Always Rumors

[babynurse101]

So I am a fairly new nurse still (just passed my 9th month in my first job) and I've made several dumb mistakes along the way. Insulin given incorrectly once during orientation, narcs given too soon after a c-section once shortly after orientation, and not clamping an abx PB after it was done and the bag exploded... oops. Like i said, really really stupid errors but I haven't hurt anyone, never been written up, and I've never made the same mistake twice.

However, last week was bad. I was about an hour from the end of my shift and got a new GYN pt from PACU. She came up in the middle of a blood transfusion - her starting count before surgery was only 7.5 - and with two other completely dry lines. I hurried to get fluids going again before her veins collapsed and then stopped the blood as it was done by the end of my assessment/charting.

She was due for another unit, and as I hadn't hung blood since my orientation ended several months ago, I asked a seasoned nursed to come in with me as a refresher and back up. Bear in mind, we're the only two nurses on the floor at the end of an incredibly busy shift. No excuse, but fact.

So we primed the line with saline and went through all the motions and hung the bag with the same tubing - first mistake, as it was due to expire at 2330 and we were hanging this 2hr infusion at 2215. Stupid, but we didn't think beyond "It's not bad now." Spiked the blood and we started it at a rate of 100 - second mistake, as our hospital has a policy that we can only start at 75 for the first 15min. (We actually were trying to find said policy at change of shift but our hospital recently changed the website and we were lost.)

Got all the 15min signs - everything good - and ran down the hall to stop a pt trying to get out of bed w/o assistance, etc. Got them taken care of and it was change of shift time. Went back to the GYN room with oncoming nurse to clear the PCA pump and discovered a pink NS bag, though the line was red as well. Clamped off the saline and gave report, the patient is sitting up in bed laughing and chatting with us during. Realized at the end of report that the tubing expired in twenty minutes and we pitched everything then - over half a unit not given. We called the doc and got a repeat order, and the replacement unit was hung about twenty minutes later.

I completely understand that this was a big mistake, and shouldn't have happened if I'd been paying attention. My educator spoke to me about it and said I'd have to probably repeat my "education" on blood and get signed off - I'm all for it, I need the refresher. The other nurse that hung the blood with me is getting similar help. One of the dayshift nurses when she heard about it asked me point-blank why I didn't just "lie and say the tubing was new" but it honestly didn't occur to me. I'm not a liar by nature and I do my very best for each patient every night, so of course I'm gonna tell the truth.

My question is that now, the entire unit is gossiping behind my back that I "hung blood wrong and almost killed a patient" and am "definitely going to get fired." They think I'm a danger and completely incompetent. I've worked several shifts since this incident so I'm not entirely afraid of being fired (wouldn't they have stopped me working?), but this horrible backtalking is dealing a severe blow to my confidence. I understand my error was bad and that even though we were having a night from hell I shouldn't have missed it - and believe me it won't happen again, but I don't think the patient's life was ever in danger. Am I wrong? Am I just not cut out for this, as they're making me believe? The past 9 months on this unit have completely drained me. Any advice or help is much appreciated.

[sarose611]

Since you tare the one spreading unfounded rumors about me, perhaps YOU would be the one gossiping in the break room. Nurses understand no one is perfect and we all make mistakes. Good nures also realize that we bear a legal and ethical responsibility to our . Patients, and tha in nursing, there are rarely.unimportant mistakes. I certainly hope you are never MY nurse if you think.mistakes are just.part of the job I certainly hope our poster DOES find help, and becomes a better nurse for it. She sounds like she cres, at least!

[Anna Flaxis, BSN, RN]

I'll bet you never forget to clamp the saline when running blood ever again!

Had that not happened, the safest thing for the patient would have been to just run in the unit without interruption. Many blood administration sets are made to handle multiple units, and CDC guidelines are to change the set within 24 hours of initiation. The 4 hour/2 unit policy seems to be pretty standard for most facilities, but I'm having a hard time finding the evidence to support this.

I'd be willing to bet that not EVERY nurse is gossiping about you. As others have stated, this will blow over when something more interesting to talk about comes along- and it will. In the meantime, I commend your integrity and humility, keep up the good work, and make a mental note of who gossips and who doesn't.

[NickiLaughs, ADN, BSN, RN]

I was curious about the tubing expiring also. Usually it's good for 2 units of blood. I've forgot to clamp the saline line before. I can't believe your coworkers are calling that "almost killing the patient."

