.... I made another mistake :( Need encouragement.

missKate · Jan 8, 2008

do not beat yourself up.

you did take care of the patient.

the whole thing needs to be written up so that the process issue that you were the victim of can be dealt with. things like communication improvement (which is not just your facility, by the way) and better paper flow organization need to be addressed. the OAR forms- which I am sure are the same thing by a different name in our hospital- are things that management has to answer to. So your colleague is right. what happened is not "all your fault" which is what you are feeling.

with more experience you likely will make phone calls and find out that the patient has been seen a lot sooner- but that takes time, and as an ED nurse myself- I rather doubt that you were eating bon bons while this pt was waiting.

ERnewbieRN, BSN, RN · Jan 8, 2008

Hey, I am also a new RN in the ED (graduated in May, started work in June, off orientation in September). I have made plenty of silly mistakes on the job, feel like a total moron, but then realize that what's done is done and the best thing I can do is learn from the situation. Making a mistake can make you feel like it's the end of the world... but 9 times out of 10, it's not! It sounds like you didn't do anything that actually harmed the patient, and your patient left the department breathing To me that's a pretty good start. And I'm sure you know that next time a situation like this happens, you will be on the lookout for admitting orders and will probably rifle through the chart a little more thoroughly. Mistakes, although they make us feel terrible, are the surest way to make us learn!

This too shall pass... you are going to make a great nurse. It's a tough transition to get the hang of the fast pace/high stress of the ED, but once you get the hang of this you can face most anything :) Good luck, I'm sure things will turn out fine!

Imafloat, BSN, RN · Jan 8, 2008

The patient wasn't harmed, you said she was alert, oriented and comfortable. You are in the scariest part of your nursing career, those first weeks on your own. Let up on yourself a bit, this is for you, it is obvious you care about your patients. Your med error was that you undermedicated, thankfully it wasn't worse, and I bet you are even more careful when giving meds as a result.

The first few months on my own were the most stressful of my life. I dreaded work, I felt like I was slogging through quicksand on the way to getting report every night.

I wrote an article about my first year of nursing in the article section, it was a roller coaster ride, full of low-lows and high-highs, and some in between days that allowed me to keep going. In 6 months you will be looking back at these days and be amazed at how far you have come.

Good luck to you!

RNRao · Jan 8, 2008

It's OK........we have all made our own errors. I feel even safer knowing that your accountable for your actions by self disclosing here on this site. I bet you'll never make the same mistake(s) twice.......... don't be so hard on yourself. Learn from the experience and march forward myfriend. Keep that chin up.

Alison

oramar · Jan 8, 2008

One thing an experienced nurse does is make periodic searches through charts for orders. Now I am not blaming you because it takes a long time to automatically incorporate this into you day. The reason I do this is because I missed orders on a few occasions myself, have not missed order completely in years but have caught them very late in shift. Our secretaries comb charts for orders constantly but still they do get missed. I think institutions should realize that this is a system problem and start to address the problem. Perhaps when the day comes that doctors no longer do paper orders things will improve because it happens a lot. PS I am not ER nurse but things get missed all the time up on the floors also.

getoverit, BSN, RN, EMT-P · Jan 9, 2008

Like some other posts have said, you've taken responsibility for it and you probably won't make the same mistake again. One thing Oramar said that is good advice is to periodically look through the chart for new orders. I try to pull it up every hour or two and do a custom search for any new orders entered since my last search. Takes 2-3 minutes and it's a good routine to get in.

Now....my worst med error. A gentleman arrested right in front of me and we started coding him. I had defibrillated him and started with the meds. Decided to go high-dose epi (this was 10+ years ago) and gave him 3mL push. When it came time for the next epi the syringe would only pull back 2cc, that's when I realized I"d accidentally given him 60 of Lasix. I felt like I was going to barf, and he wasn't resuscitated. When I told the medical director of the ER, he said the fact that I came to him on my own was enough to make him feel that I didn't need any further action. In fact, he said the whole thing was "completely harmless" and if he had been resuscitated then at least he wouldn't have to worry about being diuresed! Made me laugh and feel better....and it was something that only happened once.

I'm sure you've heard this before....but try to develop a systematic approach to everything and do it the same way each time. That'll help avoid overlooking something in the future.

Trauma Columnist · Jan 9, 2008

You've admitted your mistake, there was no harm to the patient - you have to trudge on. Are you perhaps trying to handle too many patients? Is it usual to hold pts in your ER for prolonged time? Please don't get down on yourself. Working a busy ER takes several years to feel totally comfortable. SInce you know an experienced nurse, I would use her as a resource and ask her to tell you where she sees your weak points.

Please don't give up - good luck.

Laughs-a-lot, RN · Jan 9, 2008

You learn from these errors and it helps you to be more organized. You can also pass on your new found knowledge to other new or soon to be nurses, because they will probably come across the same scenerio

gonzo1, ASN, RN · Jan 9, 2008

We all make mistakes. The fact that you fessed up means you are my kind of nurse. Honesty is always the best policy.

I never make the same mistake twice. I make new, different ones.

TRAMA1RN · Jan 9, 2008

I have always worked ER, first thing I do when I take a patient over is go through the entire chart and every piece of paper, PIA yes but this way I know what is with the chart and what isn't. I do not depend on verbal reports as people forget things accidentally and on purpose, yes this does happen. After I look at patients med history, diabetics will always get accuchecks remember: Cardiac patients are almost always on ASA or coumadin, repiratory patients will almost always have SVN's or other treatments and peak flows, remember these are common things to look for and if they are not ordered you should be asking why. If you are holding a patient for any reason always check for orders. If you had the patient for so long I am surprised after your AM assessment that you were not aware of some of the things ordered, usually the patient will be asking for accuchecks and such. Sorry this is long but it does go back to my thinking that new nurses need to spend more tome learning the basics in medsurge before going into specialties such as ER, I know this is not a popular opinion but nursing school does not have enough time to teach all the basic things.

nursemoons14 · Jan 9, 2008

The patient wasn't harmed, you said she was alert, oriented and comfortable. You are in the scariest part of your nursing career, those first weeks on your own. Let up on yourself a bit, this is for you, it is obvious you care about your patients. Your med error was that you undermedicated, thankfully it wasn't worse, and I bet you are even more careful when giving meds as a result.
The first few months on my own were the most stressful of my life. I dreaded work, I felt like I was slogging through quicksand on the way to getting report every night.
I wrote an article about my first year of nursing in the article section, it was a roller coaster ride, full of low-lows and high-highs, and some in between days that allowed me to keep going. In 6 months you will be looking back at these days and be amazed at how far you have come.
Good luck to you!

This maybe true at the time being, but if you are doing accuchecks odds are the pt is diabetic and they can become very unorientated very fast. My advice is whenever your taking report at shift change, make sure your aware if the pt is admited.... still belongs to emerg... or is awaiting to be assessed by an admiting team. Get a plan going for each pt. Like chances they will be d/c'd, or referred on. Usually you can get a grasp for this when you assess. and will be looking for those admit orders. I have had residents toss their admitting orders in with the rest of the progress records when they know to put it in the recieving box.

Hope this helps