Clinical Placement Tips for Nursing Students

I know how scary it can be starting a new clinical placement and worrying about a multitude of things! Being prepared enough, answering instructors questions, and caring competently for your patients. Well, I'm here to help... Nurses Announcements Archive HowTo

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First of all, keep in mind that things are changing. When most of us went to nursing school, our clinical instructors were responsible for our learning in clinical placements. Now it seems instructors are dropping off students in some cases leaving floor nurses responsible for teaching. We are not getting paid anything extra for this, and as much as it may seem you are helping, it actually does end up making more work for the floor nurses (Think of having a 7 year old help you bake cookies. They are trying hard, and they are helping but everything is a little slower, you have to supervise everything, and as special as it can be to see their growing confidence, you know you could've made the cookies much faster had you just done it yourself).

This is not meant to degrade students. I actually enjoy teaching! I just want to try to give a bit of a different perspective to students so they can understand how the floor nurses feel. Yes, we remember what it's like to be a student. You guys have not yet had to be a floor nurse with full load of patients and responsibilities though, so while this does not excuse outright rudeness, just keep in mind that sometimes with the stresses of so much responsibility, burnout, short staffing, etc., students are another responsibility thrown on top in some places, and this frustration can sometimes leak out onto the students. Try not to take it personally if it happens.

Tips To Getting the Best Experience

STEP 1 Be humble and appreciative.

This alone makes a huge difference. Cockiness, arrogance or entitlement are an automatic turn off to most nurses. We are not being paid to teach you (unlike your instructor) so things as simple as showing appreciation go a long way!

STEP 2 Don't act like you know everything.

You don't. If someone tells you something or corrects you on something don't answer "I know" (for some reason a lot of students seem to use this as a response even when being corrected on an incorrect behaviour? lol) Say something like thank you, I will do it that way. Or thank you, I will try to do it that way in the future, etc. Or even when being told about things. I remember one shift, I had a coworker (who is known to be pretty blunt) who was working in the special care nursery and she had a student in there with her. She was trying to explain different things we do in the nursery, the protocols, the different assessments, etc. The student would say "I know" to almost everything she said. Finally the nurse said "If you know everything about the nursery, then get the hell out and let someone else learn about it. You're done." - Best way for the nurse to handle it? Not really, no. Understandable she got annoyed? Um, YES! Don't be this person.

STEP 4 Be prepared.

Research your patients, their medications, things you will commonly encounter on your floor. Make sure your instructor shows you the supply rooms, how to use the pumps etc. before she sets you loose onto the floor. Knowing where to fetch supplies for staff is a pretty essential thing you need to know! But more importantly knowing about your patients' diagnosis, treatment, meds etc is VERY IMPORTANT!

STEP 4 Try not to have your whole clinical group gather in one spot frequently if you can help it.

Especially at the desk or the break room. This can be frustrating for staff trying to get to their belongings, or if they are charting at the desk and have 6-8 people standing in a group now talking. In general, try to be respectful and speak quietly when you are at the desk as people are most likely trying to chart.

STEP 5 If at all possible, do your charting on a side computer somewhere, and not one of the main computers.

I don't know if this is possible in all hospitals, but I know it can be very frustrating when all the students take over all the main computers and the RN is either needing to check orders/give meds or even chart themselves and there is nowhere left to sit :no:

STEP 6 NEVER LOG SOMEONE OUT!!!

I left the desk for a second when a patient was calling out for me, quickly locking the screen (didn't save my document as the person seemed to need help quickly). When I came back, a student was sitting at my computer doing something... I asked "umm... did you log me off??" and she goes "yes..?" and I'm like *inside screaming and cursing* "Okay.. well I was in the middle of a huge charting thing I was almost done of and now you've gotten rid of it... Please ask in the future before logging a nurse off a computer.." She was very apologetic and I tried very hard to be nice about it, but inside I was so pissed off. Yes, I probably should've saved it, but patients come first and no student should be logging RNs out of computers! Don't do this! (without asking anyway)

STEP 7 Be helpful.

