HUGE mistake in clinical....

Published

Specializes in Community Health.

pt. was 90, total care with dysphagia and recently admitted after recovering from aspirational pnuemonia. i took care of him yesterday with no problem. today, i was told we had to make sure we brushed his teeth after breakfast. i had a brief tutorial on brushing teeth and other aspects of basic pt. care in ns, but i had only done denture care in clinicals up to that point...but i figured it couldn't be too hard, i'd seen the cna's do it on other pt's before so i gave it a shot. i dipped the brush in a little bit of water and put a tiny dab of toothpaste on and brushed...when it came time to spit, i gave the pt. the emesis basin and instructed him to do so. he spit out a tiny amount but there was still a lot in his mouth and i could tell he was having difficulty spitting it out because it was a thick consistancy and sticking to his mouth. he started to swallow some of it...and i started to freak out thinking "oh god he's going to swallow a big chunk of that and it will become lodged in his airway", so i took the cup of water which had a tiny amount left in it (literally about a centimeter) and gave it to him and told him to swish and spit. as soon as i did it, i realized what a monumental mistake i had just made...he’s an aspiration risk on thickened liquids. ****:eek:. i leaned him forward and helped him to spit it out, which he did but he started coughing like crazy and struggling for air (which is a pretty common occurrence with him but it is always scary when it happens) i had my partner go get the rn while i tried to help him get all of it out. she came in and made sure his airway was clear, and he ended up being fine, thank god. she asked me what happened and i was honest...i got lectured for it (i knew i would) but she was pretty understanding since this is our first clinical rotation.

my instructor was a different story...she took me into the post-conference room and proceeded to ream me out, telling me that i wasn't taking this seriously and that i needed to remember that i was dealing with a human life, that this man could be my grandfather and i was acting without empathy :o

then, she called a special class meeting…she didn’t name me by name or state exactly what happened, but i’m sure everyone knew she was talking about me because i was the only one crying. she launched into a lecture, again, about the fact that these are human beings and that people can die from our mistakes, and how maybe some of us (meaning me, i'm sure) are just not meant to be nurses, and are “in it for the money” and really didn’t care about being a good nurse or caring for their patients. part of me felt like crawling under a rock and dying, and part of me wanted to scream at her. i know that it is her license on the line, and i know she has to address concerns with patient safety…but she has no idea what she is talking about when it comes to my empathy or how serious i take this. i was up until 1am last night researching this man’s medical conditions and learning how to ask him questions in his native language just so i could communicate with him better-why would i bother doing that if i didn’t care? if i didn’t take this seriously, why did i get the nurse right away? why would i tell her what i did? like i mentioned the coughing spells aren’t unusual for him so i could have easily gotten away with it, but i didn’t even think twice about it. it was a mistake-a bad one, yes, but it was not made because i didn't have empathy or just didn't give a crap about this man's well being...it wasn't even that i didn't know aspiration precautions, i was just so afraid of him choking that i momentarily forgot.

the truth is no matter how bad she made me feel, it's nothing compared to the butt-kicking i did to myself. i held it together the best i could but as soon as i got into the car i broke down crying and had to pull over because i couldn't drive. i watched my grandfather succumb to aspirational pneumonia, i remember vividly what it was like to watch him struggle to breathe and the look of terror on his face when he couldn't. the idea that a stupid mistake like that could potentially cause someone to go through that pain is really heartbreaking and makes me wonder if i can really handle this career :crying2:

Up Vote Up Vote ×

We all my mistakes, don't let one destroy your confidence.

Up Vote Up Vote ×

What year are you in??? Our instructors would never allow us to do mouth care on a pt that was risk for aspiration without her being present and suction ready. If your a senior then yes, you can do it alone if you feel you are ready. Most important out of this is if you are ever hesitant about doing a procedure ask questions. You will be fine, you know why? You will never make that mistake again. We all make mistakes, and we learn from them. Hang tough, the fact that you care shows me you will be a good nurse.:heartbeat

Up Vote Up Vote ×

This is a small bump in a book of mistakes, know that you are human, and they happen to the BEST.

Example: Sigmoidoscopy, pt drugged and half awake with versed, CRNA and nurses watching him as doc is inserting scope...pt O2 sats start dropping and he is gasping for air...room full of panic minus doc....nurse forgot to connect nasal cannula to the oxygen and turn it on.

Up Vote Up Vote ×

If I make a mistake (which I will at times), I need to know it and be corrected and take responsibility... I can accept that. But to be judged as not caring?! As not trying hard enough?! As not taking it seriously?! Boy, that really gets to me.

I get all tied up in knots inside wondering what it would take for this person to accept that I DO care and DID try and STILL made a mistake. Is the error *so bad* that the person CAN'T FATHOM that it was an honest mistake *despite* diligent efforts and wasn't due to flat out carelessness? I'm one of those who takes everything TOO seriously and a judgement like can be truly devastating. I'll take it seriously, take responsibility for it, work to improve, AND beat myself up just fine without extra heaps of guilt thrown on top.

I don't know why I take it so to heart - at times, it may clear that that person has *no* real basis for determing for how much I care or how much effort I put into. Maybe this type of shaming and lecturing is simply a person's reaction to frustration and fright and doesn't even really reflect any judgement upon the sincerity of my intentions. Or maybe the person is trying to say that certain kinds of mistakes would tend to lead to them *question* a person's competence/judgement - as opposed to implication that this kind of mistake *almost certainly* means you're incompetent and you'll have A LOT of working to prove otherwise.

My logical mind tells that moving forward is the best option... what's done is done, now look forward... easier said than done. But one way or another, I get through it. Hopefully, you will be a faster learner than I've been in being able to leave behind the useless feedback ("you must not care!") while keep the useful feedback ("here's how to do it better next time").

