I keep identifying new ways to prevent them, but someting always slips through.
Most commonly, an order will say something like: Tylenol 325mg I-II tabs PO Q6h prn. I will only see the 325 and not the "1 to 2" part.
That's just an example. I have also missed a couple things outright. A few weeks ago I nearly gave the wrong heparin due to miscounting the zeroes... the patient would have got only a fraction of the dose.
A nurse at work has been on me about it, a bit overly so. Okay, a lot overly so. I feel like she's obsessed with everything I do. She has taken her concerns to our boss, and wasn't happy with her response so is taking it to the next higher boss now. Our direct supervisor is trying to help me but has advised me not to make even the tiniest mistake while I'm under such scrutiny, and yesterday, I made a mistake. She's fed up with me even though she agrees that my coworkers is overstepping her bounds.
In the past month I've made probably 4 real mistakes:
-one near underdose of heparin, caught by the other nurse
-one missed order which the MD did not flag (I was off the floor though on an ACLS run and left my patient in the care of another nurse for a while)
-one wrong route of an antibiotic.
-one antibiotic that didn't infuse, which I caught later and corrected, on an abnormally busy day... but it took me a long time to catch it
I have been trying SO hard not to mess anything up. I've become nearly obsessive compulsive, checking everything over and over throughout the day. Even after I've already seen it. And at the end of the day I check over every bit of paperwork and the patients themselves, with a second set of eyes to help me. But this overzealous nurse has written up, along with these errors which were true errors that needed to be adressed, about three times as many things that never happened. For example I had a detox patient with a high BP and she thought I never gave him his blood pressure medication. She asked him and he said nobody had given him any pills all day.
He also thought that something that had happened 4 hours ago, had happened "yesterday" (and this was day shift), that there were women in the bed near his, and that his walls and window were moving! Yet she is writing this up as an incident report, using sketchy circumstantial evidence to paint me in the most negative light possible. Even if most of them are false, enough write-ups and you look bad.
I can't afford to make a single mistake. Even non-mistakes are getting me in deep hot water. I am utterly desperate and trying my hardest to do everything perfectly, but I am in a job where neither of us are likely to be fired or transferred, and I can't quit.
Maybe I'm a terrible nurse for making these mistakes. All I can say is that I am doing my best. I am not stupid, careless, or lazy. For some reason I just keep messing up. And with this obsessive woman relentlessly breathing down my neck, it's so bad that I am losing confidence, losing sleep and losing weight from all the anxiety.
Can anyone help?
How do you prevent med errors?
Why do I keep making them? I've been a nurse for almost 3 years now.
How many med errors do you think each nurse makes on average anyway?
Am I just in the wrong career field? Should I not be a nurse?
Well I can't change jobs or anything, I'm in the military. As for shifts, we only have 8 nurses, and she follows everything I do whether she is on the shift with me or if she follows me
Is this nurse in the military too? I work in a military hospital and the military nurses have two sets of guidelines to follow and two sets of protocols. Causing problems to intensified.
I do have AD/HD diagnosed a year ago. Since taking medication I made a 180 degree turn for the better at work. Stupidly, I openly told coworkers I had it. I thought it would be good for others to know, like my strengths and weaknesses. I was wrong. I am very suspicious that this nurse has it in for me for that reason. At the moment maybe it's stress because since this all started (this nurse harassing me suddenly I'm making errors again the way I used to before medication. But sometimes they happen even on nonstressful days.
Even now I'm paranoid she or someone else will search the internet and find this post, but I need advice, I need someone outside the situation who is a nurse to talk to.
Hello, Bulk
Ok, Let me explain to you that information about your ADH/ADD is confidential and your are cover under the ADA. Many people feel if you ADD/ADH and/or learning disabilities that you cannot perfom the duties of a nurse. A lot of nurses do have a problem with individuals that are different or not normal or have learning disabilities and yes, they try to remove the individual from their nursing position. Then they try to go after your license. One would think nurses would be understandable about individuals with learning disabilities and would like to assist the person. I found the older generation cannot relate to learning disabilities and think it is a disease without a cure. I laugh about it and shake my head. In addition, that includes with someone that had blood clots are not capable of doing their duties as a nurse. Therefore, you do not share that type of information with the staff at all and it can be reveal to your supervisor (which she can find adaptable assignment for you or give suggestions).
