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I shouldn't be a nurse...

I started working again on ltc, but first day on the job on my own I made a horrible horrible mistake. As I write this I am trembling and crying and I feel so sick towards myself that I am nauseous and wanna throw up. What happened was someone was found on the floor by a cna. i had someone's meds and insulin on my hands, I set those on the table because I was gonna help the cna, but then I also thought if i let go of the meds, what if someone comes along and eats up the meds or stick themselves with the insulin. another cna came up so I told her to help the other cna lift the patient up. I went to give the meds. Then i don't know what i did anymore. I think someone started asking me their pain meds or something. My intention was to go give the med then go back to the fall patient to assess, but somehow I forgot. So when I got home I was thinking about my day when it occured to me that I did not go back to the fall pt and assess and do an IR . He was not my pt though, but since i was the one who was there first i think i am supposed to make the IR. Or i could just be a witness. I don't know. But I feel really really bad that I didnt do anything. I am so sick of myself, I deserve to die. I feel that I'm a horrible nurse, even though this is only my 6th day as one, assess and write an IR is a basic thing to do with a fall, and i know that, i know why it is so important, and i know the complications if a fall is not followed through...so i am asking myself where the hell was my mind. I wanna talk to someone but I don't know who to talk to, I am scared to death. I don't know if the nurse who had the pt made an IR...i am praying so hard that she did. I really think I shouldnt be a nurse. This is such a horrible horrible mistake.

ShannonRN2010, BSN, RN

Specializes in MS, LTC, Post Op.

Okay first off, you are human and we all make mistakes...I don't know one nurse that hasn't made some kind of mistake in the past.

The best thing you can do, is use this experience as a learning experience. Your a new nurse...don't beat yourself up over this!

nurse_mo1986

Has 3 years experience.

Wow, ok ok ok...take a deep breath and....CALM DOWN:) first of all, if the pt is ok, then the IR is ONLY another piece of paper. Don't sweat it, just fill it out the next time you're at work. Also, if this is bothering you that bad, just call your DON, or Supervisor. It's not that big of a deal.

You will learn in nursing that EVERYONE makes mistakes. It happens. One time i gave the wrong pt a seroquel. You know what happened to me? NOTHING. lol, the pt was much calmer than normal, but the DR. laughed at me:)

You're new, give yourself some time to pick these things up, and don't sweat the small stuff.

gee.. i'm so sorry you're feeling so bad about this :( I know i hate when i get those feelings.. that dread that just hits you, and feeling sick all over .. from what u've written it doesn't sound like you are being careless at all! You made a decision based on your judgment; that you couldn't just leave the meds out like that and you delegated to another team member to help out. Who knows.. maybe with more experience you would decide to do something else, like tuck the meds away somewhere and help out yourself, but you are still developing that judgment.. I find with nursing, the more you work at it, the greater your brain capacity becomes.. it's as if you're able to hold so many details in ur head in one time. lol, i don't know how much this is true. Maybe to help ease ur mind you can talk to the nurse manager or a nurse you trust? I'm thinking that the CNA might have likely told the actual nurse after the incident??

I know it's hard to keep going in nursing when you see so much potential to make errors.. i know this is how i feel up to now.. I really have no good answer. maybe it's about changing our outlook on life? seeing that really there's a lot of factors that we can't control, we can't always have good flawless days.. we just have to make the best out of what we're given. Take it one day at a time.. :)

hope you feel better, take care!

i havent been sleeping at all.. I am very worried about the gentleman who fell... I am worried that what if nobody wrote an IR (although it also won't make sense if they didnt)... therefore nobody would've called for the md.. I am thinking of worst-case scenarios in my mind. I am really scared.

Calm down. I think, if possible, you shoulld call someone supportive in management or a co workers with more experience to help talk you off the ledge, so to speak and put everything in perspective. This patient has a nurse, who isn't you. ShYe or he should have assessed the patient and called the doc. and followed up and possibly reminded you of the incident report, if you even had to fill one out. The CNA who found the patient may have been the witness so you may not have been needed. I understand that you forgot and are upset, but I think you are making it worse than it is. Call someone who knows something that can tell you what you can do, if anything. Letting you imagination run wild is not going to help. I know, I am a new nurse and have had a couple days when I've gone home and all I can think about was what I did and didn't do and what the patient outcome would be and how would it effect my career and so on and so on and so on. I've had days where I cried and couldn't eat and felt sick and sometimes just went straight to bed because I didn't want to think about it anymore. Most of those times, when I spoke with someone who knew more they could put things in perspective for me and that is really helpful. A new nurses imagination can be very creative, so try and talk to someone. God bless.

