Is it selfish?

dream'n, BSN, RN · Jul 11, 2021

5 hours ago, LibraNurse27 said:

Hi all, although I just posted about getting some positivity around nursing, I am not currently feeling positive = ( Yesterday I gave Norco to a post op pt and I didn't see she had already gotten IV Tylenol 90 mins ago in pre-op. Our order set has oxycodone and Norco but says don't give Norco if pt got IV Tylenol. pt was allergic to oxycodone. No one thought it was a big deal but I hate making mistakes and always ruminate on them even if no harm to pt. It's the second minor med error I've mad at this new job within 7 months. I only made 2 errors ever in my 5 yrs at the hospital, one was a double dose of vitamin B and once an "underdone" of PO morphine (obviously easily fixed LOL)

This job is non union and seems easy to get fired. My boss actually said don't report minor stuff because he has to put it in your file. I see other nurses only report big stuff like falls, needle sticks, significant med or procedure errors. I still submitted an incident report. I have a terrible guilty thought that I wouldn't mind getting fired and doing something else, although it would be embarrassing and distressing. I am the primary income and provide health insurance for my partner. I feel if I were single I'd quit and do a lower paying job and downsize while I figure things out. If I can't even handle this low stress outpatient job, I don't think I should be a nurse. Is it selfish to ask my partner for us to live somewhere cheaper for a bit so I can figure out what to do next?

Is it selfish to want to be happy in the one and only life you've been given? Absolutely not. The older I get the more I'm realizing how much time I've wasted due to stress and fear.

I do have one suggestion. I recently started an online course that is free through coursera called "The Science of Wellbeing" and it is helping me understand what truly makes people happy and what we believe makes us happy, but doesn't. It's teaching me my strengths and mindfulness. No I'm not affiliated with this course or coursera at all, but I'm really getting a lot out of it. There isn't a grade you get or anything like that, it also is take it at your own pace.

FolksBtrippin, BSN, RN · Jul 11, 2021

The culture matters a lot when it comes to incident reports.

I once saw a nurse do an incident report over a child's stubbed toe. She was not the sharpest knife in the drawer, but she was also really worried that she would be penalized for not writing one. That facility did have a habit of writing up RNs for not reporting innocuous stuff. So that's how it went there.

Other places I've worked have a don't ask don't tell kind of mindset.

It took me a long time to realize that I really do need to go with the flow of the culture where I work. It felt like an affront to my integrity for a while, until I saw that when I do things my own way no matter what the culture is, I usually just clog stuff up and it helps no one.

JKL33 · Jul 12, 2021

On 7/10/2021 at 3:46 PM, LibraNurse27 said:

If I can't even handle this low stress outpatient job, I don't think I should be a nurse.

I think you can handle it and should be a nurse unless you decide for positive/proactive (rather than negative/reactive) reasons that you truly don't want to any more because you believe something else is a better fit for you.

Use logic combined with an awareness of your workplace culture in order to rationally decide what to fret about and what not to waste any time worrying about. For the Tylenol issue you described, I would handle it in the traditional way assuming that the workplace culture didn't demand otherwise: Notify relevant provider, document having done so and that no interventions were deemed necessary.

Then forget about it. It is often nothing more than directives based on skewed attitudes that have made "errors" of this caliber seem like such a big deal.

LibraNurse27, BSN, RN · Jul 12, 2021

3 hours ago, JKL33 said:

It is often nothing more than directives based on skewed attitudes that have made "errors" of this caliber seem like such a big deal.

Interesting! Do you feel that reporting small errors like this is unnecessary? I'm never sure, because some managers seem annoyed by people reporting small issues, and others want you to report everything. Some managers are nice when you report and others make you want to hide any mistakes.

Davey Do · Jul 12, 2021

10 hours ago, LibraNurse27 said:

Interesting! Do you feel that reporting small errors like this is unnecessary?

Reporting errors is a a way of CYA and a method to improve. However, there comes a time in an experienced Nurse's life when they can, for themselves, make the decision to report or not.

Perhaps I'm rationalizing, but here's a case in point: Years ago, I made a med error administering a benzo. I informed necessary parties and wrote myself up.

Then, a short time before I got fired & retired from nursing, I found out after the fact that I had given a 50 mg dose of Trazodone instead of the RX 100mg. The Patient was asleep by the time that I discovered my error and I made mention of the error to my work wife, Eleanor.

Eleanor just shrugged and said, "Oh well". I decided that the reporting process wasn't necessary.

"Oh well."

JKL33 · Jul 13, 2021

On 7/11/2021 at 11:31 PM, LibraNurse27 said:

Interesting! Do you feel that reporting small errors like this is unnecessary? I'm never sure, because some managers seem annoyed by people reporting small issues, and others want you to report everything. Some managers are nice when you report and others make you want to hide any mistakes.

