I made a mistake and I am terrified to go back to work

[DH1234]

Basically my pt's BP was high like Systolic BP of 170s and her base line has been like in 150s-160s. And I was looking at the orders of when to notify the Dr. but it said not to call unless systolic BP was greater than 180. And her BP did come down to the 160s by the end of my shift but that's not an excuse. And I did not know until the next night when the off going nurse giving me report that she had PRN meds for high blood pressure above 170. I feel like a fool how did I not catch this, and being a new nurse 4 weeks off of orientation does not excuse this mistake. I pretty much put my pt at harm. I just got my license, and I am already making mistakes to were I can lose it.

Be honest how bad of a mistake did I make? How do I go back to work, and face my manager and co-workers? Do nurses get fired for this action? I am just dreading going back to work because of this big screw up of mine. How do y'all get over mistakes.

[JBMmom, MSN, NP]

Take a breath. Big mistake? Not really. What's the concern with high blood pressure? A stroke, right? Well, with a systolic of 170s that's not a huge likelihood. Over time, increased blood pressures can lead to heart failure, but it's not an immediate thing, and if you have blood pressure medications and prns, this is likely not a new condition for the patient. Since you had a prn should you have administered one? Yes. But, are there likely to be any negative effects from the error? No. Just learn and move on. If you get yourself all over excited over any mistake, you're going to have a tough time. Everyone makes mistakes.

[Lynker, LPN]

I haven't started working as a nurse yet, so coming from an also new nurse it seems like a simple mistake. Things happen. I wouldn't beat down on yourself so much. Learn and grow from it. You're not going to put you license in jeopardy because you're still new and didn't know a patient's med order. It'll be alright!

[AnLe, ASN, RN]

What I found to be helpful for this is jotting down any prn BP medications into my brain sheet and when to give it. Example: hydralazine-SBP>160.

It also helps when your patient has high BP and they don't have any PRNs available. Will you always need it? No. It just made it easier for me to be aware of it.

[MiralaxOnIceRN, BSN, RN]

I highly doubt that anyone will even approach you on the subject. Unless the patient had a aortic dissection or something this is barely life threatening. Learn to take it in stride. Mistakes happen, learn from them and move on. After a while you'll just know what to look for and do what the orders say.

[Sour Lemon]

In the grand scheme of things, that is very minor. Just get in a habit of looking for PRNs when you see anything out of range. People sometimes slip up and call the doctor at 3AM when there's already an order to cover the problem.

*** If your employer fired new graduates over things like that, they wouldn't be hiring new graduates to start out with ...because they'd have to fire them all.

[Here.I.Stand, BSN, RN]

Oh goodness, RaDonda Vaught didn’t even lose her license! Deep breath... it’ll be ok, just learn from this. ?

[TriciaJ, RN]

This is an error to slap yourself in the forehead over, not fear for your license. Learning the difference will go a long way to protecting your own blood pressure over time.

[AlwaysLearning247, BSN]

Don’t beat yourself up, you’re not going to lose your license over this! Next time you’ll always make sure to check your PRN orders. Also, it’s good to remember that a patient’s blood pressure isn’t magically high overnight for the most part (unless they’re stoking our and in that case you usually hold BP meds anyways unless the SBP is >200). It’s hard to keep someone’s blood pressure down permanently, unless they’re on a drip. When I was a brand new nurse I would freak over high blood pressures all the time. I’ve grown to see that they didn’t get this high BP overnight and we’re not going to be able to fix it 100% overnight either! I’ve had many doctors want to monitor SBP of 170-190 and call if the patient is symptomatic. Good luck and again don’t beat yourself up over this!!

[headofcurls, BSN, RN]

It’s okay. ? You’re learning. You learned from this mistake. Every nurse makes mistakes. Show yourself some compassion.

[egg122 NP, MSN, APRN]

Honestly - the fact you rechecked the BP showed diligence and the use of critical thinking. I don't really see the error, the BP was below the give parameter by end of shift and you used your judgement to reassess rather than just give the med. So many BP readings are inaccurate anyway due to the wrong size cuff. I wish there was more monitoring and use of judgement than I see in long term care...

[RN_atlast]

Now you will always check your PRN orders for your patients. Try to make it a habit to do this as early on in your shift as possible. If time-willing, I check my patient’s labs, H&P, consult notes, and imaging as early as possible. I also write down what time which meds are due, and when I do this I look at what PRNs I have to work with if A, B, or C happens.

People put a lot of pressure on report. Basically in report I want to know what I can’t find in the chart, any abnormalities, any changes in the plan of care, difficult social/family dynamics so I can proceed with sensitivity. The rest you can get from the chart.

If I’m waiting for report, I’m skimming the chart.

Re the BP, you recognized it was slightly above the patient’s baseline and per orders did not warrant a call to the proper provider. Following that, in the future as your thinking skills develop your mind will wonder “what PRNs are there?” If any. Before I call a provider about something I usually check to see if it’s a new finding, if it’s been addressed in their notes, if there are interventions I can do already for it, etc.

I’m only a year into nursing but I love to learn, am constantly studying and researching things, accept all teaching from my seasoned colleagues, and am happy to say after a year I’ve grown immensely. Can only hope I continue to do so!