Offer to fetch supplies, answer call bells, answer the phone (if this is allowed), put charts together, etc. NEVER NEVER say "I already did that skill" or "I'm already checked off on that skill". Doing something once does NOT mean you have mastered it, and I don't care if you've already "checked it off", great way to piss off your nurse who is trying to perhaps give you experience is by saying this.

STEP 8 DO NOT EVER EVER degrade the unit you are on.

I don't care if you hate maternity, you hate med-surg, you would never work in palliative, etc, etc. You are there to learn, and if you start bad-mouthing the unit or the specialty, you will quickly piss everyone off. For example, I once had a student say to me "I don't think I could ever work peds.. it's so boring and slow and nothing good ever happens. Don't know how you guys stand it. I need more going on in my specialty"

Realize that as a student, you have about 1/50th of the responsibility of the nurses. So even if you think it's "boring" realize that 1) you may actually be here on an uncharacteristically slow day, and one day does not equal how a specialty is. 2) You are working with one patient, and now they are improving. Why don't you come tell me how boring it is when the child is on q1hr mask treatements, iv steroids, high flow 02 etc and their family is terrified and looking to you for answers and reassurance. (As well as your other patients of course, which are of such a huge variety that it is never "boring") 3) Realize that even if you don't like the specialty, the people who work on that unit obviously have chosen the unit for a reason, and unless you come upon the few people who hate their job, you are insulting them and being very offensive. You don't have to pretend the unit is your dream job and you've never worked anywhere better, etc etc, but just be respectful and a hard worker.

Also don't compare it to other places in a degrading way (at such-and-such hospital/unit, they never do that. Such-and-such hospital always makes sure everyone's meals are piping hot and there is never a gross smell like here. Such-and-such hospital LOVES having students and in fact they say we keep the place running. Such-and-such hospital doesn't use this type of IV pump and they said the ___ pump is the best on the market. ETC) This is just annoying. Especially when done frequently. With an air of cockiness. If you say something in a respectful manner or something that is appropriate that is fine but keep in mind these types of statements can be annoying.

Along the lines of the above, if you have previous experience, (LPN, paramedic, etc etc) do not try to lord it over people or use it to show off in any way. This can be very unbecoming. Only bring it up if very relevant and in a non bragging manner. (again another example of what not to do, that I had said to me by an LPN student: "Oh yeah, I was a paramedic. I've put in probably thousands of IVs. Once I got a 14g IV in the hand of 3 year old, no one could believe I got it in," etc blah blah. First of all, sounds like BS, secondly, if you bring something like this up out of almost nowhere it is very braggy and annoying. Don't be a bragger. If someone asks if you have previous experience, talk about it, if they ask if you've done something before and you've done it many times in the past, I'm not saying pretend you didn't. Always be honest, but REMAIN humble. There is a big difference between saying "yes I feel comfortable doing IVs, I've worked as a paramedic for __ years so I have been doing IVs for a number of years" and the above conversation I noted

STEP 9 If someone asks you to do something, do it.

But do not do things that are outside of your scope as a student, or that you are not competent in. Make sure you say "I'm sorry but as a student I'm not allowed to push IV narcotics" or whatever it is. If it is something you are not competent or comfortable with, but are allowed to do, simply explain to the nurse that you have not had much practice with that yet, and if she has time to help you with it you would appreciate it, but if not, it is okay and you will be happy to observe.

STEP 10 Remember, it is about the PATIENTS, NOT the students.

I find sometimes (again with the entitlement) students will get irritated that "their experience" is not the way they want (eg. woman giving birth decides she doesn't want students present. I can see how that would be disappointing, but to say you deserve it and how dare someone not allow you, and "if the other nurses can be there why can't I?" is not appropriate. First of all you are not a nurse yet, so it's not "the other nurses", secondly the nurses are there performing an essential job, so this is different.) Be grateful for all experiences you have, and be accepting of patients desires, or situations where the nurse doesn't have time to slow everything down for you. It's about the patient after all. Observe closely in these situations and if it is slower later you can probably ask some questions! If not, ask your instructor about the experience and situation later.

