Learn From My Mistakes

Roy Fokker, BSN, RN · Aug 4, 2007

* Night shift nurses, don't assume a patient is sleeping.... lest you discover that their "sleep" is because of a blood glucose of 42 or a systolic BP of 40.... :eek:

* Be very careful of what ancillary staff do to a patient. I once had a lab tech give water to my pre-op patient. She thought she was being helpful. Of course, she wasn't the one who got chewed out...

* Don't encourage patient's to "fix their own IV pumps when it beeps". Dissuade the patient, even if s/he says "but the other nurse said I could do it". Especially if patient is getting vessicant medications.

* Night shift nurses, a lot of your elderly patients will suffer from some degree of "sun downers" syndrome. Insist on having a sitter if possible. Better safe than sorry.

* Pain killers affect mental status of people. Don't ever forget that. Be very careful of giving anti-psychotics or anxiolytics for the first time to patients who have never had them before.

* Don't take abuse from anyone - patients included.

* When in doubt - ask, look it up or otherwise try and educate yourself. Don't give a med or do something you've never done before all by yourself. We are all human - it's ok to ask for help sometimes.

* The pharmacist is your friend. Be on good terms with him/her and please take advantage of their wealth of knowledge regarding medications.

* Don't hesitate to ask a physician for clarification of orders. S/he's not the one who has to carry it out - you do. It's your license and your butt on the line.

* Be careful about IV push for drugs. Even something as little as 0.625 mg of Inapsine pushed in fast can gork a patient.

* When calling a rapid response or a code on your patient, please remember to try and breathe. Send someone to get the crash cart, a heart monitor (can't tell you how many times I've walked in to assist with a code and found people just milling around without even having a heart monitor set up!) and the blood glucose machine. Try to make some room around the patient.

cheers,

inis200 · Aug 4, 2007

When giving a med through a port on a central cath, be sure you take everything with you when you're done. My nurse preceptor handed me all the syringes I needed to give my pt the med, therefore, she put together the "needles" on the syringes. It turns out, she didn't screw on the needles tight enough, and after I gave the meds and came back to check on my pt, I found the needle was still in one of the ports and the pt was bleeding!!! I was horrified. Now, when I attach the needles (which are actually needleless) to the syringes, I make sure they're on TIGHT and I don't leave anything behind when I'm leaving!

jadespirro · Aug 5, 2007

As a new nurse, there is a lot of information that is not known. Their is a high learning curve and we must try to slow down the process and take in what is being taught. Here are just a few of the many things I have learned in the last five weeks of my orientation.

1) Trust your gut!!!!! If it doesn't feel like the right way to do it, chances are you have a reason for feeling that way.

2) One of the absolutes to nursing has to do with NARCOTICS, always, always, always, pull narcs when you are going to give them, NEVER carry them on your person for extended periods of time, pull them, witness and waste, then give. In a peer review committe dilaudid in your pocket because "you were trying to save time from going back and forth to the pixis" will not cut it, and is one of the many excuses diverters give

3) Always be accountable for your practice including and especially mistakes...we all make them

4) Read your charts in the morning to confirm drug orders found on the MAR.....

5) If a doctors order is ambiguous and calls for "Ativan 0.5 mg q6h or Librium 25 mg q6h"......pick up on these pieces of the puzzle and put them all together. Have the ordering doctor make them clearer (D/C one med, make one PRN) Sometimes orders like these will go through pharmacy and quite a few nurses before someone rights this wrong

6) If you sign your name (RN) with an LVN, for blood administration and she says I always hang my own blood even though I am not suppose to, spikes the blood and walks out of the room- You as the RN are equally if not more accountable for this...

7) If you get in report your patient is going to get an EGD today and they already have consent signed, check and make sure it is DONE, don't just assume that nurse did it and did it right

8) If you have a patient that is in restraints make certain the reporting nurse writes the verbal order, or what have you, in the chart

9) If you have a horrible preceptor, demand for another one, if they can't provide one for you, you must ask yourself WHY??????