How do I know about this information? I am a learning disabled individual and I did the same as you by revealing it to the staff and supervisor. Well, they tried to run me out of the field and I did not allow them too. They concentrated on me so much that I used them as a saftey check and they had no ideal how I turn it on them. I was pissed at first, then I switch the angry into positive fuel by saying "hey since you are would you do a check on this medication? and I thought the process of this drug could interact with antiboditics and I need to call the physician." They were astonish that I was correct and I taught then something each day. Therefore, use them as safety net as they are looking down your throat and smile (less stress).
I felt they were head hunting and decided to change my status as a floor nurse and become a nurse practitioner. I have a great relationship with my patients and taught them a lot about their medication and health disease. I love them and they were like family. They are respectable and enjoyable to have as patients. Therefore, instead of me working on the floor, I will be working as an independent and write rxs for disease process and injuries.
I will be able to function a lot better than a floor nurse. It was a personal choice I decided for me last year after a back injury. But it may not be your choice.
You have to decide what position is adaptable and best fit.
Do not reveal your personal information to anyone accept your nurse manger and/or supervisor.
Do you feel that you have the qualities of a leader? If so, return to school and become a crn or a np.
They cannot fire you as quickly as other.
In conclusion, do your best without being stressed and will be able to concentrate better.
What you are describing is me on stimulants or when I didn't faithfully take my meds every day, not just the days I worked. Talk to your doctor and look at how you are taking your meds and whether a change in meds is in order. Are you seeing a doctor who specializes in adult ADHD?
I have ADHD, I am an RN on a busy telemetry and cardiac stepdown unit, and everyone knows about my having ADHD. The self-fulfilling prophecy spiral of hell is hard to break out of. Thankfully, I have been through it growing up not knowing what was intrinsically wrong with me. Faith, and its' practice helped me beyond compare. Enough said about that here. I found out about the ADHD in nursing school when other students started making comments about the way I studied. I didn't study for a test by simply studing the material but I would bring in all kinds of things we learned previously because I'm not a linear thinker but a mosaic thinker. Still it wasn't until I finally got on Strattera that I had the most important tool possible for me to follow through in a linear fashion.
I want you to know I believe you are doing your best to climb a steep climb. Why is it steep? Because it is other people's expectation of you - self fulfilling prophecy. I'll tell you this quickly and then tell you how I did it and continue to do it. What matters is what you think. Be very stingy about the power you give others over you. At first, I had to develop my routine, I learned I could not veer from it even if I felt confident I could. I also ask questions and seek double checks from nurses who are not quick to judge especially when hanging cardiac drips and heparin. I always thank others who remind me of something even though I may not have forgotten it; I just had other priorities first. Say, "Thanks, I never get mad or feel irritated with a good will reminder. Remember, everyone makes mistakes; everyone forgets. Attitude is everything. Yes I have ADHD and I'm OK with it. I love nursing. The compliments I get from my patients and their families give me a real high. I compliment my aide and work at making the environment I work in the environment I want to work in. I say to the float nurse and nurse aide, "Hi, I'm Mary and you are on the nice floor, ask away". I am always late because I care about how I give off my team. If I feel like my lateness is because of my ADHD, then I clock out manually with a time that is fair to my employer. I don't go back in patient rooms; however, unless it is OK with the nurse coming on and I'm still on the clock. When someone has the attitude of "I caught something you did wrong or forgot". Smile and say, thanks, you saved my skin! And do what is right, even if it means calling a doctor and telling him/her what you did if the patient COULD have a problem. Your person is OK if you did something wrong unintentionally. Not even God will judge you. Stand in the light and don't hide behind ADHD!! It is not an excuse for error. It is an excuse to be a real person. You might find your co-workers becoming less guarded too. Take full responsibility for your actions, wrong or right! Take pride in being a hard worker because we must work harder than someone without ADHD. Try to make yourself available to your aide when she needs you. Your job is first but having the willingness to help your aide is career saving to you. All this takes time. What nurses say on my floor is that the scariest nurses are those without questions, who don't build relationships with their co-workers by using them as spring boards if only to seek support in a decision you think is right but not quite sure. This builds trust and cohesion on the floor. I love my job and those I work with. In a crisis, I know I've got what I need and will be there when I am needed.