If it seems quite busy on the unit, having students added can be stressful for the nurse.

You can try to relieve this a bit by saying when you first meet "I am happy to learn anything I can from you, and I understand if it's too busy to explain much! I will simply observe in those cases, and anything you can tell me when time permits I will be grateful to hear"

As I said, I do enjoy students when it's not too crazy busy, and I like to help new grads when they are starting on our unit too. I have obviously also had some bad experiences too though, and this can be very frustrating and a turnoff. Nurses having multiple bad experiences with students can turn them off altogether, so if everyone worked to follow these guidelines it would help not only yourself but everyone else.

Here is an example story:

I once had an instructor place TWO students with me on a one-to-one pediatric patient (this is basically picu for our hospital as its a smaller rural hospital, and no picu unless they reach the level we need to air vac them out, which this child almost was). I felt very very frustrated that I would be closed in this room all day with TWO nursing students and an extremely ill child. This could've went extremely badly, and I was automatically frustrated just by hearing that she was doing this to me without even asking. I actually had a look of shock on my face automatically and said "TWO?? Are you serious?!" I'm sure that didn't seem very welcoming to the students, which I feel bad about in hindsight, as it wasn't their fault, but that is a very stressful thing to thrust upon someone without even asking). However, these 2 students turned out to be very respectful and appropriate and said something along the lines of what I advised you/students in general to say above (we understand you're going to be really busy in here! We are happy to just watch, and if you have time to explain stuff: great! If not we completely understand, the patient comes first!) , which made me feel a bit more relaxed starting out. As I was able to get the patient more stabilized, I then felt more as though I was able to teach and taught them all kinds of stuff about the situation including chest assessments, the benefits of the optiflow, when we use it, retractions, work of breathing, how to interpret blood gases, IV fluids in use, meds in use, ETC, etc. They were very very grateful and thankful to me, and this made me feel good and appreciated, and as though I made a difference. They were attentive and excited to learn, and showed great interest in anything I said. All of this making it more likely that I would do the same thing again. If they were rude, snotty, ungrateful, entitled, etc. I wouldn't have felt the same and it would've been a much different shift for everyone. I probably would've mostly just done my work and tried to ignore them, letting them observe and adding minimal remarks.

So you see, your attitude and behaviour can make a huge difference in "your experience" (also the experience of other students, as they say "one bad apple can spoil the whole bunch").

There will always be nurses having rough days, rough shifts, etc, that may be less than thrilled about having a student (again, instructors are paid for this, staff nurses are not). If you follow these instructions I am pretty confident to say most nurses would agree with me this will help you. It doesn't guarantee every nurse will love you of course, as sometimes no matter what you do, for an overworked understaffed unit, extra responsibility for a nurse will be frustrating and bothersome, but I think for the most part you will have better success if you follow this advice.

(Note, a student asked for nurses to share tips for students in clinical in another post so I wrote most of this up for that post. I then felt it could be useful for other students as well so decided to share here)

Heathermaizey said:
Here is what I am going to say and some people will agree, and some people won't and that's fine. I never expect everybody to agree with me.

I am going into my fourth and final semester. I have never once witnessed anything but complete professionalism from anybody in my cohort, not once. That's not kudos to my instructors it's due to the quality of people in my cohort who know how to act. We've always had great rotations.

That's not the same for the nurses I have encountered at certain clinical sites who very apparently do not want students on their floors. I've always used the kill them with kindness strategy but that doesn't work on everyone. And I can also understand that some nurses are not up to having students.

But I would never in a million years go into the general nursing forum on here and tell nurses how they should act towards students they have and that's what really bothers me with this. I know that the majority of nurses are not the same as a very, very few I encountered that I could see did not want us there. Never. You don't think of us as your equals as human beings. To you nursing students are children, not competent adults that are there to learn new skills.