10) Find someone who is a professional, ethical, and prudent nurse to get clarification from all aspects of what you learn in orientation, because believe me some people will tell you with absolute certainty what they are doing is acceptable and low and behold YOU could lose your license for it

11) Be proactive and ask questions...lots and lots of questions

12) Nurses must have stethescopes and they MUST use them

If you havent guessed it by now I have had a nightmare of a so called orientation.........................Disappointed but moving on

B

:uhoh21: :madface: :uhoh3: :angryfire:o

I trust that it will get better, better somewhere else

Monica RN,BSN · Aug 5, 2007

Would anyone else like to share their screw ups, major or minor, in the hopes that other new grads will avoid them? Maybe this can be a sticky if there is interest.
-- Asking a "provocative" questions during orientation class. I wanted to know why nurses were required to give report in English only (even though the report is one on one). Angry answer: "Because it's the policy here and this is America and we speak English."
-- Assuming that I had lost the MAR and telling my preceptor and getting dressed down a little. Actually, the unit clerk had taken it to write orders.
-- Dumping half a bag of Lidocaine down the drain. Unused drugs go in the drug disposal can.
-- You know those dry antibiotics that you mix in the IV bag by snapping open the little bottle. Well, I forced solution into the little bottle, mixed it, then removed the insertion cap before pushing the fluid back into the bag. I was completely discombobulated about what to do. If you ever do this, either waste it or clamp with neck of the insert tube so you can get the solution back in the bag.
-- A wife of a patient came in the morning before work to see how he was doing. I was too frank and said he'd hadn't slept and had been in a lot of pain. Her face fell flat and I gave her a bad start to her day. I really could have put a better spin on this bad news.

I am now a well seasoned RN of 20 yrs. I do love this thread and love to read student threads. I can think back and find that even I relate to some of the things you'll are learning and doing today.

When I went to give my very first IM injection, I let go with both hands. Instructor was a bit speechless, not wanting to say anything with the patient right there.

MissMonica · Aug 5, 2007

What a great topic! I love learning from other's mistakes!!! Thank you for starting this post. Ok, mine are:

1. Even a young, alert & oriented x 3 person can become disoriented after certain meds (narcotics, sedatives...) so use your bed alarms, double check, keep doors open, etc. Do what you must to keep your pt. safe at all times!!! Recently, I had a pt. who was in her young 40s and otherwise healthy but she hadnt slept in 2 days, so the evening nurse gave her a sedative before my night shift. In report I was told she was a/o x3, self care, ambulatory. I went to see her and she was "sleeping" so I did a quick check and figured I see her later in the shift. 20 minutes later she fell off the bedside commode and tore her leg open down to the bone! She needed sutures and xrays and more antibiotics, etc!!!! Very scary.......

2. Ask, ask, ask. I ask doctors for order clarification, pharmacy for new med usages, lab for which tube to draw blood into, older nurses what a certain acronym or procedure is....etc....I have never regretted asking, even if the doctor screams at me for calling. I have regretted times I didnt ask for help because I was nervous, self-concious or embarassed. Remember your question is always valid if you are caring for someone!

3. Dont burn bridges! I once left a hospital where I had a great position, great compensation and lots of friends and comraderie on my unit. I thought my new hospital would be better and it was HELL. When I tried to go back, my old hospital gave me the cold shoulder because I left on bad terms with my former manager. To this day (2 hospitals later) I regret this. That was the best job I ever had !!!

I can probably think of 20 more mistakes....I'll get back to you if I can think of more good ones..... :idea:

VivaRN · Aug 7, 2007

A few of my more memorable screw-ups:

1) If you have an IVF hanging on a pressure bag, deflate the pressure bag before unspiking. Or you will get a SHOWER... does not increase family members' trust in you!

2) Cautiously observe the dynamics of the unit before choosing confidants. The people most eager to befriend you may not really be friends.

3) When taking report on a new admit always find out where the patient is coming from and when you can expect them to arrive. Get the name and number of the person giving you the report (if there are questions later).

4) Always ask when you don't know, or you're about to do something that seems a little weird...

5) Make sure from more experienced nurses that you have done/tried everything before you call. Especially on nights.

Good luck!

LisaJanae · Aug 10, 2007

Oh my gosh...i LOVE these!! We need to start his post on the general nursing board too!! I love reading all these jewels of knowledge! It's these little things that you don't learn in school that REALLY help!! THANKS for sharing!!!

smile123 · Aug 10, 2007

Great idea. Here's some:

1) When giving K replacements, they are usually in 10 mEq in 100 ml bags. Give them over 1 hour or longer, so they don't burn the pt's veins. The other trick is to insert 1 ml of 1% lidocaine into the IVPB bag so the pt will feel more comfortable. Be sure to mark the bag "#2 of 3" so the next nurse will know how much was given.

