How to cope after a serious med error

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Last night, I made a serious med error during a hectic ER shift. I have worked 24 years with no med errors and this one was a huge one. The patient is going to be OK but my confidence in my abilities has been destroyed and

I am questioning my abilities, my reasoning and whether I should stay in this hectic work environment. Right now I feel like an incompetent, horrible nurse. How did you get through an event such as this. I am so depressed right now.:sniff:

Specializes in ED only.

Thanks to you who have posted support. This is exactly what I needed today because I am still beating myself up for this mistake. I am reluctant to go back to work after my weekend off, worried that my stress level will prevent me from performing as I should. And, will the ED physician I was working with ever trust me again!! So many negative thoughts in my head.

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Wow, Tabitha!!

what a great response! I don't have as many years in nursing as you, but I've become an advocate of "systemic" fixes to sources of error. Maybe it's my prior background in computers. I heard a great talk by an OSHA doc at a safety conference on this very subject. He displayed a picture of a car that had the gas hose in the fill pipe but pulled out of the pump with the dismayed car owner looking at it.

His response was "It's not the driver's fault . . . the car manufacturers should put an ignition kill switch in the fill pipe, and if the nozzle is still inserted . . . the car won't start!"

He went on to talk about IV pumps . . . why not program drug compatibility into the pump, and as long as you're not bypassing entry of the drug name, the pump will put up an incompatibility warning whenever incompatible drugs are on the same pump. Now, obviously, they may all be on separate lines but at least it will make you stop and think. And he went on to mention numerous other examples of "systemic" fixes. :twocents:

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Alot of us have been there. Med errors undermine confidence and do serious damage to self esteem. You deserve respect for coming forth with your error. You will get through this, I promise you. Sum it up as a learning experience because I can imagine that you have many more patients that need you. Hugging you right now :)

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Specializes in Cardiac Telemetry, ED.

Unless the ED physician is a total @$$, s/he will look at your track record of being a great nurse and understand that anyone is capable of making a mistake.

I'm glad you're talking about your feelings about this. We're here for you!

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Specializes in RN Education, OB, ED, Administration.
Thanks to you who have posted support. This is exactly what I needed today because I am still beating myself up for this mistake. I am reluctant to go back to work after my weekend off, worried that my stress level will prevent me from performing as I should. And, will the ED physician I was working with ever trust me again!! So many negative thoughts in my head.

Do you work in small hospital or academia/large hospital? You know what, I can empathize with why you'd be worried; but I'd bet any amount of money that the doc would be at least as understanding as your nursing colleagues. More than ever before, docs and nurses alike are receiving education regarding the fact that errors rarely occur because of absolute human stupidity. That is not to say that they don't, however, in most all cases there are identifiable extenuating circumstances. You can bet your derrière that the MD in question has made one or more mistakes in the past and I can almost guarantee that he will not hold a grudge for your error. If it were me, I might pull him aside and perhaps voice my concerns. I bet you will walk away feeling much better.

Remember, even the most skilled and experienced surgeon is human at the end of the day. There is a degree of risk to the work he or she does and the only way the human element of risk can be removed is by using robots and I'm sure that robotics is not without risk altogether as they are operated by--you guessed it--humans! A surgeon with the steadiest hand in the industry can and will have one slip and damage an artery and, in the end, it does not make him any less of a surgeon. But that's just my opinion.

Also, there is literature coming out to support that 12 hour shifts are too long to be fully competent in the care we humans give. How about that?! Most of us work 12 hour shifts performing some of the most important work there is, that is, caring for the life of another human being!

Take for example the U.S. trucking industry, which allows for a operator to drive for no longer than 11 hours without a rest break of at least 8 hours and there are many who think that 11 hours is too long. See: http://www.saferoads.org/statement-fmcsa-hours-service-rule-truck-drivers. According to Wikipedia (a highly reputable source ... haha), Australian truck drivers must rest 30 minutes for every five hours they drive. In Europe, total driving time cannot exceed 9 hours and a rest time of 45 minutes must be taken every 4.5 hours (time can be divided). http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32006R0561:EN:HTML Now, unless these truck driver associations and regulatory bodies are merely trying to prevent DVT in their industry professionals, I suspect another motive. I believe, and I could be wrong, that the primary motive of such strict measures are to ensure the safety of both the truck driver and the other motorists on the road.

How is it that our Nurses can be expected to perform at peak levels of mental acuity at the tail end of a 12-hour shift? How many of you have stayed over and worked 16 hours? I know I have! How many of you do it without a sip of water or a break and with an achingly FULL bladder. But I digress ...

So, Sister Nurse of mine, don't be so quick to take all of the blame. There were UNDOUBTEDLY other factors involved.

And, that's all I have to say about that.

Best!

Tabitha

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Specializes in ER, ICU, Education.

