Feel like I'm too dumb to be a nurse

[coconut3431]

I've been working as a nurse for 4 months. Today, i had a resident's family member come in and say that she (resident ) doesn't look right. The family member said they told the other nurse that she is getting worst and worst. Now, this is the first time I had this patient. So, I take her vital signs everything is normal. Her o2 was 92. I even get an rn to come and recheck her to make sure. The rn rechecks her and says nothing seems out of the ordinary but that she'll call the doctor to order blood test to make sure. So I call the doctor. The doctor tells me to get a chest xray and blood work. So i get the chest xray done, and send off for bloodwork. Chest x ray reveal pneumonia. I thought the chest xray was sent to her office. So I wait on the doctors call, meanwhile i finish passing out my meds. She calls at 5 pm and says its 5pm why haven't I call her? I tell her my reason and aplogize, she says I need to take better care of my patient. I have people lives in my hand. During my shift i an taking the residents vital signs they are normal. Towards the end of shift change i tell the nurse taking over what's going on with the patient. She goes a takes her vital signs and they are really low. They send her out and call the doctor . The doctor tells her she should be reported, and that this is unacceptable. The nurse says you right she could've died. I can hear the cna's saying she's a nurse, you think she would know. Im sitting there looking stupid. I feel like I'm too dumb to be a nurse. Does anyone have any advice, became i am thinking of quitting my job.

[kakamegamama]

Did you ever make a huge mistake in your years as a nurse?

Oh yes! One of the first times I gave a newborn infant an antibiotic, I gave too much! The nurse before me had given the dose, had not charted it nor reported it. I went on duty, looked at the chart in which she had not charted....AFTER I gave it, she charted she had given. I was terrified! So, I called the doc, who very graciously said that he often prescribed double doses on the first dose anyway. Whew!!! I learned so much from that experience....hang in there. Take what happened and learn from it. You've only been working there a very short period of time. You are still a novice, a new learner. Learn from this.

[SaltySarcasticSally, LPN, RN]

Learn from this, use it to your advantage! We all mistakes and yours was an honest one, you were observing your patient well, you just dropped the ball on the CXR results. Your reflecting on it and know you made a mistake, you feel badly for it, and that right there means your a good nurse already. We are human, so many forget that, what separates a good nurse from a bad nurse is taking complete responsibility for that choice, reflecting on what you could have done differently, and actually doing it that next time.

I made a med error in my first 6 months as an LPN. I was so devastated. Thankfully my patient had no long term lasting effects and the error was due to my own inexperience and a system breakdown too long to explain here. I literally cried for days and wanted to quit. The best advice I got was from my boss at the time who told me I made the best mistake a nurse could make because my patient was ultimately fine and I learned a huge lesson from it. I was put on a probationary period which was also the best thing that could have happened because it made me organize my nursing process and do a series of self checks to make sure something like that never happened again. I had to show my DON how I was organizing myself and I successfully completed my probationary period. I have never made a med error like that again and that one experience has saved me from making many more med errors because I know now how easily it can happen so I triple check things.

Your patient likely would have had the same outcome considering the CXR results were only not known for a few hours, the elderly get sick fast and furious I am sure as you know. Don't let it beat you down, turn into a learning experience, and gain confidence from knowing that you now know what to do in future situations that are similar to this.

[kbrn2002, ADN, RN]

I have to disagree that you made some sort of "huge mistake". The O2 sat, if it was significantly below her normal indicated the need for a CXR, which was done. I've never encountered an LTC protocol where a doctor who ordered a CXR can only find out the result by the LTC calling them. The MD ordered the CXR, they are responsible for following up on the result.

There is an LTC protocol where the MD ordering the x-ray needs to have the results called in ASAP, that happens to be the protocol where I work. The protocol exists because unless the circumstances are unusual x-rays are performed in the facility by an independent portable imaging company and the imaging reports are faxed directly to us so the ordering MD has no access to the report until we call it in. At that point if the MD wants to review the images they can be accessed through a web portal for the portable imaging company but the images are not automatically uploaded to the patients medical record in EPIC.

I can see why a nurse unfamiliar with this particular system would assume that any imaging results are forwarded to the ordering MD, but that is why it is never safe to assume. I am sure the OP learned a valuable lesson here that any abnormal imaging or lab results need to be reported via phone call to the ordering MD, if nothing else to give the MD a heads up that the results are available for review.