2) When you take a verbal/phone order from a doctor, be sure to repeat back the order. Make sure you have the proper med name (ask them to spell it out if you are not sure (especially if you can not understand their accent), dosage, the frequency, the route, PRN or not, for the specific condition (moderate pain, nausea, anxiety, etc.)

3) When leaning over a patient, raise the bed up so you don't injure your back. Then before you leave the patient's room, be sure to put the bed back down. Your back and safety of the patient will be preserved.

4) Ask some of the new grad nurses a little ahead of you (i.e. February class if you came on board in July) for pointers. They will have stuff fresh in their minds! They are also more open to helping a new grad nurse!

5) If you are taking report from the OR recovery RN (and you are on the general floor), be sure to ask the time and quantity of the last antibiotic and pain med given. Also ask how much "credit" you can have on IV fluids, if the pt is on room air or NC, basic V/S, PCA type and setup, and how the patient awakened from the surgery (some of them have a bad time coming out of anesthesia).

6) To get ready to receive a post op patient, get an IV pole, order an IV IMED module and 'brain". If the pt has a PCA, you only need to order an IV IMED module because the "brain" is already there. Look for a "Xmas tree" (green nozzle adapter) for O2 to hook up patients with NC's (nasal cannulas).

7) Always be sure to check HIP meds: heparin, insulin and pain meds) with another nurse. There are serious errors that can be avoided if you double check with someone else. In our facility, we have to chart who we checked the med with, especially if we give less than a "full "dose on pain meds.

8) Xerox a copy of commonly used phone numbers, doctor's pager numbers and "house" knowledge from the unit secretary or charge nurse. Carry it with you. This will save you a lot of time instead of asking "what's the number of pharmacy?" all the time.

9) Observe what organization time management sheets other nurses on the floor use. Ask for a copy. See which ones are helpful for you. I found having a clip board with one sheet for each of my patients with key info (basic profile, code, FSBG, meds, labs, assessment, treatments, nursing care, careplan, education, I/O, PCA) kept me organized. Some nurses only used a single sheet of paper for ALL of their patients, but I found I needed room to write all my notes and to be able to read them afterwards!

10) On IVPB's, use the trick of holding the PB med lower than the main med to back fill the PB med. Then you'll avoid air in the lines and the alarm going off. You can always fill the PB IV line with the PB med, but some times, it's just faster to back fill the line with the NS or LR from the main line.

11) If you are caring for a pt who on isolation precautions (when you need to gown up, don gloves, etc.) you can save yourself trips if you organize all your meds and treatments in a bunch before entering the room. You can also ask the pt from the door whether they need anything before you enter (ask them about their pain, if they need an extra blanket, sheet, etc.)

12) Say you have med A due at 2pm and med B is due at 3pm. Instead of doing 2 trips, give both at 2:30pm. Then you will still be in the appropriate time window, and it will save you time going in and out of the pt's room twice.

13) Cultivate strong relationships with your nursing aides. They can help your shift run more smoothly. Let them know of changing conditions with your patients or when to be ready for another post/op pt. Be sure to thank them every shift!

14) Always ask questions. It may take you "longer" to find out the answer, but it will help you avoid potential med errors later.

Hope that helps!

firstyearstudent · Aug 10, 2007

-- Always double check when the last PRN med was given. Don't go by the previous nurse's recollection from report. He or she is tired and frazzled and can't be expected to remember everything correctly.

firstyearstudent · Aug 10, 2007

Great idea. Here's some:
12) Say you have med A due at 2pm and med B is due at 3pm. Instead of doing 2 trips, give both at 2:30pm. Then you will still be in the appropriate time window, and it will save you time going in and out of the pt's room twice.

This is generally good advice, but I did this once and then found out that the first drug was purposely scheduled an hour before the other because they interacted. Others are premeds. So be careful. Is one of the drugs scheduled before regular med pass for a reasoon? Learn from my mistakes!

sshannon · Aug 10, 2007

Also ask how much "credit" you can have on IV fluids

Will graduate in December, so hang with me here. Could you please explain what an IV credit is and how this works? Is this fluid you include in their I/O when they come to the floor? Or does it refer to something else?

Thanks.