Hard stops, required lab assessment, and anxiety

by bestnurseicanbe bestnurseicanbe (New) New Nurse Student

Specializes in Med-surge. Has 2 years experience.

I’m still new at my job, technically. It’s much different than my old job and I have to administer meds I’ve never given. The computer has some hard stops, (Coumadin INR before administration, two checks for insulin, etc.) I was so caught up in knowing about the medication, reading the vial, checking the right patient, using it for the right reason, etc. that I forgot to check a lab value. I realized this two days later on my day off and the feeling of anxiety and dread overcame me. There was no hard stop. I’m not one to rely on the computer system for everything and practice my five rights the best I can.
I'm dealing with a lot of anxiety lately in my new position. Going over things I may have missed after I leave. I’m afraid I’m going to come in and get blindsighted by a mistake I’ve made. It’s horrible. 
I have the absolute best intentions and I realize I’m a nurse who spends a lot of time helping and assessing patients. I find solace in knowing I tried my hardest daily. It just isn’t significantly reducing my anxiety.

Often times when I’ve made small mistakes and spent hours or days fretting about them, down the line they seem minuscule and are able to be chalked up to a learning experience that shaped me. However, I refuse to get complacent and I’m hard on myself for not knowing everything I should.

I just can’t get over this one and would like to talk about PTT and subq heparin at the ordered dose. Does your computer have hard stops? And would you dread if you administered one dose without checking? 
Thank you in advance.

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 52 years experience. 1,183 Posts

Not to encourage complacency at all, but a little perspective is in order. You have already learned that some mistakes you will make as a new grad will seem dreadful but in the fullness of time are actually pretty minor. NOBODY expects a new grad to know everything an experienced RN does. That's sort of the definition of passing NCLEX: documenting that you are OK to begin your nursing career as a newbie, not to jump in as if it were three or four years down the road already, LOL.

By all means pick a quiet time to pick the brains of some very experienced nurse at coffee about PTT and heparin. It's not that hard and you'll feel a lt better once it makes more sense to you now than it did before you had to give it the first time. And also remember that of all the drugs that could get somebody in trouble, heparin and insulin are the easiest to check and then to fix.

That said, never, ever skip the check first. If somebody made  mistake before you and it wasn't picked up, you could end up being on the spot. Checks are there for a reason.