Getting back in the saddle after a med error

[trishamn, MS, RN]

This past week I was coming to the end of my new grad program on a med/surg floor. My first shift of three went amazing and my preceptor was extremely impressed. Then came day two, and I made the most ridiculous med error. I told my preceptor right away and the NP on the patients case was on the floor, so we also told her. I called pharmacy to see what else we could do and how we should proceed with the pt.'s medication. The pt. was fine and the error did not affect his health at all.

The fun started when I had to meet with my supervisor and the director of med/surg. I had to explain the situation numerous times and the director kept asking me to explain what I was thinking over and over again. I ended up saying I wasn't thinking and the error I made was out of stupidity and not doing the three checks of medication administration that we all learn in the first class of nursing school. I started to cry.....yes, I CRIED AT WORK. I felt so embarrassed and incompetent.

The next day my preceptor had to watch me give every medication and before I had time to do something, she would quickly say, "don't forget to do x, y, and z." I felt like I was under a microscope and my preceptor told my supervisor and director about every detail of the day. It was awful and I cried again at work.

I am working with the director of the new grad program on education and was told that many nurses overcome a med error after working with the hospital educator. My first shift is tomorrow and I feel sick when I think about going back to work. I am not sure med/surg is for me, but want to prove to my supervisor and director that I can do the job. I feel like I can't ask my preceptor, supervisor, director and new grad educator any questions because it may be taken out of context.

I enjoy working with multiple pt.'s one on one and have considered home health, or in a clinic. I also enjoy working with wounds and doing IV's, which has made me consider looking into being a PICC line nurse. My preceptor said that my interests would get boring because they would become repetitive, which I don't agree with. However, if I am not able to make it through this next week, I feel I will have a difficult time getting into a hospital.

Any words of wisdom or suggestions would be much appreciated! Thank you in advance.

[traumaRUs, MSN, APRN]

I can tell you that many nurses (if not all) have made a med error.

[jadelpn, LPN, EMT-B]

Home health is a great option. Variety, one on one. But you need to get some experience under you first. Take what they have to teach you and embrace it. EVERYONE makes medication errors. AND your preceptor is supposed to watch you like a hawk. So that was the process issue part of this.

In giving medications, always use your resources, and never cut corners. Do it the right way. Don't scan labels, don't take a bunch of meds out and get confused, don't take pills out of packets before you are at bedside and scanning them against the bracelet. And triple check names.....be mindful and careful.

You got this, you WILL get your groove.

Best Wishes!

[Karou]

You will be a better nurse after this. By asking you what you were thinking, they were trying to get you to explain why/how you made the error (self analysis) and probably wanted you to come up with a plan of how to avoid making that error in the future.

Medication errors happen. Some are bigger/worse than others. I am glad your patient wasn't harmed.

While I don't want to diminish the severity of what happened- your patient wasn't harmed, you haven't been fired, and you learned something. The only thing you can do now is move on with it and continue to be safe in your practice and medication administration.

I have made a few medication errors. Have had some patients fall. Forgot to carry out some orders, or forgot to document something. Pissed off a couple of doctors (sometimes I was right, sometimes they were fools). You can only move on and do better. We are all nurses, but before that we are all human.

[trishamn, MS, RN]

I appreciate the comments so much. I am spending most of my day trying to figure out how to get rid myself of this sickening feeling I have about going back to work tomorrow. I do have experience as a home health nurse as a CNA and LPN. I do agree that working in med/surg is very valuable. I have learned so much. Again, thank you for your responses.

[CrunchRN, ADN, RN]

It happened. Lesson learned. Even big bad experienced nurses make med errors. Just learn from it. Hugs.

[Libby1987]

I love home health, it's been a wonderful career for me. Coming into it without acute care experience makes it extra challenging. It's so much more than procedures, which are easy to teach. It's the assessments, understanding of disease mgmt, pharmacology and critical thinking that is both difficult to teach and to learn in the home health setting.

