I made a big mistake on night shift i need to vent (LONG) sorry

jelrtLPN · Oct 8, 2005

Okay, you made a mistake. However your preceptor also made a very big mistake. she is your life line, she should have been going behind you, monitering these things as well...thats her job of being a preceptor. You are in a new very overwheliming situation, between the paper work and the rules and regs you have to learn, the patients you have to moniter and just trying to adjust from being a student to being a "real Nurse" you are going to make mistakes. I would like to know if she was brought into the loop when the ***t hit the fan. If not she should have been, just to realise that she should have also owned up to "missing " it....Please, get a good nites sleep, start fresh on the next shift. We all make mistakes as nurses, we are human, thats the best part of being a nurse. we are human...........There is a saying, That that dosent kill us, makes us stronger..and this will always remind you to check your vitals more carefully im sure....Good Luck

P.S. Your a great nurse, i can tell that because this is worring you so......

ZASHAGALKA, RN · Oct 8, 2005

OK. You're pt's HR was 150/min @ 2am but 70-80-s the rest of the time?

That's not even a mistake, why are you beating yourself up about it?!?

1. That was probably your pt exerting themselves at that time and the increased HR is a compensation measure. (or possibly a short run of SVT which is common post op and usually not a problem - and if it had become a problem, it would stress the pt to the point they would call you - and if it was a potential problem, you doc should have had the pt on tele, anyway).

2. Especially in POST OP pts, HR is important because it can be an important sign of bleeding or infection, both of which will cause it to go up. But, until treated, both will cause your HR to go up AND STAY UP. A HR in 1 hr out of the normal is an anomaly, not a problem.

3. Your techs should be REPORTING any HRs over 120 to you - before they chart it. This is why we have backups.

4. You're doc was unreasonable.

5. When you are more sure of yourself in nursing, make sure your assertiveness rises to match. That doc would have been too busy defending my huff and puff to be spreading his own. 'So, doc, are you telling me you prefer me to treat every stray number INSTEAD of your pt????', 'So what you are saying is that you want to be called at 2am regardless whether your patient is stable or not? - Should I have called you about the 99.8 temp, too? Or maybe I should have waited and called you about that at 3am??'

Keep the faith. You are doing fine - I agree with your manager, you should be going forwards, not backwards.

Timothy.

AMARTIN1 · Oct 8, 2005

Well its my 7 week orientation and i made a mistake.......ok i went in the other day and had 4 pts and a new admission......from the get go my pt were off the wall a ton of pain issures ....one pt wnated her pain med every 2 hr alternating with percocet and morphine .....so i had to call the doc and handle that........one pt wanted her pain med upped so i had to call the doc and handle that....another wanted pain med and c/o of SOB so i had to call trauma since they were following him and handle that.......another was a pre op and needed a pca with first time teaching.......i didnt get to report til almost 9 pm .....my post up came to floor and was fine i assessed he she was good her pca was good and her vitals good like hr-76 bp 116/78 her temp was 100.2 wich was down from the what it was in the PACU so any way my issues with the other four went on all night i was consatantly medicating them or handling problems......i checked on the my post up every hr and she was fine we talked and joked i made sure her urine out put was good.......i kept checking her b/p since it was low in pACU and it was good 110-120/s over o 70-80's her temp had come down to 99.8 she was good pain free and breathing fine....it was like 15 min before change and her doc was up and she said why did the tech but a hr of 150 in the comp at 2 am and i said no thats a mistake i went to the comp and sure enough 150 i went to my paper and sure enough 150 i coundlt believe it i had q15 min vitals on written down and ther hr was 142 or 130 on them .......i was dumbfounded......i missed a hr that high ........the doc was soooo mad and with good reason......right away i got her labs up for the am and luckily they were fine practically picture perfect i did an EKG and it was normal but she was tachy at 120 .......she POX 99 on RA bp was fine temp fine.....she said she felt great..........the doc filled out an incident report on me yelled a bit about how our attending is going to flip and once we knew the pt was ok left.....i was so upset i cried .......i couldnt believe i let that go by me and didnt notice it i was concerned with my other pt but i was inh her room alot and i looked at vitals but i gues i was so concerned with temp and b/p i missed it .....it seems like such a big number to miss ......everyone was soooo nice.....i overheard my preceptor tell the doc "she is usually very very good i am really suprised" she told me it happened the pt is fine and noone is in trouble.......alot of the other nurses said at least i took ownership that i missed it some people wouldnt.....my manager called me at home and to make sure im ok she told some mistakes she made and she said this will make me better and i will always double check my vitals even things that were normal.....she want me to tak steps forward and not stspas back since i only have 3 weeks left.......i just feel soooo bad i keep replaying it in my mind and wondering how i could have missed it ......i know i was busy but its no exscuse.......i want to get over this but im having a hard time....am i a horrible nurse......please help i feel horrible