I have worn many different hats in my life, much which included training new management and employees. I never treated them any less than somebody who were excited to be in a new job and excited to learn.

You have what to me, is a very valuable opportunity, to be a truly great nurse whom students look up to and aspire to be. Not every day is going to be unicorns and rainbows with people trying to learn.

There are these common posts on allnurses.com that suggest that nursing students have gotten worse since decades ago, and more arrogant.

I'm a student myself, and every student in my past 4 clinical groups have been nothing but respectful and kind to our professor and nurses on the floor. Even overly nice to kiss up to them, which I don't prefer, but to each his own.

I do agree that we should be treated as equals, with dignity and respect, and I've definitely noticed this pattern in clinical rotations.

I've had nurses dump their patient tasks on me while they went for an hour and a half break, or sat at their desks chatting, while I had to skip my breaks.

I've had nurses ignore me when I wanted to let them know something about their patients, including a medication error one nurse did (that I caught by looking at the charts), and I went straight to my professor after being ignored by her.

I've had seen nurses insult patients behind their backs and ignore their calls for pain meds. Literally saw a nurse sit down, stare at the patient's room, and drink her coffee (during her shift) when the same patient was in agonizing pain, and again, called my professor.

Just some of many incidents only last semester, and I definitely had to report the more serious ones.

HOWEVER, I've had many more nurses who were willing to teach me and were so proactive in their manner to help me have the best experience possible. We're all human, regardless of being a nursing student, nurse, or any other occupation, and you're going to find these types of people everywhere that look down on others. Just don't confuse being treated as an unequal with being treated as a student.

I'm very glad that OP is one of these nurses and is willing to share this information with us. We need more nurses like her.

Specializes in Pediatrics, Mother-Baby and SCN.
milesims said:
Very informative post!

I definitely have the bad habit of saying, "I know," and I realized only recently how rude and unbecoming I have been. It's like an unnecessary defense mechanism to maintain pride. Definitely never saying that again, even if I DO know (hahaha), thanks to your post.

Thank you very much!

Thank you! Glad you found it informative ? Yes, I have also said "I know" in the past too on occasion and I cringe to think of it! If you do kind of know it, I think it would come across better if you said more detail, such as "Oh I have read a bit about that once, can you tell me a little more about it from your experience? etc.

You're welcome!

I will reply to your next post separately for ease of quoting :up:

Specializes in Pediatrics, Mother-Baby and SCN.
milesims said:
@milesims There are these common posts on allnurses.com that suggest that nursing students have gotten worse since decades ago, and more arrogant.

I'm a student myself, and every student in my past 4 clinical groups have been nothing but respectful and kind to our professor and nurses on the floor. Even overly nice to kiss up to them, which I don't prefer, but to each his own.

Not even just decades but definitely over the last number of years!

Keep in mind you can't see everything all of your classmates do all of the time. It is definitely possible you have missed on some comments, some actions, or otherwise things that may have been not only "respectful and kind". It's also possible you have had that many good groups in a row but is more likely that you are not witnessing some of these milder behaviours. Similar to certain things in health care "once you see you can't unsee it". Ie you may miss a certain skin condition/dx/heart sound/breath sound ETC til you are familiar enough with it, then it seems like you're hearing it or seeing it all over the place! It hasn't actually increased in frequency, just you are now noticing it. If that makes sense? ?

milesims said:
I do agree that we should be treated as equals, with dignity and respect, and I've definitely noticed this pattern in clinical rotations.

Again as I had said in an earlier post, you are definitely an equal in terms of being a human being, a person worthy of respect. This is definitely true! However, not an equal in terms of education level, knowledge level and experience level. When I was 3 months out of school I didn't expect the nurse with 20 years experience to "treat me as an equal". I looked up to her and wanted to learn from her as much as possible!

