How to not be discouraged when you've missed something or done something wrong as a New Nurse?

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Specializes in ACE.

I have been a Nurse since Feb 2020, yesterday we had a patient in the Retirement home he had a puncture wound from getting blood drawn, and I documented it and took a picture. But management emailed me saying I have to complete a full Risk assessment on that person. Now they said it to me nicely but I was like oh man this is my first time I was ever told by someone to do something or something that I missed but I am sure it happens to everyone.

All I gotta do they said is to go back and change the date to when it was discovered and document on it. Other Nurses say its not a big deal and it will not get you fired but some say its serious documentation.

I had one friend his patient in his retirement home came back from the Hospital and he only assessed his vitals but did not check for ulcers or skin tears, and the next day the morning nurse told him that she started the assessments and he just needs to finish it up.

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5 minutes ago, DribbleKing97 said:

I have been a Nurse since Feb 2020, yesterday we had a patient in the Retirement home he had a puncture wound from getting blood drawn, and I documented it and took a picture.

Why would you do that for a venipuncture site? That doesn't make any sense. You would expect a puncture wound from a venipuncture. What exactly did you miss?

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Specializes in ACE.
1 minute ago, Wuzzie said:

Why would you do that for a venipuncture site? That doesn't make any sense. You would expect a puncture wound from a venipuncture. What exactly did you miss?

I guess the policies saying that because its a bruise it needs to be documented.

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3 minutes ago, DribbleKing97 said:

I guess the policies saying that because its a bruise it needs to be documented.

Was it an enormous bruise or something? I'm just trying to wrap my head around the ridiculousness of it and why your supervisor said it would trigger a full "risk" assessment.

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Specializes in ACE.
2 minutes ago, Wuzzie said:

Was it an enormous bruise or something? I'm just trying to wrap my head around the ridiculousness of it and why your supervisor said it would trigger a full "risk" assessment.

Have no idea. Like I already documented that it was from the blood tech and not our staff. I guess its to just monitor so that if it gets worse there is supplementary documentation?

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Specializes in Med/Surg, LTACH, LTC, Home Health.

Is this a long term care facility?

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14 minutes ago, DribbleKing97 said:

I guess its to just monitor so that if it gets worse there is supplementary documentation?

Ginormous waste of your time. ?‍♀️

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Specializes in retired LTC.

Not a waste of time, really. In LTC, you have NO IDEA how blown out of proportion things can become when family come in and see a 'new bruise'. Like the cash cow lawsuit bells start cha-changing! And then they start to suspect the facility of all kinds of other things. And the phone calls to the State DOH/Ombudsman follow next. (I kid you NOT.)

Better to have a full documented 'assessment' available for review that to be caught WITHOUT one, esp for the State audit. Sometimes the risk assessment DOES identify some risk factors that will need to be addressed and care-planned.

It is usually just a facility's policy that the whole protocol be implemented for episodes like this. A nuisance, yes. But a thought to be considered also is that the bruise was caused by an 'outside provider' (the phlebotomy folk), not caused by in-house staff. This is esp important if further injury/sequellae occurs as a result because liability then falls onto the phlebotomy service re THEIR employee.

Years of LTC experience has jaded me into playing the devil's advocate re anything that can be construed into an 'incident/occurrence report'. Sad!

To OP - don't feel discouraged. You really didn't miss anything, just some facility specific policy. It takes time to learn all the fine ins & outs of such procedural necessities Just ask somebody else or a supervisor if there's anything else you need to do. And just know, that as I gained more experience in LTC, the paperwork became proportionately more & more each year. Just something to look forward to! ?

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Specializes in ACE.
Just now, amoLucia said:

Not a waste of time, really. In LTC, you have NO IDEA how blown out of proportion things can become when family come in and see a 'new bruise'. Like the cash cow lawsuit bells start cha-changing! And then they start to suspect the facility of all kinds of other things. And the phone calls to the State DOH/Ombudsman follow next. (I kid you NOT.)

Better to have a full documented 'assessment' available for review that to be caught WITHOUT one, esp for the State audit. Sometimes the risk assessment DOES identify some risk factors that will need to be addressed and care-planned.

It is usually just a facility's policy that the whole protocol be implemented for episodes like this. A nuisance, yes. But a thought to be considered also is that the bruise was caused by an 'outside provider' (the phlebotomy folk), not caused by in-house staff. This is esp important if further injury/sequellae occurs as a result because liability then falls onto the phlebotomy service re THEIR employee.

Years of LTC experience has jaded me into playing the devil's advocate re anything that can be construed into an 'incident/occurrence report'. Sad!

That is precisely what I was saying. The little things will come back to bite you!

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6 minutes ago, amoLucia said:

Not a waste of time, really. In LTC, you have NO IDEA how blown out of proportion things can become when family come in and see a 'new bruise'.

So you have to document if they have a tiny little bruise around an obvious venipuncture site? Sheesh what do you do with hangnails? I still think it's a waste of time capitulating to crazy people and idiotic regulations.

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Specializes in school nurse.

How to not be discouraged?

1. Start by making an exhaustive list of all the people you know who are perfect.

2. If you made a mistake, learn from it.

3. If you didn't make a mistake, learn what particular employer hoops - silly though they may be- that you are personally willing to jump through to keep the job. Then go from there.

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Specializes in retired LTC.
10 minutes ago, Wuzzie said:

So you have to document if they have a tiny little bruise around an obvious venipuncture site? Sheesh what do you do with hangnails? I still think it's a waste of time capitulating to crazy people and idiotic regulations.

I doubt that the 'identified' bruise was minimal; prob much more bruised. Obviously, it was enough that it was noted by OP. There's always some fine line to determine when something is OK enough NOT to implement a full 'incident report'. But better to report something than not and then YOU be accused of being the responsible party (and THAT really does happen). When in doubt, better to err on the safe side. And while a bruise might just be explainable, I always made it a point to notify the family - again, better to be PROACTIVE than reactive.

And Wuzzie, I agree with you that people are crazy and so are bureaucratic R&Rs. But that's the reality of today's HC environment.

To OP - you're just CYA when you do the reporting. Remember, it's just a report, not an admission of guilt or confession. Let TPTB do the investigation - just keep your documentation focused without accusations or blame.

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