I've just finished my orientation (Friday) and I can't tell you how many little things I've done wrong. I gave my pt the wrong insulin and had to call the doctor (yikes!!) but that turned out okay. I miscalculated a time to draw a vancomyacin level, the MD wanted it exactly eight hours after it was started and it was drawn six hours after, the MD was pissed and wrote it up!! :bluecry1: I eventually got over it after feeling like an idiot and crying about it but I will never do it again and have to give myself time outs when i start to get overwhelmed with too many things at once!! You should be proud of yourself for owning up to your mistake, it will make you a better nurse in the longrun :wink2:. I hope we can all look back on our mistakes later and offer advice when another new nurse has the same experience and anxiety. It seems like you have a good support system at work also, that goes a long way. It gets easier. Good luck and God Bless. You made it this far and you will do fine :kiss . AMARTIN1

Tweety, BSN, RN · Oct 8, 2005

OK. You're pt's HR was 150/min @ 2am but 70-80-s the rest of the time?
That's not even a mistake, why are you beating yourself up about it?!?
Timothy.

No it was in the 70s postop, at 2AM jumped to 150s and stayed tachy after that.

Mulan · Oct 8, 2005

If the patient was fine, don't worry about it.

ZASHAGALKA made some very good points.

Sounds to me like you were dealing with a resident, and she was concerned about covering her own azz.

Tweety, BSN, RN · Oct 8, 2005

You were on orientation, I hope your preceptor took some ownership.

Anyway, just take it as an opportunity for a hard lesson learned. I know it's tough to get over these kinds of things without beating yourself up.

Sounds like you're a great nurse and doing a good job.

christvs, DNP, RN, NP · Oct 8, 2005

Well its my 7 week orientation and i made a mistake.......ok i went in the other day and had 4 pts and a new admission......from the get go my pt were off the wall a ton of pain issures ....one pt wnated her pain med every 2 hr alternating with percocet and morphine .....so i had to call the doc and handle that........one pt wanted her pain med upped so i had to call the doc and handle that....another wanted pain med and c/o of SOB so i had to call trauma since they were following him and handle that.......another was a pre op and needed a pca with first time teaching.......i didnt get to report til almost 9 pm .....my post up came to floor and was fine i assessed he she was good her pca was good and her vitals good like hr-76 bp 116/78 her temp was 100.2 wich was down from the what it was in the PACU so any way my issues with the other four went on all night i was consatantly medicating them or handling problems......i checked on the my post up every hr and she was fine we talked and joked i made sure her urine out put was good.......i kept checking her b/p since it was low in pACU and it was good 110-120/s over o 70-80's her temp had come down to 99.8 she was good pain free and breathing fine....it was like 15 min before change and her doc was up and she said why did the tech but a hr of 150 in the comp at 2 am and i said no thats a mistake i went to the comp and sure enough 150 i went to my paper and sure enough 150 i coundlt believe it i had q15 min vitals on written down and ther hr was 142 or 130 on them .......i was dumbfounded......i missed a hr that high ........the doc was soooo mad and with good reason......right away i got her labs up for the am and luckily they were fine practically picture perfect i did an EKG and it was normal but she was tachy at 120 .......she POX 99 on RA bp was fine temp fine.....she said she felt great..........the doc filled out an incident report on me yelled a bit about how our attending is going to flip and once we knew the pt was ok left.....i was so upset i cried .......i couldnt believe i let that go by me and didnt notice it i was concerned with my other pt but i was inh her room alot and i looked at vitals but i gues i was so concerned with temp and b/p i missed it .....it seems like such a big number to miss ......everyone was soooo nice.....i overheard my preceptor tell the doc "she is usually very very good i am really suprised" she told me it happened the pt is fine and noone is in trouble.......alot of the other nurses said at least i took ownership that i missed it some people wouldnt.....my manager called me at home and to make sure im ok she told some mistakes she made and she said this will make me better and i will always double check my vitals even things that were normal.....she want me to tak steps forward and not stspas back since i only have 3 weeks left.......i just feel soooo bad i keep replaying it in my mind and wondering how i could have missed it ......i know i was busy but its no exscuse.......i want to get over this but im having a hard time....am i a horrible nurse......please help i feel horrible

Nicole, I think you're a very good nurse because you are trying your best to do every possible thing you can do for your pts, spend the time talking to them & making sure they're ok, etc. Don't let that doc get to you. Your pt. was stable & her HR was acceptable for nearly most of the time you had her. It is ridiculous to be expected to call the doc for one abnormal HR, when like someone else on her said, maybe the pt was moving around a lot & that caused her HR to be elevated at that one moment. Sounds like that doc is just on a power trip, but no one should be yelling at you or anyone else for that matter. And I agree that your preceptor should be included in this discussion since she is supposed to be watching you. I'm a new grad RN & just finished my 11th week of orientation (one more week to go!!!) & I know how it can get with preceptors who help you out, but not all the time. It can be really frustrating.