[TruvyNurse]

I think Ruby Vee said it best. (She is wise!) You're going to mess up. Learn from it. Brush it off. It could have gone a lot worse. I have been a nurse for 3 years and YES I've made plenty of mistakes. BUT I learned so much. You never stop learning. Just regroup and think how you would have handled it different. Ignore the CNAs comments. Go back to work with your head up!

[OrganizedChaos, LVN]

The OP works at a nursing home/LTC/SNF. Not all nursing homes have converted to EHR systems due to the time and massive expense involved. Hence, it is very possible that the OP works at a facility that still utilizes old-fashioned paper charting.

Yes.

At all the nursing homes I worked at they were still documenting on paper & you had to fax or call the doctor. I'm sure there are nursing homes on computers but none of the ones I've come across.

[Alex_RN, BSN]

DO NOT QUIT YOUR JOB. I know how you feel. These are very minor things, not even errors, really. I am a smart, observant, hardworking, kickass RN and I will NOT tell you about my errors in my first 6 months of nursing because I am not going to write that s*&% down anywhere.

What you experienced is a very normal learning curve. Now you will kick things up a little when a patient is vulnerable. That is an important lesson to learn, especially when you are an overloaded, busy new RN still finding your time management. Now you know a little more about how your facility's labs/radiology reporting is done (by you, apparently.). Maybe in your next job or the next software update it will be different.

At my job, no one told me I was supposed to notify the MD either. Now I know which MDs want to be notified and which MD's get angry if I call before 8am, which ones round at 2am, which one's want me to leave a message and which one's get furious if you leave a message.

You feel bad about yourself because you want to do the best for your patients, but find a way to get over it: Go for a run, maybe write down how you feel, but forgive yourself. Nursing is hard and has the potential for mishaps at every turn. You will develop your own list of red flags.

[LovingLife123]

You should always check bract the physician for any test result that is off. Always. I do it in the hospital. I always see the results way before any physician will. Remember, you may have say 20 patients in an LTC. Your physicians have hundreds of patients. With lots of test results they can't possibly constantly sift through. It's up to you to bring an abnormal result to their attention.

92 is not really a normal sat rate. It's closely riding the border which should mean you need to do a little bit closer monitoring.

You are not expected to know everything. Not ever. You should though have an understanding of vital signs and what those mean as those are your signals when something is going wrong. That's why they are called "vital" signs.

I would simply talk to your superiors and ask what the parameters are for vital signs in your facility and what the test reporting procedures are. I'm sure somebody could take some time and train you on this. If not, they are doing you and their residents a severe disservice.

[Avid reader]

I would identify competent nurses that you could call for feedback if they are willing, who would also provide rationales for their decisions for learning opportunities. Make a record of cases that baffle you and get advice. Knowledge isn't acquired through osmosis, you have to seek it out and be persistent. For every Sx there is a reason and it's your job to know why, because firstly for me it's exceedingly interesting, but most of all your licence and livelihood depends on it.

[Leonardo Del Toro, RN]

I would not feel guilty at all. Yes it takes a while to know when things are serious and when pt's situations can wait. Regardless, you should contact the physician immediately if you see anything abnormal. Look at baselines, look at the patient's face: do they look sick? Hard to arouse, fever that escalate quickly. There are unimos signs and you'll only learn to have good judgment with time. Ounce you decide you have to contact the physician, you make every attempt you can, document you did attempt and not is out of your hand. If the situation is very serious you can send the patient out or call the on call Dr. In any case. It is not your fault. The fault is from a screwed up system that do not train nurses on the floor. Only on stupid useless "rotations" that teach nurses NOTHING. It will take time to learn but you'll get there. YOU ARE SMART.

[Simonesays, BSN, RN]

I wish I could like some of these responses more than once! You've been given great advice. Don't be too hard on yourself. You are a new nurse. We all make mistakes. I have been nursing for a few years now and I made a few recently. I also felt horrible after. Reflect closely on this situation and use it to improve your practice. You will be a better nurse for it.