Even now, as I am almost at exactly 4 years experience, I don't expect nurses with more experience to treat me "as an equal". On pediatrics I more or less do expect my opinion to have basically the same weight as other staff, due to my amount of time working, my assessment skills history and other staff's awareness and trust/confidence in my ability.

(Although if a physician doesn't take my assessments as seriously I understand (it does sting a bit though if they don't seem concerned with my report vs, someone else saying the same thing basically... just a made up example but you get the drift.) ) On maternity I definitely don't consider myself "an equal" and defer to more senior maternity staff in most cases unless it's something out of the ordinary/requiring extensive advocation or something. Don't get me wrong, I advocate for my patients strongly no matter which "side" or which doctor, what diagnosis etc! Just so that's clear

milesims said:
I've had nurses dump their patient tasks on me while they went for an hour and a half break, or sat at their desks chatting, while I had to skip my breaks.

I've had nurses ignore me when I wanted to let them know something about their patients, including a medication error one nurse did (that I caught by looking at the charts), and I went straight to my professor after being ignored by her.

Now just to play the devils advocate ( ;) ), firstly, saying the nurse "dumped" the patient tasks on you- aren't you assigned to this patient and aren't the tasks supposed to be completed by you for the shift? Isn't that kind of your main goal of the clinical experience for the day? If not, I can see where your assigned nurse may have gotten confused because it is usually the understanding that the students are to be "saved" the majority/all of the "tasks" whenever possible (such as health histories, vitals, regular morning meds, assessment, ETC). So it is possible the nurse thought you were supposed to be doing these tasks under supervision from your instructor. That is what I would've thought just going by other student experiences we have seen...

As far as the hour and a half break/sitting at the desk chatting, a lot of units/hospitals are going through staffing crises, lot of sick time being called in and overtime not being filled. There is a lot of burnout occurring, which also addresses one of your next points, that I will get to shortly. Anyway, again it is possible that this nurse has been working a lot of hours/OT etc, and when she realized a student was working she may have thought this was the perfect opportunity to take a longer lunch as her pt was being taken care of by the student, (or time may have got away from her since she didn't feel the pressure to get back to the unit super quickly as she probably usually had to do so). The "chatting" could be possibly related to a patient situation, or could be again a coping strategy to try to stay functional due to staffing crises and the stress that comes with that.

Now again, I said I was being the devil's advocate. It's entirely possible that this nurse was actually a lazy worker, terrible work ethic, useless and takes advantage of students. But consider thinking of it in this type of light and see how your thoughts on her may change. (This type of thinking can help better understand your patients as well!! Such as an elderly patient hitting and yelling. Sometimes they get the reputation of being "an old a**hole" and no one wants to deal with him. However, if you use this type of thinking you could say well maybe he is actually scared, or confused and that is why he is lashing out like this. Then you can use strategies to explore these, and then implement some interventions if anything seems to apply.) I do not intend for you to think I'm saying plan interventions against floor nurses. I just meant try to think of things from a different perspective and see if there is any other explanation for something.

Ignoring you- can be lost in thought, overwhelmed with people repeatedly approaching you, overwhelmed with getting frequent updates from multiple students on multiple different patients on multiple different issues (and ironically enough no one reporting the 1-2 pieces of info you actually WOULD'VE wanted to know and only finding out 2 hours later due to my control freak nature :/--- yes this actually happens). I have definitely been approached while in the middle of doing something and at times it may have appeared I was "ignoring a student" as I worked out a calculation or searched through my brain for a number/fact/name, etc. When I am deep in thought I often have to be spoken to twice to actually get my attention as the noise can get quite loud when students are there (more people on the unit in general=more noise, not a student specific thing) and so I get at times into a groove of trying to block everything out. I would never purposefully ignore someone but if the student didn't try to get my attention again they may think I ignored them if I didn't hear them! Also if i'm doing something and don't feel that it's the best time for a report or update I may defer you at that time unless it's urgent.

-Again, possible this person/these people are just simply rude a**holes, but also possible that some of these other things may apply as well.