[lavenderskies, BSN]

I am spending most of my day trying to figure out how to get rid myself of this sickening feeling I have about going back to work tomorrow.

You've had great advice given. Especially the *why* of how the mistake was made. And it's true everyone makes mistakes.

As far as your comment above....my advice is to NOT focus on the mistake other than to ONE time walk yourself administering that med and doing it correctly or catching your mistake before you made it and patting yourself on your back. As in replace the bad memory.

Then... as far as going to work tomorrow. Ask yourself-

How can I be a better nurse than I was yesterday? (Everyday) And go rock it :)

[primarycares]

I too made a med error 3 years ago during my new grad med/surg internship with my preceptor standing 2 feet away, reported and owned it immediately, consulted with PA and pharmacy and found that no harm had been done to the patient. The place where our stories diverge is that following inquiries into the mistake and how it was made, 2 supervisors and my manager all approached me during the following shift, reassured me, and then shared with me the worst mistakes they had ever made in their careers!! Needless to say, the stories they told were way worse than my straightforward and (thankfully) harmless med error, and the support that they offered both moved me and helped carry me through the shame and self-doubt that threatened my self-confidence in our challenging work. I carry both the exact details of that med error AND the funny/awful stories my mentors shared with me every single day on the floor, and I know that it makes me a better nurse. Please believe in yourself and that you will overcome and be stronger for the challenge - good luck!

[Mavrick, BSN, RN]

I carry both the exact details of that med error AND the funny/awful stories my mentors shared with me every single day on the floor, and I know that it makes me a better nurse. Please believe in yourself and that you will overcome and be stronger for the challenge - good luck!

I made a med error in 1984. Another ICU nurse asked me to check her Insulin Drip calculation and I agreed it was correct. Morning blood glucose on the patient was 16.

What went wrong? I was busy with my own two patients and quickly glanced over her work. I didn't actually work out the calculations myself.

What did I learn? I NEVER glance at drip or medication calculations. I actually write it down and use a calculator for anything but the most obvious (even then I feel guilty). Same with checking PCA settings.

This error may stick with you for life. Use it to make you the better, more experienced nurse. Many times this is how we got that way.

[iluvivt, BSN, RN]

It seems as if your first instinct is to run in that you are contemplating what you may be interested in in a possible attempt to get away from Med-surg and that is natural but there is another way to look at this. I could be wrong but that is my take on this! You need to focus in on what steps you took and what you were thinking that led to the error. If you believe that you did not follow the 5 or 6 rights of medication administration then why not? Were you busy..did you think it was a no brainer so you skipped it..did you read the label correctly..give too much..too little or the wrong dose..what was it? You can't fix anything unless you take it apart and then make an action plan and stick to it! Forgive yourself for making a mistake and use it as a learning experience so you do not do it again. If you get in the habit of treating each drug administrations with the same respect and cautious administrations steps, no matter how inconsequential you think it is in scheme of things, you will greatly reduce if not eliminate medication errors. Even check up on pharmacy.. even flip your IV bags over an make sure the label matches what the bag is. We just had this happen...label and bag were not the same... the nurse caught just in time to save the patient!

By the way.the nurse who told you that being a Vascular Access Nurse or Specialist is boring is so wrong.You are NOT just inserting PICCs. You must know and be able to assess all types of patients for the most appropriate vascular access ,know contraindications,know the ph and osmolalities of tons of medications,know how to insert arterial lines, all types of peripherals including using Ultrasound to do it and many are now inserting internal jugular lines as I soon hope to do. There is so much more I can't even begin to tell you but I can tell you to peek into any decent IV nursing book and you will be surprised all there is to know and do.

[Cola89]

Honestly, your preceptor can't tell you what will get boring for YOU. She can say what would seem boring for HER, but who knows thyself better than thyself?! As for med errors, you feel bad and have learned/are learning. Maybe it's humiliating, but you should be able to build (not rebuild, because you're new!) up your confidence in time.