Ok, Let me explain to you that information about your ADH/ADD is confidential and your are cover under the ADA. Many people feel if you ADD/ADH and/or learning disabilities that you cannot perfom the duties of a nurse. A lot of nurses do have a problem with individuals that are different or not normal or have learning disabilities and yes, they try to remove the individual from their nursing position. Then they try to go after your license. One would think nurses would be understandable about individuals with learning disabilities and would like to assist the person. I found the older generation cannot relate to learning disabilities and think it is a disease without a cure. I laugh about it and shake my head. In addition, that includes with someone that had blood clots are not capable of doing their duties as a nurse. Therefore, you do not share that type of information with the staff at all and it can be reveal to your supervisor (which she can find adaptable assignment for you or give suggestions).
How do I know about this information? I am a learning disabled individual and I did the same as you by revealing it to the staff and supervisor. Well, they tried to run me out of the field and I did not allow them too. They concentrated on me so much that I used them as a saftey check and they had no ideal how I turn it on them. I was pissed at first, then I switch the angry into positive fuel by saying "hey since you are would you do a check on this medication? and I thought the process of this drug could interact with antiboditics and I need to call the physician." They were astonish that I was correct and I taught then something each day. Therefore, use them as safety net as they are looking down your throat and smile (less stress).
I felt they were head hunting and decided to change my status as a floor nurse and become a nurse practitioner. I have a great relationship with my patients and taught them a lot about their medication and health disease. I love them and they were like family. They are respectable and enjoyable to have as patients. Therefore, instead of me working on the floor, I will be working as an independent and write rxs for disease process and injuries.
I will be able to function a lot better than a floor nurse. It was a personal choice I decided for me last year after a back injury. But it may not be your choice.
You have to decide what position is adaptable and best fit.
Do not reveal your personal information to anyone accept your nurse manger and/or supervisor.
Do you feel that you have the qualities of a leader? If so, return to school and become a crn or a np.
They cannot fire you as quickly as other.
In conclusion, do your best without being stressed and will be able to concentrate better.
If you need several techniques....let me know.
Buttons
Hello, Bulky
My and RN has great suggestions. I used a 6x4 white blank index card and a sheet as MY described at the bottom of her post. In addition, I am much better on a computor than doing the "old tradition" writing every thing. Because I can wiz right through the pages without difficulty.
Moon, no matter what medications she takes will not resolve the problems. ADD/ADH is not a disease and it is important to understand the concept. A lot of people in society who are adults are ADD/ADH and children are too. The medicine tries to get a person to be calm and to concentrate on their work, reading, and etc.
ADD/ADH is an adult that has significantly problems in these four areas:
A. Inattention B. Impulsivity C. Hyperactivity D. Boredome
Some psychologist believe that ADD is cause by a brain injury.
ADH is a medical condition, caued by genetic factor factors, that result in certain neurological difference.
A. Problems with Attention B. problems with a lack of impulse Control C. problems with Over-activity or motor restlessnes D. problem being easily bored
ADD/ADH or AD/AH can be treated by medications, change of diet, alternative treatments and natural substance.
It is not a disease. It is a disorder that occurs in the brain and the individual has excess energy which needs to be control.
Bulk, need to do things in a way that will prevent her being distracted, reduce the level of stress from others (like the nurse going after her), finding a method to use everyday consistently (misspelled), taking her time, possibly - have a smaller case load that have more invole patients (unstable) - due to more concentration and specific to the disease process, having the same patients every shift until discharge, having someone to be a coach not a preceptor for evaluation each week and to be use as resource for her- oh that coach can take the pressure off her by telling the other nurses come to her if they see a problem, she needs to be given feedback and that is basically it.