Up Vote Up Vote ×
Specializes in Rehab, Med Surg, Home Care.
What year are you in??? Our instructors would never allow us to do mouth care on a pt that was risk for aspiration without her being present and suction ready. If your a senior then yes, you can do it alone if you feel you are ready. Most important out of this is if you are ever hesitant about doing a procedure ask questions. You will be fine, you know why? You will never make that mistake again. We all make mistakes, and we learn from them. Hang tough, the fact that you care shows me you will be a good nurse.:heartbeat

I agree. How is it possible you were sent to do a potentially hazardous (to your pt) procedure with NO preparation as to how this SHOULD have been done safely?! In delegating this task to you, your instructor was responsible for assessing whether you had the knowledge and skill to safely perform the task.

Up Vote Up Vote ×

im in my second semester of a 2 year program

once i read dysphagia/aspirational pneumonia

and then i read mouth care

i said this cant be good ...i am not going to beat you up for it, or condemn you or anything ...i still have 2 more semesters to go, and im sure i will have my turn

i just wanted to state, not in defense of the professor but just in general. They kind of depend on us going in there with the knowledge they gave us. So if you covered oral care in 101, im sure they touched on if the patient had dysphagia, make sure theres suction at the bedside ...and i wouldnt use toothpaste, i would use those foam sponged tips that are damp, no water ...just the liquid you pour onto the tip. We're working under their license, so yeah if they flip out its because theyre under a lot of pressure, and g-d forbid something did happen to the patient how would it reflect on the school.

BUT!

Going forward, I know youre going to be the best at mouth care for a patient with dysphagia due to this experience! SO if i ever had dysphagia, I would love to have you give me mouth care because I know you learned A LOT.

Also, if youre ever unsure ...just ask. Theres no such thing as a stupid question, safety is always priority. Good luck!

edited to add:

If our professors only assigned us patients that are "what we covered" then how are we ever going to learn? We only have 2 years (some of us) not even a full two years....26 weeks a year. So whatever little experience we do get here in school is going to prepare us for the field. The heck are we gonna do when we have 10 patients, and one is on a vent. Not give them AM care because no one showed us in nursing school?

Hopefully this will be a wake up call for the curriculum, make sure they reaaaaally stress safety for ALL patients that need oral care..or whatever the case may be

Up Vote Up Vote ×
Specializes in Community Health.

Thanks for the responses...I know that we all make mistakes so I'm trying not to let it discourage me. The one big lesson that it taught me is that if I am told to do something that I think isn't right or in the pt's best interest I should bring it up. I was a little confused as to why I was being told to do mouthcare on him in the first place considering he is an aspiration risk, but I just assumed that they wouldn't ask me to do it if it wasn't safe. Apparently since he was put on aspiration precaution he gets gycerine swabs, but someone mistakenly told me to brush his teeth...I'm kicking myself for not bringing it up.

Waitingforthedream, I'm still in my first rotation of school (LPN program). This was my 5th time in clinical...last time they had me on my own with a high fall risk with history of fractures and dementia, she thought she could walk and was constantly trying to get up, I thought for sure she was going to fall. I like to be challenged but I feel like some of the pt's we are assigned too are too high risk for students who have little to no prior experience...

JJJjoy I'm the same way! I felt so ridiculous crying in front of my class but that was probably the most hurtful thing I've had said to me in a long time...it hits close to home because my grandmother is really sick right now, and I've been really emotional about that and as a result extra sentimental about my patients...I really do look at all of them like they could be one of my family members, and this patient in particular I was starting to bond with. So to be told that I "didn't care" about his well being was a shot to the gut. And my instructor is someone who I really do have a lot of respect for...she's tough but fair and I value her opinion. Yesterday she pulled me aside to tell me what a great job I had done on my first client assesment and I was like on cloud 9, so this was just a huge let down :(

Natingale-We were given a handout on oral care and that was about the extent of our instruction. Our school is abysmal when it comes to hands-on teaching, we basically have to learn everything by doing in clinical. But I do see your point and I agree that it was my responsibility to make the call...

Up Vote Up Vote ×

Do you guys get to evaluate the course? I would definitely bring it up. Like I said, you could be my nurse any day because i know this experience has made you stronger.

idk if you keep a journal, but write down this experience and all your experiences. What would you have done differently, whether its forgetting to say goodbye to a patient or forgetting to get them a warm blanket before you left. Its nice to reflect on the good and bad when this is all over.

Up Vote Up Vote ×

Just to let you and the other poster who said that we as students practice under our intrustors license....that's not true. i believe i heard a clinical instructor say this before also BUT in the very first nursing class we ever had at our school (the really basic intro to issues in nursing) we were taught that students DO NOT practice under their clinical instructor's license. the only person who can practice under a license is the person it belongs to. and i don't see how this could differ from school to school as it's such an important issue.

Up Vote Up Vote ×

Everyone makes mistakes - learn from them and move on. Don't beat yourself up over it!!! :redbeathe

Up Vote Up Vote ×
Just to let you and the other poster who said that we as students practice under our intrustors license....that's not true. i believe i heard a clinical instructor say this before also BUT in the very first nursing class we ever had at our school (the really basic intro to issues in nursing) we were taught that students DO NOT practice under their clinical instructor's license. the only person who can practice under a license is the person it belongs to. and i don't see how this could differ from school to school as it's such an important issue.

Basically what I heard as a student was that we do not work under our instructors licences, we are in fact working under our own future licences. The school i'm sure has some liability to assume, which in turn would also suggest that any really bad mistakes could jeopardize and instructors job, but not their licence.

Up Vote Up Vote ×
+ Join the Discussion