I messed up today.

Jolie, BSN · Oct 22, 2016

Was there a deficit in this patient's care? Yes.

Did you find it and get it addressed? Yes.

Might it have been better for the patient to have received alternate IV fluids sooner? Perhaps.

But you DID use critical thinking to determine that the patient's nutritional needs were not being met. Apparently that put you miles ahead of the physician writing the orders, and the pharmacist filling them. If you view this as your error, please help me understand why. I think you should be applauded.

Libby1987 · Oct 22, 2016

I remember my first job working on a surgical unit and leaving a patient unnecessarily on CL 2 days post op. I did nothing because the MD hadnt come in and placed an order to advance her diet. Starving and I did nothing about the patient not included in rounds. I got my ass chewed out well by a senior nurse. I learned something very valuable and almost 30 yrs in I've been proactive since.

It was a lousy 2 days for the patient but it wasn't wasted on me.

Better to learn by less critical mistakes than a biggie.

Crorns · Oct 22, 2016

I wish that I would have caught it sooner. I didn't put it together until the very end of my shift while I was giving report to the on coming nurse. My charge nurse and the on coming nurse both agreed that it should have been addressed sooner. Of course I agree! I just feel like I dropped the ball on this, but I don't think I was the only one to do that in this case since a physician didn't address the issue either. Thank you for the perspective!

Libby1987 · Oct 22, 2016

I wish that I would have caught it sooner. I didn't put it together until the very end of my shift while I was giving report to the on coming nurse. My charge nurse and the on coming nurse both agreed that it should have been addressed sooner. Of course I agree! I just feel like I dropped the ball on this, but I don't think I was the only one to do that in this case since a physician didn't address the issue either. Thank you for the perspective!

Neither beat yourself up nor make excuses. You missed something. It wasn't huge thankfully but if it were no excuse would make you feel better so don't get used to falling back on them. You don't need to feel bad, simply recognize your miss, pitch your reins and kick forward.

CCU BSN RN · Oct 22, 2016

Was this person diabetic?

A fasting blood glucose in the 60's is relatively normal. Harm wasn't done. That's hardly a mistake as far as I'm concerned.

Mistake would be a diabetic patient, you gave insulin while NPO and only on NS.

leighaRNBSN · Oct 22, 2016

As a new nurse, the day you're describing is something I fear. I fear messing up. You're ability to acknowledge it, to understand that your patient's needs could have been met better shows your potential to be a great nurse. I'd be more afraid if this didn't bother you. Best of luck from one new grad to another. Don't dread tomorrow, look it as your opportunity to be better.

CrunchRN, ADN, RN · Oct 22, 2016

Telemetry is super tough. You did fine. Quit beating yourself up.

Meriwhen, ASN, BSN, MSN, RN · Oct 23, 2016

Considering that many facilities use 60-99 as the normal range for blood glucose, 63 is not bad at all. Even for a NPO/fasting patient. And a tip about normal ranges: values don't necessarily have to be in the exact middle for things to be A-OK.

If, according to your facility's P&P, 63 is considered hypoglycemic, then you follow the facility's hypoglycemia protocol.

No major mistake here, IMO. Sounds like you did fine.

ohiosam2 · Oct 23, 2016

You are pretty much new to the floor! Give yourself a break. The floors can get rough. It is really tough to learn how to organize yourself and get a routine down so that you think of things like this. We are all human. I have news for you, we are all going to overlook things. The point is to learn from it, change your practice to avoid it in the future and walk on. This is difficult for nurses. We worry excessively because we care. Twenty years ago I was oriented by this real battle axe of a nurse (God rest her soul I miss her!) and she told me, "Are all of your patients okay at the end of the shift? Good, stop worrying and welcome to nursing. You do your best, you learn from your mistakes and you go on." Take a deep breath. Think about how to avoid this in the future and get back to it. I can tell you will make it because you are worrying. Patients need nurses who care like you. DO NOT give up. By the way, as an NP I can say the doctor should have known better and should have ordered some fluid with some glucose!

greenerpastures · Oct 23, 2016

Take a deep breath and forgive yourself. Always remember, review the numbers, but READ your patient's signs and symptoms. The patient may be 63 in between meals frequently. If he/she was not exhibiting signs of hypoglycemia, how would you have known it dropped that low if they were eating normally? You wouldn't.

Two or three nurses before you (2 days NPO- 4 shifts) missed it too. It's a minor learning moment. Now you know, after a day, a patient should have fluids with D5 or LR to keep them balanced. Forgive yourself. This was not an "error". It will be the first of many learning experiences you'll have in your first year.

MLPN · Oct 24, 2016

You shouldn't be so hard on yourself. You noticed it, whenever and however you noticed. Thank God it wasn't a very big issue. These are the issues when realized, that will end up making a good nurse, a great nurse! Good luck to you!