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I am a combo. I would never vent to a patient about horrible staffing or encourage them to complain, but I do try to set realistic expectations. The "B" scenario reminds me of a requirement for my 1:8 ratio (with an extra 8 assigned to "cover") acute care othro job. We were instructed to sit next to the patient at eye level and have a "caring moment". We were supposed to encourage them to talk about anything and ask for anything while assuring them that we "had time" to listen and provide. I never did it. Not even once. It would have been more realistic to tell them that I could fly or that I was the queen of England.

I think we're all aware of the Vecuronium error by now. It was a horrific mistake by a careless nurse. I've seen nursing evolve in my career. There used to simpler, easier to navigate systems. But it seems like, every year, the work flow becomes a more complicated obstacle course to navigate. Alarms, safety alerts, multi step processes, warnings flashing left and right. Name alert! Look alike, sound alike! Mandatory prompts piled on, not to mention the bookkeeping and charge capturing features built into EMRs, requiring the mental energy of nurses. Of course, we all have different psychological make ups. People's brains work, and process information differently. Some are highly sensitive to sensory overload. Others have more trouble staying focused due to their lower thresholds, sometimes called ADD. I personally dislike calling normal variations in people disorders though. I don't think the creators of many of these systems have really accounted for the above factors. Often, these are reactionary systems to previous errors. There are new ones every year, they keep getting piled on. After awhile, people start to tune it all out. They just click, click past it all, trying to keep up. I think this a problem worth exploring.

Ya know what? Both of these nurses were talking to an anxious family, not an entitled, belligerent or abusive family. I would challenge anyone to be so yippy-skippy when the family is demanding steak dinners for everyone and the spouse is threatening to "take you outside and mess you up" if you don't ______" (insert absolutely insane demand.) Yes, we all need to be positive and set the tone. But isn't there a little leeway between Nurse Nightmare and Nurse Sunshine, the company whore?

You observed the 5 rights except for the fact that the medication was from another patient’s supply. If anything, you are guilty of cheating the other patient from a pill that they were charged for and you gave your patient a free dose. Just learn from it and next time, pause and think before you act and document. I don’t think you’re going to lose your license over this.

What a mess. At least "IT" finally happened and you got it over with. Hopefully it'll compel mom to get off high-center and get a plan in place for school. Great assessment and intervention...I know you were reluctant to call EMS but you did the right thing. Fantastic job and fantastic advocate for the child!

These are very serious allegations, almost to the point of abuse. Have you talked to your instructor about these situations?

