Feeling really bad!

kiszi, RN · Apr 30, 2016

Don't beat yourself up, take it as a lesson learned. Does your lab not call critical values?

PapaBearRN, BSN · Apr 30, 2016

You learned your lesson and I'm sure you won't make that mistake again. Beating yourself up is natural and shows to me that you care. But now try not to be so hard on yourself.

Double-Helix, BSN, RN · May 1, 2016

These things happen. I'm sure you'll always remember to review labs from here on out. You're not the only one who overlooked it either. Both his doctor and the overnight nurse missed it to. Learn from this, and try not to be too hard on yourself.

iluvivt, BSN, RN · May 4, 2016

What is your process for checking lab results? Dkes your facility not call the murse with critcal labs and then document that they spoke wit you.If they DO NOT you must close the gap now with your own process.By that I mean you must write down on your worksheet any lab the patient has done then you need a little check box that you looked at all the lab and called any critical values such as a low K or Mg or low Hgb. It will happen again if you do not change how you collect and proceess the lab information.

iluvivt, BSN, RN · May 4, 2016

Forgive typos...I am on my phone and can't go back to correct

Here.I.Stand, BSN, RN · May 6, 2016

Hugs!! Mistakes happen -- we're human. Add to that an insane RN : pt ratio, and mistakes are even more prone to happen. There's a reason we use the phrase "safe/unsafe staffing."

I've been an RN for 13 yrs and never have > 2 pts at a time, and I still note my tasks in red on my brain sheet. I've been doing that since nursing school, when I forgot to give a med. :bag: At the beginning of my shift, I note what times they're due to be drawn, or make a red check mark if any labs are pending at the beginning of my shift.

calivianya, BSN, RN · May 7, 2016

2.8 is not a critical where I work. 2.7 is where the cut off is; I wouldn't get called for a 2.8 either.

Non critical (but low) labs are the worst. They are low, but you have to find them for yourself. Don't feel bad. It was an honest mistake, and I bet you will triple check to see if your labs have come back from here on out, which is what really matters.

Lad345 · May 9, 2016

I know right now it feels terrible, but just know the onus is not on you entirely. I don't know your specific policies, but where I am the lab draws are done at 0400, so that they are available for MD review when the medical teams arrive between 0600-0800. In all honesty, the act of paging labs is not done to inform MDs about the *existence* of lab results, it's moreso a small *reminder* to them that an abnormal lab is out there. Just as nurses are ultimately responsible for ensuring that a tech's verbal report of a blood sugar matches the machine report in the chart; MDs are accountable for looking at labs to confirm verbal nurse reports. I mean, if your tech forgets to call and report a FSBG result to you, that doesn't excuse you from checking the FSBG and giving insulin coverage if needed.

Yes, you should have glanced through labs and FYI paged it to them at some point during your shift. But ultimately I would think that they should have looked at the pt's labs on their rounds? Or when they wrote the pt's daily progress note?

In the line of accountability you noticing and reminding them is important, but unless it's a true critical reported directly to you from a lab tech, its not really the nurse's true "responsibility" to remind MDs to look at their labs. Labs are a medical diagnostic tool that only physicians can officially interpret. We're advocates and liaisons between patients and all the different disciplines, but we can't always check behind everyone. It's definitely something we should TRY to do, but that comes with time I think. You can't sit and actively look for issues in the entire EHR, but you'll gradually find yourself checking certain things to be sure they are done.

If those were the last labs the patient had had done, and none were ordered for the night before the planned discharge, then the MD inadvertently articulated "labs no longer needed". Logically, that'd should occur if they were reviewed and determined to be acceptable. The night nurse also should have looked at the labs, and he or she could have paged as well to jog their memory, and see if they wanted to replace the K. But again, while it's helpful and things get missed less when several team members are compelled to check the labs, the MD was the one truly responsible. If you're going to give certain medicine that directly correlate labs, like bumex or lasix, yes you should definitely be checking them first thing in your shift.

But, in my opinion, it's rather poor-planning on the part of that MD to not have checked their labs from the day before until the day of actual discharge. At the core of healthcare, your responsibility is providing safe, effective patient care through ongoing assessment and carrying out orders; it is the MD who should be ensuring that ongoing diagnoses are accurate, electrolytes and blood components are at acceptable levels, the POC is progressing, orders are up to date, and meds are still appropriate with current pt status.

I say all this because I would personally take issue if I overheard a veteran charge guilt-tripping a new nurse over something like that. I guarantee she or he has done something similar when they first started out. Habits like consistently checking behind labs, having the confidence and intuition to question orders, and getting a feel for radiology comes with time. It's always helpful to find a mentor to go to help point you in the right direction and help you grow. If that charge is continually overly-critical, I'd pull her aside and remind her you're new, you're committed to learning, and ask if she has any suggestions to improve your work flow. If extending deference to her doesn't help and she starts making a habit of guilting you like that, maybe distance yourself from her and find another, more empathetic veteran to assist you.

I can't stand nurses that treat new nurses poorly and pretend like they just started out in nursing as knowledgeable as they are today. Your mistake still happens to nurses with years of experience, because on extremely busy days we may only get a quick glance and it's universally expected that MDs will perform all of their responsibilities during their rounds and notes.

Just let it roll off your back and learn from it. You'll find your method for getting everything you need from the chart quickly, don't worry it just takes try time. From the sound of it, you got chided by your charge because things unfortunately roll down hill. But just know, you aren't the most culpable, and you are not really the reason discharge was delayed.