It seems that you work in a long-term care setting. One thing I think is important to consider is the most serious complications that commonly occur in your setting, the pathophysiology behind them, how these complications present (early signs/late signs), interventions, and related protocols. As some places don't have very extensive orientations, these might need to be things you need to research yourself. Talk to your manager/colleagues to find out what these complications might be and where your resources are. I would probably start with different infections (i.e. pneumonia, UTI, influenza), falls, CVA, and MI (if you work in a long-term care setting).

As some others said, there were a few things you did well in this scenario. You listened to the family's concerns (so important! Particularly in settings where patients are known to have dementia and baseline confusion. If the patient is new to you, you might not pick up on new/worsened confusion but the family will.) And if the family has concerns, try to find out what exactly they are. This can help you when you communicate with the MD.

As well, you sought a second nurse's opinion. Even better, if you can find an expert nurse who knows the pt's baseline and can help assess for early signs of deterioration.

And last piece of advice, if you haven't done so already, talk to your manager. (i.e. I hear Mrs. X went to the ICU with pneumonia. I was hoping to discuss the case with you to further my learning so that I can improve my practice.) These are things you want to do anyways, so include your manager in this conversation and let them know that too. They will probably appreciate your self-reflection and willingness to improve your practice.

Good luck and don't get too down on yourself!! We were all new nurses. And most of us didn't (and still don't) know everything

[NurseCard, ADN]

One thing I'm confused about... and I'm sorry if this was already answered or

brought up... when the physician called you at 5pm to ask about the X ray

results, did you tell her that the patient had pneumonia? Or did you fax

the results over to her right then? I'm just confused as to why the doctor

didn't go ahead and send the resident out when she got the Xray result.

Or did she order an antibiotic to be given at the facility? What did she

want to do about the pneumonia?

Sounds like the only thing you did wrong was not call about the

Xray results and you said you didn't know you needed to.

And other posters have given you good advice about

monitoring mental status, listening to family members

when they insist that something is wrong, and checking

02 sats.

You're doing fine!!! Chin up!!!

[Davey Do]

Some years ago, I was receiving shift report from the 7A to 7P nurse, who was a new one, and had given insulin to a patient whose blood sugar bottomed out. I don't remember the exact circumstances, but the new nurse acted accordingly, gave the patient some OJ, contacted the doctor, documented, etc. I remember how bad the new nurse said she felt and was very down on herself.

I consoled the new nurse, letting her know that everyone makes mistakes, but it's what one does after the mistake that matters, and she did the right things. I praised her for her actions and believed she felt some relief as a result.

I admire you, coconut, identifying your actions and seeking guidance. That's one of the big things that makes for a good nurse: self-appraisal and seeking to improve.

Making and admitting to mistakes is a very humbling experience. It shows that you care enough about yourself and those you serve to rectify the situation and gain experience and knowledge as a result.

I'm sure in my career, I've made, as you call "a huge mistake" coconut, but nothing comes to mind at this time. However, if I were put in a crisis situation right now, I'm sure something would. I can hear myself say, "Oh- be sure to do this or not do that because one time..." I've learned from my mistakes, and that's what makes me, at least, an adequate nurse.

Those nurses who don't care and do not learn are the scary ones, coconut. For example, a couple of years ago, I received shift report from the evening nurse who did not know the lab results of two medically compromised patients and did nothing about a patient requiring an immediate intervention.

The patient requiring immediate intervention was off of the geriatric psych unit within 20 minutes and had surgery that night. One of the medically compromised patients died a week later on the medical floor.

I use this example to illustrate the uncaring actions of an uncaring, incompetent nurse. This nurse had a cavalier attitude and was more concerned about giving report quickly so they could go out and smoke. This nurse's lack of concern and caring brought the wrath of Davey Do down upon them.

Needless to say, this nurse quit their job a short time later, probably partially due to the fact of the reputation that followed them after this incident.

But this incident has also caused other nurses to be more aware of the patients' status. Recently, a new nurse was to give me shift report and sought advice from a seasoned nurse on what information I expected from them. I could tell during report the new nurse was nervous, but as they were at least trying​ to do an adequate job, they received nothing but praises and guidance from me.

I reiterate, coconut: Nurses who make mistakes are not scary. It's the nurses who don't care that are scary.

And, once again, you have my admiration.

The very best to you!