Let's define "perfect nurse" so we can know how to be one. A perfect nurse is one who never makes a mistake. One who never makes a medication administration error and therefore adheres to all patient rights of medication administration every single time without fail. One who adheres to all professional standards of practice throughout every second of every work day. One who distinguishes between being a "good worker" and a "good nurse" and so knows when to stand up to her boss and refuse work assignments. One who knows her limitations, so can anticipate coming across something she might not have learned yet and will avoid being put into situations that might cause her to exceed her limitations. One who will always without fail ask for help when needed and ask or look something up before doing something new. The nature of nurses' work and their role as "last line of defense" in patient safety demands that a nurse be able to think critically. So the nurse's brain is the utmost important tool in her work belt and must remain sharp. Brains are complex and often fail unexpectedly in people of all intelligence levels...e.g. looking for glasses when they're on your head. Brains can have moments of lapses when people are: fatigued; sick; distracted; overloaded with information; under intense stress; etc. Yet a perfect nurse does not have brain failure...EVER. A perfect nurse can work 12 hour shifts and still not have one single second of brain failure...EVER. Questions for Consideration: 1. Is it possible to be a perfect nurse in an understaffed hospital? Is it possible to be a perfect nurse in any imperfect work environment? (Yes? -Tips to do so?) 2. Tragically, being a "good worker" is too often in conflict with being a "good nurse". If a working nurse is striving hard to please the boss due to her high work ethic, she quite possibly is failing to ensure patients' safety by taking on more than she can handle. So how do we reconcile nursing school knowledge and professional standards of practice with current unsafe conditions of many nursing jobs? Do employers have any obligation to make being a "good worker" the same thing as being a "good nurse" -- or does it all fall on the nurse to be perfect when faced with imperfect demands in an imperfect environment? 3. How can work environments, administration of health facilities, nursing schools, health care laws, or other entities which affect nursing jobs make it possible for the perfect nurse to remain perfect at all times in her job? 4. If any of you nurses have never experienced a second of brain failure (especially not a full 30 min. or more of brain failure), and if any of you are incapable of skipping one or more med. admin. safety steps despite any environmental circumstances, and if any of you declare yourself to be a perfect nurse as defined here...do you have tips to help the rest of us become more like you? This is a serious question and I for one am grateful you are a nurse, grateful for your service, and would be grateful to learn from you. Because truly, what nurse wouldn't want to be perfect? Sign me up! ------------------------------------------------------------------------------------------- Disclaimer: I am truly interested in having a positive discussion that attempts to answer the questions I posed here. But I am also reacting to the long discussions among at least three threads regarding the nurse charged with homicide. I don't believe a perfect human exists. I don't believe there exists a perfect nurse who is incapable, regardless of any imaginable circumstances and environments, of skipping multiple safety checks in medication administration. Yet some claim to not ever be capable of such grave errors. To ignore the potential of our brains to fail and to so willingly condemn the charged nurse as a criminal without even knowing what was going through her mind and what circumstances and environment led up to her giving the wrong medicine is scary to me and lacks something the perfect nurse would surely have: compassion; the desire to understand; the desire to remedy rather than penalize; the desire to heal. Some will say she should no longer be a nurse because she failed too badly in the professional standards of practice. I believe she was being mindless so never made the choice to skip any safety measures; I believe she had every intention of helping patients and that she took it for granted that she had no chance of harming them because she believed in those moments that there was no chance. I believe it was an accident that would not have happened in ideal work conditions, and I can imagine many things leading to a nurse becoming mindless through no fault of the nurse. Maybe she should never be a nurse again or maybe she would be the best nurse in the world after this experience. I'm not forming an opinion on non-criminal consequences right now. I try in the "Nurse Charged with Homicide" thread to convince you why, from what we know so far, the case does not warrant criminal charges. What should have been in her mind and what was in her mind are two different things, and that difference is why she is not a criminal for being in a mindless rush to give a medicine she believed would not harm the patient and then to not monitor the patient because she believed the patient was unharmed by the medicine. That's just my interpretation of the law. Don't forget, law is subjective so you get to have your interpretation too; I just hope judge and jury have more in common with my way of thinking. I hope this nurse doesn't spend a day behind bars when she likely was just trying to be a "good worker" and not experienced enough to focus solely instead on just being a "good nurse". Anyhow, though writing this was inspired by my strong feelings in the other threads, we could keep our continual conversation about this case in the other threads (if you want) and save this particular thread for positive, creative ideas that might answer some of the questions above. Also, there is a well-written and worth-reading article in this forum "Is It Possible to Never Make an Error? The Perfect Nurse Fallacy" by SafetyNurse1968 (I wrote this and forgot that article was already broaching these topics!), but the discussion following it didn't seem to have a lot of tips from any perfect nurses for how to be perfect in understaffed hospitals or otherwise unsafe work conditions, so I'm trying here too.

Poor snowflake

Another thought - this is work. Work isn't always fun. However, its what we make of it. If the compensation and overall environment is okay, I would pass on making this an issue.

Couldn't agree more. And most schools have exactly zero tolerance for a student practicing outside their scope, or refusing to respect boundaries set by instructors or God forbid a facility nurse in a clinical. And the idea of this girl in nursing school watching to make sure nurses at her clinicals were "doing things right"? She wouldn't last 10 minutes. But I disagree with having her submit questions in writing, or talking with her further about the consequences of her behavior. She's not listening, and way too much time that should be spent on patient care by the PSW and the OP is already being wasted on attempting to manage this chickie. Every time it happens, I'd just say. "We've been over this. That's the kind of question I won't be answering," and then redirect her to a PSW-appropriate task. I'd keep a quick tick list of times it happens to cover my six in case the excrement hits the air mover, but management already knows what's happening and elects to do nothing. Not OP's problem to fix, just to manage toward least disruption by and maximum productivity out of this subordinate.