Bulky, you need to eat six small meals and snacks per day. You will see a difference and do not eat a lot of carbohydrates. Drink plenty of water and sport drinks through out your day.
The ada is not applicable to military personel, they have some similar regs but your interprtations of the ADA do not really apply here. Also on confidentiality, the information that you discussed with your coworkers is not confidential medical information under HIPAA. ie your told them and they did get from the info from thier work prividing health care services to you or access to your records. you give up a lot of confidentiality when you discuss it with coworkers
Military personel cannot sue the military for any reason (ok about 2 people have been allowed too in history but the scope of that is VERY narrow)
One of the personel issues here that I see as the biggest deal is your co worker jumping the chain of command. COC is a big thing in the military, and while all commanders/supervisors claim to have an open door policy, it should only be used when the problem is directly with one of those people in the chain of command and still only after exhausting chain of command options. The nurse going to the bosses boss and stuff should result in a minumum of a one on one counseling session and even up to a letter of reprimand for not using the chain of command.
Personally, I wonder who is taking care of your co-worker's pt load while she is busy breathing down your throat????? Keep looking up. Don't let them get you down, kid.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Soounds like you have a bad case of "self-fullfilling prophesy" It has long been acknowledged within educational circles that if you believe someone will do something they will act to fullfill that expectation. If you believe that they are a Klutz and jump on them every time they fumble something then they will become more and more clumsy. What you need to do is tell the nurse who is on your back to get lost. You might think about another job somewhere where you are not faced with this.
This is excellent advice. I wish you well. Keep on working at it! No one here has made it long in nursing w/o making some error or another. Try to develop really good, solid habits that prevent errors and BELIEVE IN YOURSELF. I have ADD too----I can tell you , it can be done!
I have ADHD, I am an RN on a busy telemetry and cardiac stepdown unit, and everyone knows about my having ADHD.
I worked on a cardiac floor before now, before being diagnosed, and that is where it all started. My boss from there talked to my interim boss here and told him they'd had all kinds of problems with me. A lie! I'd only been in minor trouble, once or twice, and not even necessarily for nursing things. Military, more like.
I'd really, really like to know more about how you've overcome your AD/HD in nursing. Do you find yourself prone to making mistakes? Or is that just me, not my diagnosis? Because if you can relate then you know I really am trying so hard. And if there's something that I am not doing that I could try, I would be extremely grateful to hear it. Besides it's nice just knowing I'm not the only one.
The nurse going to the bosses boss and stuff should result in a minumum of a one on one counseling session and even up to a letter of reprimand for not using the chain of command.
It may yet. She has used the chain according to the book, but just recently, has contacted (as I said above) my old boss. This is really out of line. She is just a coworker, not a supervisor or rater. We're beginning to see compulsiveness in her behavior, anxiety, conflict with other coworkers... my current supervisor has talked to the higherups when they came to her with this coworker's concerns, and were shocked to find how much she'd exaggerated. I am wondering if, given enough rope, she'll eventually hang herself...
My and RN has great suggestions. I used a 6x4 white blank index card and a sheet as MY described at the bottom of her post. In addition, I am much better on a computor than doing the "old tradition" writing every thing. Because I can wiz right through the pages without difficulty.
Button, I do use a sort of sheet, a graphic chart drawn on my report sheets. Computer won't work for me because I cant carry it around. The report sheet trick really helps me remember all my paperwork though. I initially used the computer to design one but found this new way to be more efficient for me :)
5) Get on the computer and Customize a "jot" for yourself and print copies of it and use it. Can't tell you how many times I have watched nurses scribble info form the kardex on a sheet of paper. It's easy to overlook info when it is not in a organized format. Mine looks a bit like this but is formatted on legal size paper with the times extending across the paper, I write in the name of the med that is due under each time at the beginnig of the shift when I am organizing my binders
The binder thing I'd have to see to probably get, but it sounds similar to my grabbing the kardex, MAR and bedside flowsheets all as one before going to see a patient. I'll take a closer look at those suggestions when I'm not feeling so overwhelmed, As for a specific time to check charts, that's a good and simple idea. I have an "end of day" check ritual where I go through everything I can think of to make sure it's all done right, but it's still not a smoothly flowing habit. That might help.
