Mistakes as a new pediatric oncology RN

[peds_oncoRN]

Hi all! As the title suggests, I am a new pediatric oncology RN, just graduated in the fall, and have been on my floor at one of the top children's hospitals in the country for about 6 months. As time is flying by, I'm gaining so much experience, and also making mistakes. I'm having a hard time dealing with my slip-ups, as our patient population is fragile and precious, and I feel SO responsible for my patients' well-being, always.

Last month I had a pt receiving an investigational therapy that can cause severe inflammatory responses, and often does. I had her overnight, and she ended up needing a higher level of care and was transferred to the ICU halfway through the night. Upon review of the event, some experienced nurses seemed to have believed her stability compromise could have been caught earlier with some subtle changes in VS. Hearing this I felt so inadequate, and almost at fault for what happened. She was swiftly treated in the ICU and ended up coming back to the floor the same day but the feeling of guilt for not intervening sooner still has not left me.

This past week, I contaminated a central line. I hooked a patient's lines that had been used for his white lumen onto his yellow. He had no pending cultures and no s/sx of BSI, but the mistake is so avoidable and has the potential to cause such great harm that I can't stop kicking myself. The other nurses on my floor are so helpful and supportive, and their feedback is always positive, explaining that mistakes happen, even to experienced nurses. I just can't get past the feeling of personal responsibility and sole fault for these mistakes. To me, making mistakes, no matter how small, feels so unacceptable because these are children, and at that, children with cancer!

Anyone have similar feelings/advice/stories? I'm really struggling to bring myself to feel confident in my practice as a novice, and I don't want to be that nurse. I can be a great nurse. I graduated at the top of my class, and I CARE. I care so much, and I try to convince myself that that matters more than anything, but I'm human, how can I practice without making mistakes??

[jrt4]

The comment regarding the contamination made me cringe a little as a nurse manager on a gen peds floor with a high volume of hem/onc patients. BUT your co-workers are right...mistakes do happen. Its more important that we talk openly about mistakes that are made so everyone can learn from them. We should be supportive of self reporting and non-punitive. Identify a mentor on the unit and discuss the issues you are having with that person. Your mistake could save another patient from getting hurt if others learn from your mistake!!!

[erinadance]

Thank you jrtaylor4 for the comment regarding talking openly about mistakes. If we, as medical professionals, can share our mistakes it can lead to collaboration and solutions to fixing the problems. Brian Goldman did a TED talk about this issue among doctors, and I found it encouraging and enlightening. It was 19 minutes well spent watching it. You can see it on Youtube or TED dot com.

[iluvivt, BSN, RN]

What standard do you think you violated with the central line? Did you forget to scrub the needleless connector or what? Simply switching an infusion from one lumen to another is not necessarily a breech in a standard. Were you infusing TPN? Please clarify exactly what you did because it may not be as big of a deal as you think but I need to know the exact details.

[~PedsRN~, BSN, RN]

What standard do you think you violated with the central line? Did you forget to scrub the needleless connector or what? Simply switching an infusion from one lumen to another is not necessarily a breech in a standard. Were you infusing TPN? Please clarify exactly what you did because it may not be as big of a deal as you think but I need to know the exact details.

I was curious about this too.... ?

Hang in there, you are new and you are learning - if you go in with the attitude that you will never make a mistake and you know everything, then you are just dangerous. :) I'm nearly 3 years in and still second and third guess myself all the time. And that's ok. Better to be over cautious than to be over confident!!!!

[KelRN215, BSN, RN]

What standard do you think you violated with the central line? Did you forget to scrub the needleless connector or what? Simply switching an infusion from one lumen to another is not necessarily a breech in a standard. Were you infusing TPN? Please clarify exactly what you did because it may not be as big of a deal as you think but I need to know the exact details.

I was wondering this too. When I worked in the hospital, we used to purposely switch lumens all the time, mostly with IV antibiotics.

[AMR21, BSN, RN]

In re: mistakes. We ALL make them. Best thing you can do is learn why is was a mistake, why it happened, and how you will never let it happen again. Keep your chin up. Nursing is hard. I bet teaches don't fill the guilt like we do when they grade a paper wrong, or bankers when they mess up a decimal point. Our mistakes can really harm others and we are all too aware of that. Being vigilant and methodical and always open to feedback will help you tons and you continue to learn.

In re: the central line. I work in a busy Picu. We never disconnect and reconnect central lines. Leave the unvalved part of your extension port open for lab draws and such. If something has to be disconnected, we start over w new tubing, caps etc. (Yeah, don't disconnect that TPN/IL.) following this principal has helped a LOT!

[mhwh22]

I feel exactly the same. I just graduated in April, was hired early July and this is the beginning of my third week with my preceptor. I have already made a couple mistakes and it is DEVASTATING not because I caused harm to the patient but because I know the potential for harm was there. I also am a perfectionist- I am not good at being new and not knowing things (especially when I don't have a good preceptor helping me through it all). pediatric hem/onc is so difficult and I feel the crushing weight of anxiety and stress the day before a shift, the entire shift, and have nightmares about it at night. I am constantly second guessing myself and even though I've heard the same thing- mistakes happen and we learn through them- that just isn't helping me.

[ShantheRN, BSN, RN]

Maybe a cyclosporine infusion? We use a specific lumen for that particular drug. Otherwise, I'm confused about the line contamination thing. If it was your standard antibiotics, you're supposed to rotate lumens with those. Or....after rereading.....did you reuse an old line, rather than hook up a new daily one?

All I can say is....chin up. Luckily, your mistakes weren't lethal. Biggest thing is learning from them, and perhaps passing that info along to newer nurses so they can learn too. We've all made mistakes. I know I've had some doozies - but I bet I'll never make those mistakes again! The learning curve is steep in hem/onc. Give it a year or so.....you should start to feel more comfortable and confident in your judgement. Until then, ask a million questions!