You were between a rock and a hard place. As a very new nurse, first day on your own, it wasn't such a terrible thing. If the patient didn't die or have complications, if you called back and informed the current charge nurse that the patient needed to be assessed, or, just to really be safe, went back to work and did it yourself, I'd say you didn't do all that badly.

On the plus side, you did a good job of delegating appropriately and of preventing someone from grabbing the pill cup.

The incident report isn't so urgent but the patient does need to be assessed ASAP. To protect yourself, go do it yourself - now.

Where was your mind? On your 90 other patients probably. BTW, a lot of falls result in no injuries. But I think I'd just go do the assessment now and put your mind at ease. And you do not need to berate yourself up 1 side and down the other in front of other staff. Just try to be calm and do what needs to be done and do it now.

Valerie Salva, BSN, RN

Has 19 years experience.

From what the OP said, it sounds like the two CNAs lifted the pt before a fall assessment was done- actually it seems that no fall assessment was done. This is really disconcerting.

I think the thing to do would have been to put the pills and insulin in your pocket, do a fall assessment on the pt ( Ask the pt "Do you hurt anywhere?" palpate/visualize for abnormalities, pain, check range of motion)then lift the pt, put the pt back in the bed/chair, then get VS and a neuro assessment, question the pt about the fall (How did this happen? Did you hit your head?) inst the pt to call for help (if pt is able to follow directions) make sure call light is within reach, side/rails are up or down (depending on your facility policy) then call MD to report the fall.

As long as you have written a note to yourself w/ info about the fall, you can do the IR at the end of your shift. This is what I do.

You can just keep passing meds while waiting for the doc to call back.

If the pills/insulin get contaminated in your pocket, that's fine. Just waste them and get new meds. With a pt on the floor, it would be fine to just drop all the pills and the insulin into the nearest sharps container and get new meds later. Remember- prioritization.

I think that this being her first day on her own, the OP panicked a little bit, and did not prioritize.

I also think forgetting about the pt and not doing a fall assessment are pretty big mistakes, but not the end of the world. Best thing to do would be to follow up with your NM.

Best of luck to you!

BradleyRN

Has 28 years experience. Specializes in Med Surg, LTC, Home Health.

If you have only been a nurse for 6 days, then you shouldnt be on your own already anyway. Without proper orientation, i would find it hard to fault you for forgetting something. Also, being in LTC, you probably have more patients than you can handle as well. You and your patient are likely just victims of this greed driven lack of standards in LTC. When i became an LPN, i received 5 weeks of training (17-18 days). Now they give 3 days. It is ridiculous.

Henceforth though, the patient should be assessed before he is ever lifted off the floor.

Get yourself a PDA (palm pilot). You can write notes on it and set alarms to remind yourself of tasks that may have been delayed.

Good luck. (Taking care of too many patients requires a bit of luck.):)

Flightline, BSN, RN

Has 5 years experience. Specializes in ICU.

i havent been sleeping at all.. I am very worried about the gentleman who fell... I am worried that what if nobody wrote an IR (although it also won't make sense if they didnt)... therefore nobody would've called for the md.. I am thinking of worst-case scenarios in my mind. I am really scared.

Is there no one at this LTC place except you? You even said it wasn't your patient.

There was a chance that the nurse that was taking care of the patient took care of everyhting.

floatRN

Has 4 years experience. Specializes in Med-Surg.

Take it easy on yourself. We all make mistakes. I wouldn't worry about the incident report. Forgetting the incident report won't harm the patient in any way. There's no reason why it couldn't be filled out next time you work. Although since you didn't witness the fall and weren't even the first person to find the patient, I'm not sure you'd have to fill one out. The patient's nurse probably should do that. I would assume that the patient's nurse would also have assessed the patient and followed up with the doctor.

alyx

Has 1 years experience. Specializes in Geriatrics.

You were between a rock and a hard place. ...

On the plus side, you did a good job of delegating appropriately and of preventing someone from grabbing the pill cup.

I totally agree. We can't be all things at all times. Why do you believe that what you did was a "Mistake"? You did the right thing. You would have really been in a pickle if you had left those meds and they had fallen into the wrong hands. That's where your mistake would have been. I think you did a fantastic job ; way to go handling a fall and preventing a med error! Your deep concern is a refelction of your dedication and passion for what you do and should be applauded...perhaps it's your point of view that is the real mistake here...pat yourself on the back. I'd be honored to have you as my nurse!

Please calm down. If this was not your patient you were probably to busy to know what that pts nurse did. The cna should have reported the fall to the pts nurse and she would have taken care of incident report. Surely there was no great harm like fracture or you would probably have been aware of pts transfer to hospital. As others have said, leaving meds where others could have taken them would have been much worse. You are not responsible for everything. Next shift find out if incident report was made. You will probably find all this worrying and lashing with whips you are giving yourself was for nothing.