This is excellent advice. I wish you well. Keep on working at it! No one here has made it long in nursing w/o making some error or another. Try to develop really good, solid habits that prevent errors and BELIEVE IN YOURSELF. I have ADD too----I can tell you , it can be done!
Blue Eyes, thank you! I sometimes wonder if I can ever break out of this cycle. Tiny and even non-existent things are being dragged up from 3 years ago and it gets so depressing. If you have any specific tips I'd love to hear them. Most nurses seem to be so organized, black-and-white linear thinkers. We think differently huh? I need to find methods that work for me. Besides panic mode.
Thank you everyone SO much for your advice and support! I feel more determined and buoyed up now. I am taking leave and going home to the states in a few days. If I can get through these last few days with no errors I will be able to relax. I hope.
If not, there's always maladaptive coping mechanisms. After all I will be on vacation!
First, check all your meds with another nurse before administering them. Have the meds completely ready (drawn up, mixed up, etc.) and check them with another nurse against the MAR. Try reading the order out loud as you check it with the other nurse. I don't know how it works in adult areas, as I work in the NICU, but with pediatrics we have to check ALL our meds with another nurse and that is where most med errors are picked up.
Second, make an appointment with your doctor. I don't know if it's a general practitioner that is treating your ADHD or not, but you really need a psychiatrist specializing in this disorder. It's not enough just to take a pill, there are other treatments. Through therapy and concentration exercises, you can really maximize your treatment. Plus, there are so many meds out there, maybe the one you're on right now isn't the best choice. This is why it's vital to see a doctor that is a specialist - they're the ones that are the most up-to-date and experience with the new meds and protocols.
Specializes in Education, Acute, Med/Surg, Tele, etc.
ONE when taking a MD order always repeat it! I don't care how long I have to clarify...it must be right! keep them on line or in your site till you have it right!
In reading...what I do is so simple! I grab my card or label and put it NEXT to the MAR label! Simple huh??? That way I have very little eye scan to have to do to read it! They are next to eachother so I simply scan a few CM's! I do this before punch, after punch, and one more time!
Also..the easy to miss things...make sure it is the RIGHT patient! LOL, I have made that error before (with no ill results thank goodness!)....the EXP DATES...very hard to remember especially in actute situations...hello, nitro does expire as does insulin in times of serious need..uhggggg! (about gave an expired nitro once...caught it though..whew!).
and last but not least....DOSE! I have had pharamacy mess up and give the wrong dose even if the lable said otherwise! This sometimes takes experience..but always check the dose on the label and hope it is cool (unless you want to check with all meds!)...I had a ducolax that was to be given at 100 mg, but I was sure it was a larger cap and guess what...RIGHT ON! It was a 200.....
Be serious and aware of each and EVERY pill as an individual pill...don't think of the grand total till the end...check each pill like it was an individual..with different looks, different characteristics..who it gets along with..LOL..the works!
" I'd really, really like to know more about how you've overcome your AD/HD in nursing. Do you find yourself prone to making mistakes? Or is that just me, not my diagnosis? Because if you can relate then you know I really am trying so hard. And if there's something that I am not doing that I could try, I would be extremely grateful to hear it. Besides it's nice just knowing I'm not the only one."
Hey Bulk, If you want a penpal / e-mail pal, e-mail me off board at [email protected]. Try to have some fun on your vacation. :)
madwife2002, BSN, RN
26 Articles; 4,777 Posts
Is this nurse in the military too? I work in a military hospital and the military nurses have two sets of guidelines to follow and two sets of protocols. Causing problems to intensified.