Learn From My Mistakes

Nurses New Nurse

Published

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.

Specializes in Critical Care, Pediatrics, Geriatrics.

1) Make sure your Piggyback is unclamped, otherwise you will return to find that it has not yet run in and you are behind on your other PB's that need to be hung next

2) Don't throw your report sheet in the shredder instead of the papers that really should have been shredded (LOL)

3) Always check your restraints to make sure they are not too tight and not too loose. If they can still reach their NG tube...what good is it to have them restrained? Rest assured you will be re-inserting that baby shortly.

4) Be very careful when doing mouthcare on pt's who are very confused or have trouble swallowing. They sometimes will bite down hard and can break off the little foam swabs or start sucking on the thing like a bottle and aspirate.

5) Check the siderails on the bed for blood and poo stains. You don't want to be leaning against that unknowingly while your cleaning or turning your pt until your co-worker points it out to you.

6) At the beginning of your shift, check your 'volume to be infused' levels on your pumps to prevent your fluids from running dry. Always keep ahead one bag of important drips...insulin/heparin/vasoactives.

7) (for monitored units) always check your alarm limit settings at the beginning of your shift and make sure they are activated and appropriate for your pt.

*Just a few stupid mistakes I have learned not to repeat:lol2:

Specializes in ER/Trauma.
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.

Yes, it is the fluid credit you include in your I/O when patients come to the floor.

Now apply the same principle to your report to the next shift nurse.

For example, I hang a new 1000cc bag of saline for patient A at 4 PM. I do I/O at 5 pm - at which point I clear my pump.

Assume I cleared 500 cc.

At this point, I look at the bag and roughly estimate how much is left in the bag - say there is still 600cc left in the bag to infuse.

This 600 cc is the "credit" I give to the next shift.

So when I give report, I tell 'em "patient A has saline running at 100 cc/hr. I cleared 500 and you have 600 to credit".

Now the oncoming nurse can estimate that running at 100 cc/hr, in about 6 hours or so, patient is going to need a new bag of fluid.

I give credit report for many things - how much is left in the PCA pumps, what is the level on the NG canister or reinfuser/c-vac/pleurevac drains, other medicated drips, epidural pumps etc.

Personally, I don't think it is terribly important ... but it is a nice courtesy, especially if you have fluid bags with very little left in 'em.

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!

A couple of quotes I'd just love to share. "You learn more from your mistakes than you will ever learn from things you do right." and "Learn from other's mistakes, because you will never live long enough to make them all yourself!"

Specializes in Neuro, Critical Care.

New Grad in the ICU. Here is my advice, things I've done and seen with other new grads on my floor (and there are quite a few of us!)

1. When removing an Aline, be careful...wear googles if you have to..blood spurts.Also when disabling...lol make sure you deflate the pressure bag BEFORE unspiking the heparin bag...HA!

2. Be super careful with all needles!

3. Watch your alarms..dont turn them off. Dont let family members silence your monitors.

4. Trust your gut. Ask for help, but know when to trust yourself...dont always take someone elses word, if you dont agree, get another opinion

5. Prepare for things before they happen...always be t hinking ahead..have those bag valve masks connected and ready to go...

6. Dont discount the valsalva maneuver

7. Check, check and recheck drugs...when possible always let pharmacy mix your drugs. Check and recheck your IV drips..MAKE SURE YOU SET THE GAURDRAILS ON YOUR PUMP...this makes a huge difference as some drugs are per kg! Ive come on at night and the entire day the pt. is running propofol in MIVF settings....

8. Always label your lines! I like putting a tape tag right at the first port, that way i can give something through the MIVF really quickly....

9. Understand blood pressure. Understand how and why we sometimes manipulate blood pressure. Know drugs that raise it, lower it, drop it....same for heart rate. Know your vasoactive drugs inside and out..know which ones make you tachy and which ones make your brady...

10. Always check NG/duotube placement before putting anything in it/down it....

11. Check and recheck chest tubes! Check the set tings, the water level, is it bubbling..is there an air leak...

12. Notice trends..is the SPO2 gradually falling?? this goes with the anticipate things before they happen

13. There is a reason some abbreviations are outlawed! U for units looks like a ZERO! Write it out! I had a pt. come back from angio where the angio RN had started a heparin drip. I checked the bag, the concentration, I knew the concentration was supposed to be 250,000 Units in 250cc, however....this bag said 2500U and at a glance..I thought it said 250000...when the PTT came back unchanged I quickly realized and changed out the bag. Lucky the pt. was fine. Lucky I caught the mistake relatively quickly and the pt. was unharmed. We made an indicdent report so hopefully we can prevent that from happening in the future.

