Getting over mistakes as a new grad

[maggiemckenna]

I'm a new grad nurse and I've been off orientation for 6 weeks now. I work on a busy surgical floor with mostly ortho and neuro patients but also take general surgery and medical overflow.

Two weeks ago my manager sent me an e-mail just giving me a heads up that I had forgotten to document intake on a post-op GI patient. This patient was NPO for the duration of my shift so what this basically amounted to was me forgetting to zero out the IV pump and document the amount of maintenance IV fluids given during the shift. Sent an email back thanking my manager for the heads up and letting her know I would use the information to better prioritize in the future.

Last night was probably the worst shift I've had since being off orientation. When I got report I had a patient who was clearly septic (post-op BP 70s/40s, 102 temp, HR 100+, UTI) so I called a rapid response and spent nearly the first two hours of my shift getting this patient ready to transfer to the ICU while also trying to pass meds to my other 4 patients.

Once I transferred this patient I had to pick up another patient from a nurse who was sick and going home. This patient was also post-op but with fluid overload and possible pneumonia. She did well for most of the shift but started desating and long story short quickly decompensated. RR in the 30s, requiring 5L O2 to maintain sats >90, and a wheeze that you could hear from the doorway. Called another rapid response and ended up transferring this patient to ICU as well.

As I was leaving more than an hour after my shift had ended I realized that I had made the same mistake by not zeroing out her IV pump (she was receiving TPN) and documenting her intake for the past 8 hours before transferring her. I feel terrible that I made the same stupid mistake twice. I know in the scheme of things this is small but this pt was fluid overload and needed accurate I+Os.

All of this to say, how did you deal with these kinds of mistakes when you were a new nurse? I know that as I keep learning I'm going to keep making mistakes but I need to find a way to deal with them more effectively.

[Cvepo]

Honestly, this mistake is low on the hierarchy of mistakes lol. You sound like you are doing fine and have many some good judgment calls for being a new nurse. Just take a mental note and realize the time management and efficiency takes time, and that really no harm was done to the patient at all; it was a mere documentation issue. It'll get better, but I wouldn't stress out too much

[missmollie, ADN, BSN, RN]

Chalk it up to experience gained. As a new nurse, there are a lot of things you'll forget. Becoming cognizant of such shortcomings is how you learn on the job. Will you forget to do that again? Probably not.

You'll make quite a few minor mistakes in charting and patient care during your first year, and that is okay. As long as you are focused on providing your patients with the care they need and no major mistakes are made, you'll learn in time.

The next time your manager brings something up, take responsibility and provide a plan describing what you'll do to ensure that same mistake is not made again. Personally, I like to make a list of what I need to do on the shift according to time. When I have downtime, I check to make sure everything is completed accordingly. You might find this helps. Best of luck, you're doing fine!

[canoehead, BSN, RN]

You transferred two people to the ICU in one shift, and forgot some documentation. Well, phooey, but you picked up on two patients circling the drain, and got them appropriate care, so I guess I'll chalk it up to good prioritization. If they say word one to you, make sure they know what you did right during that shift, and then add that you will make sure that particular piece of work is completed consistently from now on. You can do it, and you've already proven you are a great nurse. No more worrying about that mistake!

[blondy2061h, MSN, RN]

That would be a tough shift did ANY nurse and you should commend yourself for a job well done recognizing your patients' needs and getting them to the higher level of care in a timely fashion. Bravo!

When I first started I would make myself a timeline on my brain sheet for each of my patients showing what times they had meds due, labs, I&O's, etc.

Example:

Bob Jones rm 2

2000: Vital Signs, I&O's,assessment___

2100: medications, glucose checks, chart assessment____

0000: vital signs, CBC check, I&O's____

0200: IV antibiotic____

0400: AM lab draw, vital signs, I&O's___

0500: check lab results, cover electrolytes___

0600: medications, double check charting, prepare written report____

It would take me 15 minutes to do this for each patient and I'd check things off to prevent missing things. You can even type a template and just add what you need each night.

I stopped using my check list after feeling comfortable for awhile. I went back to using it when I went to dayshift. I stopped using it again. I went back to using it after returning from an extended medical leave.

It sounds like you're doing well and I would stress over this.

[Natasha A., CNA, LVN]

I would highly suggest to smell the roses along the way despite the challenges and circumstances. I admire your integrity for wanting to get better and you have all of our support. You will do fine as time goes a long way. What you are experiencing is only temporary. Turn your perception of mistakes as opportunities and ask yourself what did I learn and what can i do differently? What resources will help me succeed? Get to know your team and the equipment on the unit. Practicing how to manage your work will help a lot. Hang in there :)

[butters9812]

Youre going to make a lot of mistakes as a new grad. I am a new grad too and have made mistakes, it feels awful. Sometimes I fee like the worst nurse ever. But in the grand scheme of things, you did not harm the patient at all. If you have questions or need someone to check over your charting DO IT. I still ask soo many questions throughout my shift. It sounds like you are doing fine :)

[HalfBoiled, BSN, RN]

I believe the first email was a courtesy reminder. If you get the email again, go ahead and explain what you just told us. Your nurse manager has been in your shoes before. He or she will completely understand. Your prioritization, given the circumstance, has been right. Don't beat yourself up too much.