Lab orders not did not get ordered! :(

[nicetomeetyou]

I found a job as an RN on a med-surg floor, and I love it so much. One day I came to work and the RN i was supposed to be working with called off. I had to take care of 6 patients on my own, and 2 on telemetry. They got another CNA to come in, but I was told the following day that lab orders that I noted were not ordered. I talked to my supervisor and she seemed disappointed. I have been doing fairly well. This will be my 3rd month there. I keep having nightmares about little things I may have forgotten and I'm so scared that they are going to fire me. Any advice please?

[pers]

To clarify, were you supposed to have an additional nurse working with you so you had double the patient load or were you supposed to be on orientation so had to work on your own due to the call off?

We all miss things, even experienced nurses. I work nights and have to do 24 hour chart checks so I know the experienced charge nurse who jumps all over nights for missing orders isn't perfect either!

Did you put the lab orders in or just note them? We generally don't have a secretary at night so I sometimes have to put the orders in, note them and then do a 24 hour chart check! Fortunately I haven't missed anything (that I know of) but I've pointed out several times that this isn't safe and kinda circumvents the whole point of having multiple steps. If you are the one putting the orders in I would ask someone else to note them if possible. If someone else put them in, all you can do is just be really careful as you note them off. I put a check next to every order as I find it in the computer so when I look at the page I can tell that everything is ordered.

At this point, all you can do is take a breath, learn from the mistake and try hard not to do it again. If you can figure out why you made the mistake that will definitely help as you may be able to come up with a system for preventing it (like having someone else note orders you put in or making a mark next to orders as you find them in the computer while noting them). Stressing over mistakes is good when it propels you to do better but don't stress over it to the point that you become paralyzed with fear! Sometimes we make mistakes even with the best systems in place and you have to be able to forgive yourself for it and move on.

[whisperinrain]

I'm just a first year LPN with no DON on board at the moment. There were 2 other facility nurses (I work in assisted living) and one of them neglected to order a repeat PT/INR for a resident whose routine draw came back @ 88. To summarize she was put on administrative leave and then opted to resign. This was someone who had been with the facility for over 4 years. On top of that the other seasoned nurse was also put on administrative leave for another unrelated incident. She also opted to resign. At this point I am the seasoned nurse with no director of nursing on board. I expect my outcome to be the same. I will eventually fall under (no push needed!) the bus and be dismissed. I am so discouraged and scared. You should just learn and move on from this. Your patients need you and that is the only reason I am still on board at my place. But honestly I do expect to lose in the long run!

[elkpark]

In my experience, "noting" (signing off) orders as an RN indicates that you are vouching for the orders having been completed/implemented. Does it not mean that at your hospital? How (why) did you sign off on lab orders without verifying that the orders had been entered? That seems to me like the first change/improvement to make -- don't sign off on orders without verifying that they're completed. Best wishes!