And thirdly, burn out/compassion fatigue can cause this type of response (lack of empathy) in front line staff due to the absolutely overwhelming bombardment of pain/suffering/emotional issues combined with the low staffing/lot of sick calls/lots of call ins ETC. Your brain goes into a mode where basically you are at "eat or be eaten". You have to start to try to keep your own needs met because otherwise it's not going to happen. If that nurse was tired, she knows she needs coffee to stay alert enough to do all the essential things needed for the shift. She may have been focused on that thought and not recognizing the level of pain the pt was in. She might also have not been able to empathize with the patient as she normally would due to burn out. Do some research on these issues, it's quite interesting and horrifying at times.

So not trying to give excuses for these nurses. I don't know them, I don't know you, I can't speak to their intentions and it does sound like unfortunately some unfortunate situations have arisen that you have witnessed at a student. I do suspect there is more to those stories than you would be aware of as a student, but there always a possibility they are some of those people with terrible work ethic, low skills,etc.

I am very glad to hear you have also had some good experiences too!!! I definitely agree with your comment of not confusing being treated as an unequal with being treated as a student. That is a great point, and should be a bumper sticker

Quote
I'm very glad that OP is one of these nurses and is willing to share this information with us. We need more nurses like her.

and Awww thank you ? That is very sweet of you to say! Good luck, I hope this helps too ?

I absolutely agree with you on every point.

I won't really say anymore that they "dumped" their patients on me. Because it is true, I was assigned to them. But going for an hour and a half break when you're assigned a half an hour break, and then having me skip mine, is not that nice. However, I did let it go, because I know many nurses are very burnt out and she probably did deserve that break since I was able to give it to her.

I can definitely see your point of view for nurses being too burnt out, and it alleviates my blame for sure. The one that I definitely am still upset about the medication error one... It was a med that could have harmed the patient and if I wasn't ignored, it wouldn't have to be reported to my clinical instructor and administration. Luckily, I caught it early, and the patient was fine.

But really, I don't know people's lives, so maybe I shouldn't be so quick to blame. I have the upmost respect for nurses because their work is one of the most under-appreciated, underpaid, and stressful occupations you could find. And I'm glad there are nurses like you out there!

Specializes in Pediatrics, Mother-Baby and SCN.

Yes I agree taking that long of a break isn't nice but a lot of days she had to miss all breaks and she may have had a family situation going on for all we know. Or she may have just taken advantage of the situation. Hard to know but always nice to look at the other side and give benefit of the doubt especially when it's a limited time situation like this. Now if it's your permanent job and a coworker is doing this a lot, it's a lot easier to recognize it as an issue vs a one time thing!! Glad you are able to look it at from another angle and appreciate the burn out a lot of nurses are feeling í ½í¸Š

How were you ignored exactly with the med error? I agree med errors do need to be addressed and reported. Usually it is a human error and not intentional. It is our duty to be accountable for them however when we either realize or it is pointed out to us. Some people do try to hide it due to pride and/or fear of punishment. This is not ethical and not the type of nurse you want to become. Always be as willing to report your own errors as you are to report those of others í ½í¸Ší ½í± Without knowing what you meant by "ignored" (was she zoned out focusing on something else? Was she trying to do something and didn't stop to address it at that moment?) it is hard to know.. Usually if someone completely doesn't respond to something there may be a reason? If she was not caring about the error she probably would've said something to try to dismiss it rather than "ignore" you. Either way, you are right that it is important for errors to be addressed, keep that view for your own inevitable errors. Don't get the mind set that you will never make any mistakes. We are all only human and mistakes are inevitable to some degree. Use your best practice, good safety measures and do your very best and you can minimize errors , their frequency and their severity!

And thank you for the compliment! Good luck í ½í¸Š

Well, in her defense, she was talking to another nurse about some gossip of some kind. I'd rather not give too much detail, but I was really blatantly ignored when I tried to speak and didn't want to embarrass her in front of the other nurses. I just went straight to my prof, and I'd rather not say what happened afterwards because of confidentiality... Hahaha. It really was interesting, that's all I have to say.