You deserve to die?

Get a grip, girlfriend! Someone fell. You got flustered. You're new.

Now calm the heck down.

actually, what i believe should have been done is this: the cna found the patient on the floor. you place the meds into your pocket. you go into the room and quickly assess pt. (pain, any bleeding, etc) do not move the pt as yet. have the second cna go and call the nurse. she needs to see how the pt was found, as it is her pt and she will be the one completing the incident report.

once the nurse arrives, you leave, if she and the cna are able to transfer pt on own. preferably the pt nurse should complete the incident report because alot of the questions asked, only the primary nurse would immediately know. ( like what fall precautions was taken to prevent pt fall, was pt previously sedated or were any meds given that would alter level of consciousness, is pt alert and oriented, what could have been done to prevent this. basically the pt nurse is responsible for the safety of this pt, all you know is that this pt is on the floor. that is why you should wait untill the nurse sees the pt before moving. this pt may also have a history of falls and certain precautions were not taken.this is not your fault. i would just let the charge nurse know the next time i go into work. since the pt was moved before the primary nurse could assess him, then you may have to complete the incident report. if the pt is fine without complaints, the charge nurse may simply say let it go, but know better next time. the md may need to be notified. relax, we who are imperfect are required to work perfectly...but it just can't happen. we all make mistakes.

Butterfliesnroses

Specializes in LTC.

Where I work if a residents falls we get the residents nurse. Unless said nurse is out of the building or something to that effect. The residents nurse deals with the assessment and incident report. The only thing I think you may have done wrong is not assess the resident before telling the CNAs to life them. But the CNAs should have called you on that. As a CNA I NEVER lift a resident that has not been properly assessed. If a nurse tells me to I question it (nicely of course). I wouldn't worry too much though! Everyone makes mistakes. Just this CNAs :twocents:.

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

The first time you have a pt fall, yours or someone else's, it's traumatic, and you feel like the world's worst nurse. Everyone's had a pt fall (well, maybe not those in the NICU, hope not...), and for the most part, they are fine. That first fall is harder on you than it is on them, probably. What probably happened was the CNA got the pt's nurse, they did the assessment and the IR. Even if I was in your shoes, I'd have told the CNAs to leave the pt in place, got the pt's nurse down there, and did a fast neuro/physical check -- you don't know if the person's on blood thinners and is going to need a scan if they hit their head, or if they routinely sit down in the floor and fake a fall. What if the person normally had a dilated pupil--you wouldn't know that, and would think the worst, that's why you get that pt's nurse. You didn't see anything that alarmed you right off -- no obvious bleeding, vomiting, broken bones, screaming in pain -- so take a deep breath. If that's the worst thing that happens, you will have a blessed career.

Bugaloo

Has 23 years experience. Specializes in Med-Surg, HH, Tele, Geriatrics, Psych.

actually, what i believe should have been done is this: the cna found the patient on the floor. you place the meds into your pocket. you go into the room and quickly assess pt. (pain, any bleeding, etc) do not move the pt as yet. have the second cna go and call the nurse. she needs to see how the pt was found, as it is her pt and she will be the one completing the incident report.

once the nurse arrives, you leave, if she and the cna are able to transfer pt on own. preferably the pt nurse should complete the incident report because alot of the questions asked, only the primary nurse would immediately know. ( like what fall precautions was taken to prevent pt fall, was pt previously sedated or were any meds given that would alter level of consciousness, is pt alert and oriented, what could have been done to prevent this. basically the pt nurse is responsible for the safety of this pt, all you know is that this pt is on the floor. that is why you should wait untill the nurse sees the pt before moving. this pt may also have a history of falls and certain precautions were not taken.this is not your fault. i would just let the charge nurse know the next time i go into work. since the pt was moved before the primary nurse could assess him, then you may have to complete the incident report. if the pt is fine without complaints, the charge nurse may simply say let it go, but know better next time. the md may need to be notified. relax, we who are imperfect are required to work perfectly...but it just can't happen. we all make mistakes.

:yeahthat: could not have said it any better myself!

medsurgrnco, BSN, RN

Specializes in Med-Surg, Psych.

Surely the CNAs got the pt's nurse and she followed through with VS, neuro check, assessment, calling MD and any new orders, and incident report. In your situation, I would have asked a CNA to get the pt's nurse and stayed in the room until the other nurse showed up. Then I would have asked if the other nurse needed help before leaving to give the meds. Just my suggestion on what to do in the future. New nurses easily get overwhelmed, agree with others that you should stop beating yourself up over this.

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