How to come back from a mistake?

[DH1234]

I had a very rough shift last night and to top it off I made a huge mistake bc I was distracted in the sense of I was trying to do to much at once. I had a new admit come around 2200 for chest pain and headache but everything was negative so he was kind of more staying there for observation. And he did not take any of his night time meds.

The pt at the time reports he was having 9 out 10 chest pain so my main focus and the pts was trying to get the MD to put in pain meds. MD only was willing to offer him tramadol which according to the pt does not help so I tried to get him some other po meds but the MD completely shut me down and MD would not even talk to the pt about the situation. And of course I had to be the one to get yelled at by the pt and the pt was threatening to leave. And while all that was happening I had a total care pt who called every second and had like 6 bowel movements on my shift and I really wish that was exaggeration but it was not. And that pt also chewed me out bc the MD would not give me Imodium and I asked 2x.

Finally, when I had time to get the pts calm and process everything I realized the MD did not schedule the pts meds right. So the meds he needed to take for the night were scheduled to start in the morning, and that’s when I finally realized that the pt didn’t receive his night time meds bc I didn’t catch that the way MD ordered the meds were wrong. And the admit pt was super upset bc the pt didn’t even realize either until 0300 and was demanding to take them now. And of one the meds I had to give late was warfarin bc I should have caught that the doctor scheduled it in the morning instead of in the night. Even though the MD placed the order to okay for me to give warfarin at 0400 I feel like the pt should have skipped the dose and resumed his dose at 2100 later that next day bc inr levels were good. I know I’m going to get chewed out by the morning primary team and management but I don’t know how to cope with it bc I think this has to be biggest mistake I made so far.

[JKL33]

I think everything's going to be okay.

I wasn't there but overall perhaps do what you can to focus on good nursing assessments and understanding treatment plans and rationales for them--which will help with things like prioritization and knowing where to spend extra energy as well as keeping emotions in check. For example, patients threatening to leave is not a rare occurrence and while I would work to help them understand the rationale for their admission and try to communicate with them in a calm and professional manner, I wouldn't feel particularly threatened by their threats, you know? If they choose to leave, most of the time that is their business. I also pretty much don't care if they yell at me about their treatment plan. Thinking through the big picture of why they are there and what the treatment plan is and the possible rationales for the plan helps me understand the situation.

 

22 hours ago, DH1234 said:

I know I’m going to get chewed out by the morning primary team and management but I don’t know how to cope with it bc I think this has to be biggest mistake I made so far.

I can tell this was a distressing shift; your words and phrases convey that. I hope you didn't get chewed out. In the future, try not to assume that the worst is going to happen--and try to put into perspective what it means if someone on the next shift has something to say about the work you have done (or not done). It isn't the end of the world. Don't let things take up more space in your head than they're worth; don't let your emotions be dictated by things like that. If a coworker has something to say about your work, learn what you can from their comments and the rest is pretty much, "oh well." They are responsible for their own reactions and commentary.

If you have identified something that you wish would've done differently on your shift, when giving report you just state it outright. Don't give a long, dramatic account of why it happened, just state something like, "It was a fairly unpleasant night and when I finally got things squared away I noticed that the scheduled times for the meds will need to be put back on the correct schedule." Don't go on and on about what a huge mistake it was (by the way this doesn't qualify as a huge mistake ?). Don't be self-deprecating; don't invite abuse from others. State things concisely. Remember, their reactions and replies are on THEM.

I hope you have had a chance to rest and relax since writing this.

Everything really is okay. Just keep doing your best. ??

 

 

[Lipoma, BSN, RN]

Whew. What I've learned in my short time in nursing is that the buck stops with the provider. 

You can ask and advocate ALL you want but if the provider says NO guess what? It's a no. You can only go so far up the chain of command. "Attending physician paged at this time requesting alternative pain medication d/t inadequate patient pain management" "patient offered [name of medication] but patient refused. patient educated on the importance of yada yada yada"

What is there to do? Document, document, document. If a patient threatens to leave, "it is in your best interest to remain in the hospital, but we do not hold anyone hostage here. I can page for the provider to come speak with you, but if you wish to not wait, here is your AMA form."

Page the team to change the order of the medications and document that you requested this change...if no change occur, document you are still awaiting additional orders or change to current orders. 

Definitely don't be self-depreciating. Health care is a business and according to the plethora of patient's I've dealt with, "they pay my salary" lmao

If no one died on your shift, you had a good shift.