-Christine

NurseNicoleRN · Oct 9, 2005

thanks for everyones support its really helping......my pt heart rate was fine a little tachy about 11 oclock and then stayed tachy reaching its highest point at 2 am and then coming down to 120 i left when she was at 120 so i have no idea if it came down further........im not even sure if it was a malfunction with the b/p machines sometimes our techs get way low b/p or high heart rate and when chefked manually they are far less hr or far hiugher im sure she was tachy but im really doubting it was 150 cause she was breathing normally with great b/p and said she felt great....ill never know though.....my preceptor was great she owned up to it to and even told me maybe it was partially her fault she wasnt checking them eitheir since i had sucha heavy load that night it wouldnt have hurt to have an extra pair of eyes.......usually my preceptor does check u see i have two preceptors one i am usually with and then this one but i love them both and i enjoy the differences in their teachings my other preceptor usually checks everything just to be sure and i like that too but i also think that at my 7th week i should handle alot on my own but im wishing now she would have checked.....i still cant believe i missed it but your huys words really help......as for the techs there are good and bad ones i had a bad one she never even gave me a sheet of vitals i looked them up and usually they alert me to the sllightest tick from the norm but she didnt but hey i still should have checked.....im really nervouse about returning to work and what will happen everyone says im not in trouble and honestly its not that im worried i just dont want to be looked at differently or have people feel like im irresponsible for those of you that made mistakes what happened afterward were u treated differenntly any reprucussions ???? just curious ...i go back tomorrow wish me luck

Altalorraine · Oct 9, 2005

.i just feel soooo bad i keep replaying it in my mind and wondering how i could have missed it ......i know i was busy but its no exscuse.......i want to get over this but im having a hard time....am i a horrible nurse......please help i feel horrible

Current thinking regarding mistakes is that they should be looked at as systems failures, not just the failure of one person. That doesn't mean that each and every person shouldn't look at the role he/she played, but there is usually a problem that goes far beyond one person making a mistake. In the case it sounds to me like you were overloaded with patients and distracted. The tech didn't notify you. The computer system didn't flash an alert when a high hr was entered.

See what I mean?

Learn your own lesson from what happened (I'll bet you'll be doubly vigilant with your postops from now on), but don't let anyone dare to "yell" at you or make you feel like you are a bad nurse. EVERY human being makes mistakes, including the doctor who is so mad.

Rain

No one comes to work intending to harm another. We are, however, all players in an imperfect and complex system. Almost by definition, these systems predispose patients to medical errors. Only by fundamentally changing the underlying systems can we get to the root of the problem and prevent future errors.

-Marlene Miller, M.D., M.Sc., Director of Quality and Safety Initiatives, Johns Hopkins Children's Center

AMARTIN1 · Oct 9, 2005

Current thinking regarding mistakes is that they should be looked at as systems failures, not just the failure of one person. That doesn't mean that each and every person shouldn't look at the role he/she played, but there is usually a problem that goes far beyond one person making a mistake. In the case it sounds to me like you were overloaded with patients and distracted. The tech didn't notify you. The computer system didn't flash an alert when a high hr was entered.
See what I mean?
Learn your own lesson from what happened (I'll bet you'll be doubly vigilant with your postops from now on), but don't let anyone dare to "yell" at you or make you feel like you are a bad nurse. EVERY human being makes mistakes, including the doctor who is so mad.
Rain
No one comes to work intending to harm another. We are, however, all players in an imperfect and complex system. Almost by definition, these systems predispose patients to medical errors. Only by fundamentally changing the underlying systems can we get to the root of the problem and prevent future errors.
-Marlene Miller, M.D., M.Sc., Director of Quality and Safety Initiatives, Johns Hopkins Children's Center

Well put!!!!:) I felt the same way after I made my mistakes but it was forgotten as quickly as it happened. As new nurses I think we tend to be hard on ourselves but thats how we learn to become wonderful and experienced nurses. Everything you feel is normal and I go through it too!!! Hope you have a wonderful, less eventfl shift. Hold your head high and don't let anyone talk down to you. :) AMARTIN1