Usually blood is a two RN check as others have said. I've had the super rare occurrence where the unit and paperwork did not match up. That's one of the reasons for the double check. I always make sure my tubing is primed and ready prior to bloods arrival. I'd make sure they show you how to access the the policy and procedures reference. I'd also tell your coworkers that you had no idea 10 minute expired tubing could cause loss of life and limb.

keep your diligence. You clearly care about your practice and strive to do better. Every nurse I know has made mistakes, the importance is being honest and diligent and to learn from them.

[akvarmit]

Everywhere I've worked two nurses ALWAYS check blood/identifiers/unit number together before each infusion.

[NotYourMamasRN]

Hi OP,

I just want to say that I am sorry for what you are going through. When I got my BSN I chose Horizontal/Lateral Violence in Nursing for my Capstone. The numbers on this topic are staggering, depressing, and degrading for professional nursing. I am sorry for what you are going through.

When I was a new grad, my very first job was horrific and I experienced probably the worst treatment I have ever experienced in my life. I say this as a female Vet who worked in a pretty much male only occupation, who made several long and arduous deployments with them. The treatment I received at that first job, for literally no explicable reason, turned me sour to nursing. It has taken me a lot of time, reflection, and effort to recover from that first job and find my passions within the professional nursing field.

I am happy to report that I never experienced a setting that bad again, but I did see some other settings with some degree of issues in this department just not directed at me specifically.

I remember at that first job, they were so bad to another new nurse that she confided in me that she ended up on medication. It was a really poor example of what professional nursing is.

My experience was so bad that I decided leaving was the best option for me and I have never regretted making that choice. I did not have trouble finding a new job and haven't since. I wish that people who treat others poorly in the work setting could truly appreciate what they could be doing to someone's psyche, confidence, and well being.

I hope you find a solution that works for you. Every situation requires different action plans. *Hugs*

[Irish_Mist, BSN, RN]

Hang in there, babynurse. Learn from your mistakes and move on. Don't worry about what your co-workers are saying. You can't control what people say but you can control your reaction to it. Plus, I highly doubt the entire unit is talking. Gossip is always exaggerated and in my experience, it is usually a vocal minority who do the most talking. Brush it off and move on. Continue to work with your educator/supervisor so that you can improve and excel. Your priorities are your skills and patient safety, not high school semantics.

[jk2185, BSN, RN]

First off....what you did ISN'T A BIG DEAL AT ALL. Maybe if you gave blood to the wrong patient or accidentally bolused the unit; then you would have a case for feeling bad. Expired tubing....really??? If you're only going over an hour or two..big deal. I'd say that's better then wasting the donated blood that was trashed just to adhere to a protocol. It's good to follow all the rules..yes, but not always possible. If it were me I would've had no problem finishing the transfusion with tubing that may go over the "line time" by an hour (not a big deal at all in my book). Don't think anyone has acquired a nasty infection from a line that's an hour over time; I've only heard/seen nasty infections from lines that are left up for days.

Now, as far as the gossiping. It sucks, I know...this job is hard enough. I find the ones that gossip are the nurses that aren't confident themselves and are looking for any little thing someone else does to bad-mouth that person to make themselves feel better. I'm quick to call out people for gossiping and I try my best not to participate. We ALL make mistakes. I've given probably over a thousand insulin administrations and I've mistakenly given 2 units too many or 2 units too few maybe 2 or 3 times and I felt horrible.....IT'S OK...learn from it, that's all.

Lastly, whomever said you might have killed your patient. They're just scared themselves. You weren't anywhere close to killing your patient. People should be disciplined for saying things like that.

Sorry you're going through a rough go...it's your first year. Now you can be kind and compassionate to new nurses you will encounter for the years to come.

[happynurse49, BSN]

Yes, we ALL have made mistakes, and no one should be talking behind your back. However, I am surprised you haven't been written up. You are making mistakes that shouldn't be happening. Incorrectly given insulin, or untimely use of narcotic drugs in a post op patient is a big deal. Perhaps you should get in the habit of reviewing the 5rights of med administration. Right drug, right time, right dose, right time, right patient. I am not clear on why your blood tubing was expiring so soon, bu I believe you could have replaced the tubing without ditching the blood. Wasteful.and expensive, not to.mention a delay in the patient getting the blood she needed. I have never worked anywhete that 2 nurses have to.check.and hang blood. Seems you could use some review on your hospital's policies and procedures. If you intend to remain in nursing, you need to.identify your strengths and weaknesses, and take action to.improve the weaknesses. Good Luck!

You stated right time twice and forgot right route:) No worries. Mistakes happen.