And you're right, med errors are human errors and they can happen to anyone. I'll try to be a little more understanding next time for sure =D

Specializes in Pediatrics, Mother-Baby and SCN.

Oh looks like my emojis didn't work, I'm on my phone sorry!

Ah okay. So she definitely heard you about the error and just kept talking to the other nurses? It was a good decision on your part to not try to embarrass her and go to your prof [emoji4] we definitely need to watch out for our patients safety at all times, very important. Good job being an advocate.

I am not excusing it, again hard to know when I don't really know the situation. It does sound pretty unfortunate but I applaud you for not embarrassing her or trying act superior or anything. Amazing nurses can make mistakes too [emoji4] I discovered a mistake as a newish nurse that could've killed a patient. It did send the pt to the ICU but they were okay. It was the scariest most sickening feeling I have ever had when I realized. But the nurse who made the mistake was a very experienced nurse who switched iv lines by mistake when helping change a Johnny shirt, and she was absolutely devastated, crying hysterically. So we really tried to support her best as we could too! The doctor was also supportive to her to :)

I am known for being very anal with my meds. We do mix all our own IV meds except for flagyl and cipro which are premixed. I often get an independent second check even when not required if it's a med I'm not familiar with, check my doses in safe dose guidelines etc (I work peds mostly). I have picked up errors in med mixing before, one being a fairly significant under dosing on a combo antibiotic (Septra) that 2 separate nurses calculated based on the wrong component which resulted in the patient being significantly under dosed for the entire day of iv meds.

That being said I have made mistakes too! I try very hard to be as safe and accurate as absolutely possible but no one can be perfect no matter how hard we try!!!

Once a post op patient was ordered ventolin puffers q4hrs overnight. This ended up actually being a mistake on the doctors part as well since he meant to put prn as the pt used it as needed and usually before bed and in the morning. I gave it prn and somehow missed that it was ordered regular until the morning. I did fill out an incident report on myself even though many people said not to bother as the doctor probably made the error and just sign it as patient sleeping. But I wanted to be honest as I hadn't gotten it clarified. This was when I was new, and I think one of my first mistakes! It was back when meds were on paper

I have also once confirmed a strange insulin order post op with multiple people. It was for a type 2 diabetic patient but a strange order for this doctor as the patient normally didn't take insulin. We all confirmed it, and I discussed it with the patient, and how there was a range for the insulin based on her bg.. and gave her the insulin (her bg was 17mmol/l - Canadian measurement, but it's pretty high!). When I returned back to the computer I came to realize the order was part of an order set for pre op that they had not discontinued in pre op!!! When I realized this I felt horrible! None of us had realized! I called the doctor and he said that it was fine as she would've actually benefited since she was that high. We continued monitoring her sugars and they actually barely even went down at all and he ended up considering giving her more insulin later. *shrug*. So this was not a big deal on the end, but still an error. Computer orders have made this less likely to happen but still possible if you have a doctor that likes to sneak in and see patients without you realizing and they change something and you don't happen to look at that patients chart for a bit if they had nothing due..

I have also missed picking up orders til much later in the shift back when we picked up orders on paper and copied them to the MAR on paper, due to not realizing the doctor was back around or getting busy and forgetting to check the chart again etc.

I try to readily accept and acknowledge any mistakes I have made even though I'm a huge perfectionist and hate making mistakes! I try very hard, but human error is something we can't always avoid! I try to keep this in mind if I find others mistakes, no one likes to have their face rubbed in a mistake so I try to be as kind and understanding about it as possible. I think all nurses feel horrible when they make a mistake (besides the rare outlier who is trying to purposefully harm people but that is pretty rare of course..)

Just to give you more to think about :) Good advocating for you patient and realizing an error though for sure!