As many others have noted, this is not a one-sided issue, it is multifactorial. I tell my students all the time if anyone has been practicing any length of time and says they've never made an error of any kind, they are either lying or clueless. All this means is that you have now joined the ranks of the rest of us :) I think for this reason they named the landmark study "To Err is Human".

People want a nurse that is perfect; this is a reasonable wish unless you've ever actually worked as one and know what it's like. In a perfect world, we would never make medication errors, but it isn't a perfect world or even close to it. In a perfect system, a pharmacist would be available in all ICUs and EDs, every medication would be triple checked, especially high risk medications. Staffing would be adequate, shifts would be short (8 hours or less) and we would have time to eat, pee, and decompress.

Until that happens (and I'm not holding my breath) all we can do is care for people in the way we would our own loved ones. I know every parent out there who is honest will admit to making terrible mistakes as a parent; this doesn't mean you don't love your children, simply that we are flawed beings. Likewise, an error doesn't mean you care about your patients any less.

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Specializes in ED only.

Tabitha - your support has helped me today and I am truly grateful. There were extenuating circumstances and the MD missed them too and we both were in error but I was the one who actually gave the med, thus I have been placing the blame on myself. Thanks again for your wise responses.

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Specializes in RN Education, OB, ED, Administration.
Wow, Tabitha!!

what a great response! I don't have as many years in nursing as you, but I've become an advocate of "systemic" fixes to sources of error. Maybe it's my prior background in computers. I heard a great talk by an OSHA doc at a safety conference on this very subject. He displayed a picture of a car that had the gas hose in the fill pipe but pulled out of the pump with the dismayed car owner looking at it.

His response was "It's not the driver's fault . . . the car manufacturers should put an ignition kill switch in the fill pipe, and if the nozzle is still inserted . . . the car won't start!"

He went on to talk about IV pumps . . . why not program drug compatibility into the pump, and as long as you're not bypassing entry of the drug name, the pump will put up an incompatibility warning whenever incompatible drugs are on the same pump. Now, obviously, they may all be on separate lines but at least it will make you stop and think. And he went on to mention numerous other examples of "systemic" fixes. :twocents:

Thanks SunnyCalifRN!

Hey, I am right there with you and have heard similar analogies at safety conferences. I love this one, "If you knew that 40,000 people were harmed everyday by flipping a light switch, would you ever flip the switch or would you revert to lanterns or other sources of light?" http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=1 How many of you know beyond the shadow of a doubt that GE would be working night and day to find a solution to such a danger? How much harder should we be working as a healthcare community to put an end to the appalling fact that 40,000 patients are harmed in healthcare access points across the U.S. daily?

I like system-focused fixes as well and believe they contribute to the fair and just culture we are seeking to create in our healthcare system. It is a fact, as many are finally willing to admit, that the folks who do the work are also some of the most qualified to fix the problems. The only problem I have noted is that when we nurses propose solutions, they are rarely heard and implemented if they involve significant capital investment and increases in nurse staffing. Our ideas are wonderful and valued often only to the extent to which the proposed solutions also lend a commensurate increase in efficiencies to be gained. The problem with this line of thinking is that efficiencies need to be measured and so much of professional Nursing care is immeasurable. Additionally, this idea of Kaizen and Lean Manufacturing principles does a great job of building on what we already have; however, clearly the system that we've created has failed in terms of Nurse satisfaction and patient safety. My greatest fear is that what has worked so well on the assembly line might result in the systematic decay of the last bit of flesh we have left on our weary bones.

Much Respect and Admiration,

Tabitha

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It is a fact, as many are finally willing to admit, that the folks who do the work are also some of the most qualified to fix the problems. The only problem I have noted is that when we nurses propose solutions, they are rarely heard and implemented if they involve significant capital investment and increases in nurse staffing.

Tabitha

Amen. My experience has been that real systemic solutions only occur after there's been a fatality or after the media does an "expose story".

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tommorrow is another chance to do something good for another patient. the mistake happened, you shared it with us, and in doing so, you made a difference in another patient's life because this only helps us all to become better nurses and caretakers of people.

i won't tell you not to feel bad. by all means, do feel bad, but then again, don't forget to move on from it.only consider this a lesson to be learned from.

it isn't the mistakes that makes or breaks us- it is how we learn to stand and face them, that makes all the difference. god bless you.

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Specializes in Mixed Level-1 ICU.

When we commit an error, our heart races, we feel nauseated, and the outside world dissolves.

What do we learn....what did I learn...

1. quit persistently dangerous work environments.

2. Stand Tall... never ever rush, for any reason, for anybody, at very the point of medication administration.

An extra two or three seconds to stop, look, and think seems like an eternity. But we didn't cause the many emergencies we deal with each day. Yet our measured thoughtful practice may be able to resolve them.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

(((HUGS))))...

Anyone can do this; have been there.....forgive yourself, and use this as a teachable moment.

You are only human, and I can tell a da** good nurse.

Good luck...

Jo

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