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major error in NICU



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No. 10
Old Jan 25, 2009, 10:59 AM

Default Re: major error in NICU
Do not beat yourself up. Everyone makes mistakes and you learned from it. That is what matters. Don't quit. Talk to your coworkers. IF you need to see how many mistakes are made, ask about joining the peer review board. It will open your eyes and maybe heal your heart about yours. We are all human. Mistakes will be made but as long as you learn from them, that is what matters. THank god the baby was ok. Forgive yourself then cont being the great nurse you seem to be
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No. 11
from Scraggles
Old Jan 25, 2009, 01:55 PM

Default Re: major error in NICU
Life is too short to waste the integrity of your mental health over this mistake. Yes you will feel awful for a while that's ok. However the outcome was positive and hopefully you learned a valueable lesson. We are all human and your colleagues should be supporative because eventually all Nurses will make mistakes, some without the positive outcome you had.
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No. 12
from 2ndwind
Old Jan 25, 2009, 08:15 PM

Love Re: major error in NICU
Oh, I am so sorry this happened, you practically had me in tears reading your post. I am thinking of you, hang in there... one step at a time, one day at a time, one week at a time...
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No. 13
Old Jan 26, 2009, 01:38 PM

Default Re: major error in NICU
Thanks so much for all the words of support. It helps to know that I am not the only one who has ever made a mistake. Our ratios are supposed to be 1:2 for intensive but it does not work out like that when we have 50 -60 babies. We are only staffed for about 48 babies. Luckily, I have 6 nights off to recover before I have to go back to work. I have been doing a lot of thinking about work. I am tired of the stress and nights and weekends..ect. I applied for a job doing case management and outreach for a non profit. I would go into homes and work with moms of preterm babies and children with health problems. Hopefully, it will all work out.

Regarding the IV pumps, I actually thought a few times that they are unsafe. I have worked with much better pumps with guardrails and separate buttons for rate and volume (the one I was using you have to scroll down. We only use the plum pump for the TPN. We use syringe pumps for everything else and they are also much safer. For small babies the syringe pump would be fine for TPN (we actually do that for for umbilical lines). I plan to mention all this to the risk assessment people. Not to defend myself, but hopefully to prevent it from happening to someone else.
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No. 14
Old Jan 26, 2009, 05:35 PM

Default Re: major error in NICU
The way I see it, quitting should not even be in the back of your mind. This event will make you a BETTER nurse, so quitting would do a whole lot of people a big injustice! I'm not a nurse yet, but I know that mistakes do happen and you'll need some time to heal. I can only assume you'll feel better with time.
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No. 15
Old Feb 04, 2009, 08:55 PM

Default Re: major error in NICU
Originally Posted by RN2B123 View Post
im so sorry! (hugs)

wait you were caring for 3 NICU babies by yourself? Im a nursing student but I thought that it was 1:1 or maybe 1:2 at the most...at least in adult ICU thats what it is. If im right, then thats totally unsafe work environment and id leave there asap

hopefully it all works out for you
depends on the area. One of my instructors is a NICU nurse & they have about 4 babies per nurse sometimes in the NICU she works in when she's not teaching us.
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No. 16
from balan01
Old Feb 05, 2009, 07:25 PM

Default Re: major error in NICU
hey, hey, hey. Nurses never quit. fight, fight,fight.life is a learning experience. you have to take it as a challenge.
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No. 17
from BabyLady
Old Feb 05, 2009, 07:30 PM

Default Re: major error in NICU
The thing with nursing...is that even though both nurses and doctors make mistakes that can cause catastrophic injuries or even death...they are not robots, they are human.

I am a student, and I cannot imagine having something like this in my heart...I won't fully understand it, until I experience it...so I won't try to act like I understand what you are going through.

But please, you seem to be a very caring nurse, and the other posters are right...you had too many babies.
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No. 18
from balan01
Old Feb 05, 2009, 07:31 PM

Default Re: major error in NICU
all nurses. Code red pls. Can you pls suggest nursing service policies that is most important to all of you. I badly needed some to contribute in the formulation/revision of the nursing service association in our hospital...
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No. 19
from iluvivt
Old Feb 09, 2009, 04:18 AM

Default Re: major error in NICU
OK so you made a mistake!!!!! What can you NOW do differently so it never happens again. This is what I do without fail EVERY time I start a drip or reset a pump. I needed to find something that was failproof since I see so many patients during my shift and often do not have the advantage of ever getting a report on them. So what I do every single time I do anything with an IV...including a start and site check,,,is to start at the top of the pump amd work my way to the site......check the rate....this is crucial...make sure the Volume to be infused is set correctly....has it been placed in the pump correctly...once on the pump is the clamp open......follow the tubing...make sure there are no clamps on or stopcocks are not turned in the wrong direction...next check where the IV tubing is connected..is it secure....is the CVC or PIV site OK.... it sounds like a long process but I do it so fast. I always check the bag as well and make sure it is correct and makes sense and it is for the right patient. This has worked for me my entire career and I am not going to change it now. I have caught many mistakes by nurses this way and they are always grateful that I checked. Also never increase a rate to prime your tubing...only use a prime feature or if not available to you with what you use just prime by gravity and attach your set. this is another way I have seen many mistakes and nurses get busy. I had a fellow nurse prime a lidocaine drip by increasing the rate from 20 to 220 and forgot to re-set it. The patient almost died as it was not caught right away. The nurse was upset with me b/c I had asked her to do the call b/c I was backlogged...I told her...... her policy should be as I stated and it never would have happened. Think about what I said b/c it works.
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