.

    Good luck in the rest of your semesters!
    Last edit by Amy W. on Dec 16, '02

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