I agree, these are great. I'm nine months into my job...here are some tips.

1. Be hypervigilant with IV piggyback meds. Unlike many other meds, they're not distributed via Pyxis, so you're more likely to grab the wrong bag. Also, IV piggybacks require the use of a pump, which introduces more room for error. For instance: you walk into your pt's room to hang a new heparin drip bag and hang a new antibiotic. You double-check the bags against the MAR, the nameband against the MAR, ensure proper programming of the pumps, hang the bags and leave. What you didn't realize is that you hung the heparin on the pump intended for the antibiotic, and your pt is now getting heparin at 200 ccs per hour.

2. Prior to giving meds for your shift, look over the MAR and circle the doses requiring you to break pills in half. Set these pills in a separate med cup and take it to the room, or break the pills in half one med at a time, replace the needed amount back into the pill wrapper, and waste the unneeded portion.

3. Frequently check your patients who are on heparin drips; this means lifting the covers and turning them every hour. A GI bleed can come out of nowhere, and you'll find a patient swimming in blood when you least expect it.

4. When you enter the room of a patient with multiple IV pumps and s/he looks like a plate of spaghetti lying in bed, straighten out and label all of the lines BEFORE administering any medications. Also verify programming of the pumps.

5. Observe protocol for frequency of checking residuals for tube feedings and check more frequently if you think it's needed.

6. Believe your patient. I've had some patients whom I'm convinced had hypochondriac tendencies, but the vast majority of patients will share information with you when they believe it's pertinent. And chances are that it is pertinent if they're moved to share it with you.

7. If you have a difficult patient or family, one of the most effective interventions you can make is to purposefully spend time with them at the beginning of your shift. Most of them know you're busy; they may not have had a healthcare provider who's ever really listened to them, let alone spent time explaining what's going on with the patient and how you plan to take care of someone. It's tremendously helpful for trust-building and will make your job easier in the long run.

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4. When you enter the room of a patient with multiple IV pumps and s/he looks like a plate of spaghetti lying in bed, straighten out and label all of the lines BEFORE administering any medications. Also verify programming of the pumps.

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This one is really good. The first patient I ever had that started "going bad" I hadn't done this. All of a sudden I needed to hang multiple pressors, blood, bicarb, bolus NS, and push vasoactives. But where can it go??? It was a disorganized mess in an already tense situation. You can bet I never did that again... or assumed, "well, he's stable so I won't sort it all out." Ha, ha. Famous last words.

Label your lines, put a stopcock on the CVP to make an extra bolus line. Organize your lines (TPN/insulin, pressor lines, fluid/ABX lines) so you have places to put things. Think ahead: if this patient goes bad, what are my options? When do I need to ask for another central line? It'll save you a lot of grief.

Specializes in Neuro, Critical Care.

Be short and sweet with the docs aka get to the point...ive learned to talk very quickly and the most info in the shortest amount of time lol.....that SBAR thing is good. I like it.

Specializes in Emergency.

Here is advice that I learned in the short time I've been in nursing.

Look at your meds before giving them. As a student, I gave a double dose of Reglan po because I did not pay attention. It was a liquid that the pt was only supposed to get 1/2 of (thank God it wasn't a high risk med!).

The 6 rights are there for a reason (see above).

Make sure you treat your CNA's with respect and courtesy, they will save your A**, if you are appreciative of them.

Never take someones word for it..check and double check.

Document!!!!

Listen to your pts, never ignore a complaint, they can go downhill so fast.

Never be afraid to call a Dr, even in the wee hours of the night. It's your A** on the line! (and who cares if they yell at you, you are the pt advocate)

I could probably think of more.

Amy

Use great caution with Ambien--even in very low doses. It does not always help people sleep. I had a pt the other night--5 mg Ambien--spent the whole night in a waking dream.

Specializes in Interventional Radiology.

never assume what you are being told is actually what is going on. many times night shift can give you errant information due tot the fact that they may not necessarily have done a full assessment so they didnt "bother" the patient.

always,always,always- double or even triple check your meds. make sure to follow your 5 r's. always verify you are giving the right med to the right patient. **also- don't let something interrupt you from giving meds..many times this can cause confusion.:confused:

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