Advice for new nurse? Mistake was made

[Guest1141053]

I am not sure if this is the correct forum. I am a new grad nurse and am on my 4th week of orientation. When checking vitals I did not count the correct respirations but put down an estimate number. I also put down the best oxygenation saturation rate that I saw. However I noticed that my patients HR was increased more than usual. I told preceptor when I saw her about 5 minutes later. Turned out my patient was having a transfusion reaction. I am scared about the consequences of not noticing the signs earlier and the fact that I had not documented the correct respiration rate. Overall, the patient was treated and recovered. This whole experience has shaken me though. Is it possible for your nursing license to be revoked when you are still orienting?

[hppygr8ful, ASN, RN, EMT-I]

First take a deep breath and relax. You are a new nurse who is in orientation and you missed signs and symptoms. The fact is you did right by going to your preceptor with the heart rate issue. That show beginner level Critical thinking. The good new is the reaction was caught and the patient recovered with minimal harm.

I do not think there will be any action against your license due to this mistake. You might want to go to your state board's discipline page and see the kind of things nurses do lose their licenses for.

Hppy

[JKL33]

Your license isn't going to be revoked.

Use this as an opportunity to review your actions and decide if you would do anything differently next time around. ??

[MJJFan1, BSN, RN]

It’s a learning experience for you. Don’t beat yourself up, although that’s easy for me to say but I know you feel different. It’ll bother you for a long time probably but this will never happen again on your watch because now you’ve experienced something that’s scared you deeply. Keep trucking along.

[Serhilda, ADN, RN]

No matter what anyone says here, I promise you nurses and nursing assistants are rarely counting respirations. You observe them and determine if it appears labored or not. The SpO2 though, just take that as a learning experience and move on. This is why you're on orientation, don't forget.

[turtlesRcool]

Give yourself a break here. SPO2 readers can jump around a lot. Sometimes I need to move to different fingers; sometimes I end up using an earlobe. I usually put down the best sustained number I get because while other factors (poor circulation, cold hands, nail polish, patient movement, etc.) can give me a low inaccurate reading, I'm not likely to get an erroneously high reading unless I've only just reduced or removed the patient from supplemental O2.

As for respirations, your estimate was probably pretty accurate. I know in nursing school, we're taught to count for a full minute, but in the real world, that rarely happens unless something seems off. If someone seems to have labored breathing, if someone seems to be breathing quickly or breathing slowly, then I'll meticulously count for the full minute. Someone with no known respiratory issues who seems to be breathing normally? I'll count for 15 seconds, multiply by 4, and call it good.

In your case, there might not have been much to notice earlier. Transfusion reactions don't necessarily present with big changes. You noticed the change in HR, and investigated further. That's what you should have done. Was the RR significantly different when you and the preceptor RN went to recheck? Was the O2 markedly lower? Unless there was such a big disparity as to suggest your numbers were way off, let it go and make sure you check properly next time. At least in my hospital, I'm not allowed to leave a patient for the first 15 minutes of a transfusion, so I'm the one to do the beginning and 15 minute vitals, and the patient has my full attention in case something starts to go wrong.

[Tweety, BSN, RN]

Agree with everyone else.

The patient wasn't in respiratory distress and you noticed a change in vital signs. That's good.

When I take vitals I put the pulse ox probe on first while I take the rest of the vitals and leave it on a bit, and if it's changing would stay and see what it is maintaining at. That's what should be documented, not necessarily the highest or the lowest, but what they are maintaining at. Sometimes though I will right a note. "patient with oxygen sat of 90% on room air, used incentive spirometer and two liters NC applied per standing order, and oxygen sat maintained at 98%", or something like that.

We live, we learn, and we move on.

[ClaraRedheart, BSN, RN]

This is a common mistake that I've seen our techs make. I had one patient with vitals indicitive of septicemia that were not reported to me, or caught because of an elevated MEWS score because the respirations were estimated. Had they been accurately counted, there would have been an alarm pop up on the chart and it would have been caught earlier. An elevated heart rate or an elevated temperature on their own might not mean that the patient is septic or having a reaction, but if you get one abnormal vital sign, count the resps for a full minute.