I'm looking at this with a broader perspective. There are two different things to discuss here--the patient safety aspect and the business/liability/disciplinary aspect. I wouldn't hide my actions in a situation like the one you're describing or in any situation I guess. That is, I would always assess the patient, notify the provider, perform any additional assessments or interventions that were deemed necessary and document appropriately.

I believe in incident reporting of errors big and small because when used appropriately these are very useful tools to direct future error prevention and promote patient safety.

But if it becomes clear that no one really cares about safety and the internal reporting mechanism is mostly being used as a means of nitpicking RNs, then it isn't serving its purpose and is worse than useless. In that case I would generally stick with proceeding in the way that is legally required of me and forget the rest (take care of patient, notify provider, document).

If your manager is telling you (in not so many words) that incident reports are not used productively at your place/the employer only requires certain big things to be reported so that they can apply discipline then...??‍♀️...hear what is being said and go with it.

brandy1017, ASN, RN · Jul 13, 2021

On 7/10/2021 at 2:46 PM, LibraNurse27 said:

Hi all, although I just posted about getting some positivity around nursing, I am not currently feeling positive = ( Yesterday I gave Norco to a post op pt and I didn't see she had already gotten IV Tylenol 90 mins ago in pre-op. Our order set has oxycodone and Norco but says don't give Norco if pt got IV Tylenol. pt was allergic to oxycodone. No one thought it was a big deal but I hate making mistakes and always ruminate on them even if no harm to pt. It's the second minor med error I've mad at this new job within 7 months. I only made 2 errors ever in my 5 yrs at the hospital, one was a double dose of vitamin B and once an "underdone" of PO morphine (obviously easily fixed LOL)

This job is non union and seems easy to get fired. My boss actually said don't report minor stuff because he has to put it in your file. I see other nurses only report big stuff like falls, needle sticks, significant med or procedure errors. I still submitted an incident report. I have a terrible guilty thought that I wouldn't mind getting fired and doing something else, although it would be embarrassing and distressing. I am the primary income and provide health insurance for my partner. I feel if I were single I'd quit and do a lower paying job and downsize while I figure things out. If I can't even handle this low stress outpatient job, I don't think I should be a nurse. Is it selfish to ask my partner for us to live somewhere cheaper for a bit so I can figure out what to do next?

It was a minor mistake and no harm came to the patient so I would not have done an incident report. I don't think you need to quit the job over this. Hopefully the incident report will be filed away without any damage to you.

Just curious, I thought teachers had gold plated health insurance? Surprised you are the one carrying the insurance.

LibraNurse27, BSN, RN · Jul 14, 2021

7 hours ago, brandy1017 said:

It was a minor mistake and no harm came to the patient so I would not have done an incident report. I don't think you need to quit the job over this. Hopefully the incident report will be filed away without any damage to you.

Just curious, I thought teachers had gold plated health insurance? Surprised you are the one carrying the insurance.

My boss didn't care about the incident report ? As for the insurance, I wish! Maybe in other areas, but her insurance costs half of her paycheck (not exaggerating). And my insurance is no monthly payment, no deductible, and usually no copay. That's why I feel stuck. It would be better for my mental health to do per diem or part time but then no insurance and the state does not give financial assistance for mental health conditions unless you're severely disabled. I looked into it but seems like all or nothing; I need to claim my bipolar disorder makes it impossible to work and collect disability (and move out of the Bay Area), or work full time.

speedynurse, ADN, BSN, RN, EMT-P · Jul 14, 2021

First, I don’t think you are being selfish at all if you need a change. However - really good health insurance and a relatively low stress job is something to consider before you make a change. I can say firsthand that I have awful health insurance and it can make you resent a job simply from that.

I think you are a perfectionist and conscientious- which is a good thing! However, everyone makes mistakes. Sometimes, you have to force yourself to move away just a little bit from that type A personality, especially when an error occurs. Everyone makes mistakes (I know the mistakes I have made have generally been when I was overtired, working too many hours or too long hours)….however, there are mistakes that do harm and more harmless mistakes. Sometimes you have to put things in perspective….especially if it’s a med error where there is no proof of harm. I think the bigger thing is when there are MASSIVE errors and no one cares or does anything about it. I have seen those happen in the healthcare system and it horrifies me that no one thinks that is a “big deal”.

I wish you the best in whatever decision you make - I do suggest though putting things in perspective and really thinking things through though before making a change.

SmilingBluEyes · Jul 14, 2021

6 hours ago, speedynurse said:

I wish you the best in whatever decision you make - I do suggest though putting things in perspective and really thinking things through though before making a change.

This is spot on!

Good luck!