NurseStorm said:
Oh looks like my emojis didn't work, I'm on my phone sorry!

Ah okay. So she definitely heard you about the error and just kept talking to the other nurses? It was a good decision on your part to not try to embarrass her and go to your prof [emoji4] we definitely need to watch out for our patients safety at all times, very important. Good job being an advocate.

I am not excusing it, again hard to know when I don't really know the situation. It does sound pretty unfortunate but I applaud you for not embarrassing her or trying act superior or anything. Amazing nurses can make mistakes too [emoji4] I discovered a mistake as a newish nurse that could've killed a patient. It did send the pt to the ICU but they were okay. It was the scariest most sickening feeling I have ever had when I realized. But the nurse who made the mistake was a very experienced nurse who switched iv lines by mistake when helping change a Johnny shirt, and she was absolutely devastated, crying hysterically. So we really tried to support her best as we could too! The doctor was also supportive to her to ?

I am known for being very anal with my meds. We do mix all our own IV meds except for flagyl and cipro which are premixed. I often get an independent second check even when not required if it's a med I'm not familiar with, check my doses in safe dose guidelines etc (I work peds mostly). I have picked up errors in med mixing before, one being a fairly significant under dosing on a combo antibiotic (Septra) that 2 separate nurses calculated based on the wrong component which resulted in the patient being significantly under dosed for the entire day of iv meds.

That being said I have made mistakes too! I try very hard to be as safe and accurate as absolutely possible but no one can be perfect no matter how hard we try!!!

Once a post op patient was ordered ventolin puffers q4hrs overnight. This ended up actually being a mistake on the doctors part as well since he meant to put prn as the pt used it as needed and usually before bed and in the morning. I gave it prn and somehow missed that it was ordered regular until the morning. I did fill out an incident report on myself even though many people said not to bother as the doctor probably made the error and just sign it as patient sleeping. But I wanted to be honest as I hadn't gotten it clarified. This was when I was new, and I think one of my first mistakes! It was back when meds were on paper

I have also once confirmed a strange insulin order post op with multiple people. It was for a type 2 diabetic patient but a strange order for this doctor as the patient normally didn't take insulin. We all confirmed it, and I discussed it with the patient, and how there was a range for the insulin based on her bg.. and gave her the insulin (her bg was 17mmol/l - Canadian measurement, but it's pretty high!). When I returned back to the computer I came to realize the order was part of an order set for pre op that they had not discontinued in pre op!!! When I realized this I felt horrible! None of us had realized! I called the doctor and he said that it was fine as she would've actually benefited since she was that high. We continued monitoring her sugars and they actually barely even went down at all and he ended up considering giving her more insulin later. *shrug*. So this was not a big deal on the end, but still an error. Computer orders have made this less likely to happen but still possible if you have a doctor that likes to sneak in and see patients without you realizing and they change something and you don't happen to look at that patients chart for a bit if they had nothing due..

I have also missed picking up orders til much later in the shift back when we picked up orders on paper and copied them to the MAR on paper, due to not realizing the doctor was back around or getting busy and forgetting to check the chart again etc.

I try to readily accept and acknowledge any mistakes I have made even though I'm a huge perfectionist and hate making mistakes! I try very hard, but human error is something we can't always avoid! I try to keep this in mind if I find others mistakes, no one likes to have their face rubbed in a mistake so I try to be as kind and understanding about it as possible. I think all nurses feel horrible when they make a mistake (besides the rare outlier who is trying to purposefully harm people but that is pretty rare of course..)

Just to give you more to think about ? Good advocating for you patient and realizing an error though for sure!

Good job for catching that mistake! And poor nurse.. I hope she recovered from that experience and learned from it. We all do make mistakes, and nursing isn't an exception. It happens to the best of us.

And it's amazing how so many nurses could check that insulin order and still make a mistake, that just goes to show that we're all human. Good job for catching that mistaken order!

You are amazing and you have advanced patience that I hope to achieve one day! Keep up the good work! :up: