Made a big med error as a student... i'm devastated.

RiskManager · Dec 5, 2016

Everyone, sooner or later, makes a med error. It is what you learn from it and your ability to move forward that distinguishes the professional. I have done a lot of these meetings with the personnel involved in the error and I follow a just culture approach. From the leadership point of view, what I am looking for is if the staff member or the system committed or contributed to the error; does the staff member have the necessary insight as to his/her contribution to the error and accepts responsibility thereto; has the staff member thought about what happened and how this could have been prevented; and does the staff member have any ideas or suggestions as to how future errors of this type can be prevented or mitigated. A necessary part of these meeting is giving support to the staff member. As professionals, we have probably already been staring at the ceiling at 0230 beating ourselves up about it. Appropriate corrective action may need to be applied, but we can still respect everyone's dignity in doing so.

AliNajaCat · Dec 5, 2016

Your instructor absolutely nailed it. You made an error, fortunately the patient wasn't harmed, it scared the bejaysus out of you, and you'll never do it again. It will make you a better nurse. And if she's a tough instructor, so much the better, because she took this as a teachable moment and not an excuse to go all ballistic on a good student who obviously has grasped the seriousness of the situation.

Someday you'll be an instructor and this will come back to you when one of your students does something like this. THAT will make you a better instructor.

RainMom · Dec 5, 2016

Everyone makes a med error eventually. I guarantee this is one you won't make again. It's great that your instructor was supportive & doesn't seem like this will be held against you.

One question: Did you not have a 2nd nurse (or your instructor!) check what was drawn up? Seems like some employers don't require a 2nd nurse to verify insulin anymore (cosign in in the eMAR), but I would think while in school, this would still be standard.

I also made my first med error while in nursing school. My instructor had pulled my meds for me & we reviewed them, but like you I went on my own to the room to administer them (I had already given meds a few times before). I scanned them, put them in a cup & handed them to the pt. I looked back at the screen & there was an error/warning message that one of the meds scanned was not ordered. I had been scanning, listening to the beep, but not watching the computer, & missed that one BP drug had literally just been discontinued & replaced with an extended release version by the MD. The pt had already taken the pill. I panicked & told my instructor & RN. Learned a big lesson & always make sure that my meds scan accurately before opening them!

Just relax & cut yourself some slack but be hypervigilant with your meds!

FuturePN · Dec 5, 2016

thanks guys

RainMom- I know, i was thinking that afterward. On one hand I am grateful for her having the "faith" in me not to be a second set of eyes for the insulin draw, but on the other hand with a med like that it does make sense. This facility is LTC and that is not their policy. When I did a rotation in an acute oncology floor last term all insulin had to be cosigned in the MAR. Seemed a little like overkill at the time but boy do I get it now.

I do think one of the reasons my instructor was as kind as she was was because she was feeling like she should probably be a second set of eyes for insulin draws with student nurses from now on. I feel so bad that I let her down in that regard. But maybe that's a good lesson all around. If it had been regular insulin and not Lantus for example... god i'm sick just thinking about it.

Extra Pickles · Dec 5, 2016

The bad news for you is that you are experiencing the horror of recognizing a med mistake, and suffering because of it. There's nothing to do about that but get through it. But the good news for you is that you understand what could have happened, took responsibility and know that you will never, just never do that again! Can't tell you how many times students place the blame for these kinds of mistakes on their instructor alone, they don't see their part in it. Or they make it into a much smaller thing than it is.

You took responsibility, you know what could have happened, you know what to do to make sure it doesn't happen again. It is a good lesson, and you learned it.

Pick yourself up, move on. Become a great nurse and teach a student how to avoid this mistake.

Horseshoe, BSN, RN · Dec 5, 2016

We always had to check insulin with another nurse when I worked at the hospital. I can't believe this wouldn't be the case for a student!

AliNajaCat · Dec 5, 2016

As an aside, I could never understand the paranoia about checking insulin with another nurse, especially now that every CNA and her brother can check glucoses at the bedside. If you don't give enough, what happens? The patient gets more. If you give too much, what happens? That's why the goddess gave us orange juice, glucagon, and D50W.

Now, does anybody make you check, say, IV digoxin? Or potassium? What happens if you give too much of those?

See my point?

emmjayy, BSN, RN · Dec 5, 2016

This makes my palms all sweaty. I just finished first semester and we passed meds for the last three weeks or so and it just terrifies me to think of giving the wrong dose or wrong med to a pt. Really nice to see that you got great support from your instructor and from everyone else here, and I'm so glad there was no serious harm done to your pt. Hugs to you!!

NewMurse1014 · Dec 5, 2016

Like PP said, everyone makes mistakes, and this was a great learning opportunity for you. Your instructor took the appropriate action, the patient turned out fine, and I'm sure you will be much more careful next time. Instead of beating yourself up, try to reflect constructively on the situation: 1. what might contribute to the med error? (Being rushed/distracted, not following the med rights) 2. how would the med error affect the pt? (In your case it's pretty straightforward) 3.what follow up actions should have been taken? (Notify MD, more frequent BS checks, when and what signs/symptoms to look for, give juice/glucagon/D50 as indicated). 4. What can be done to prevent similar things from happening again? It's ok to feel that way but more importantly it's what you take away from it that matters. In the end you'll be a better nurse.

HouTx, BSN, MSN, EdD · Dec 6, 2016

Thank you so much for sharing this painful experience & lessons learned. I'm sure it will be valuable for other nursing students.

Many of us have gone through the same sort of event in nursing school.... but mine was a doozy. As a senior student (back in the day when there were various nursing models such as team & functional), we had to do a couple of rotations as a 'med nurse'. I was a top-notch student, so my instructor decided that it would be OK to attend a meeting and leave me under the supervision of the Charge Nurse. Charge nurse was called away to deal with a patient emergency.... told me to proceed carefully and call her if I had any questions. . . . you see where this is going, right??

My brain just didn't fully process the importance of the three different colors of ink on the MAR: Red ink = nights (11-7), Black ink = days (7-3) and Green ink = evenings (3-11). So, I administered Dalmane to > 20 patients on an ortho floor..... AT 9 AM. My instructor returned just as I was finishing - and nearly swooned when she saw the MARs where I had carefully documented all the meds. I spent the rest of the day filling out incident reports - one for each patient. I then had to call the Chief Ortho Resident. He was highly amused - I recall gales of laughter. He actually said something like "no wonder we're having such a good day today - I should have thought doing this (administering sedatives in the morning) a long time ago"

I was scolded by my instructor - had to write a 'paper' on med errors & present it to the rest of my class. But I made it through the remainder of the semester to graduation. Over time, it became an amusing story. But, just like OP, I learned NEVER to just assume that I understood an order.... and always verify if anything was unclear.

Irish_Mist, BSN, RN · Dec 6, 2016

I almost didn't post on here because I feel so incredibly ashamed, but I feel like it might be good to talk it out.
I'm in a PN program and we're in our last term. My first term I did one med pass. My second term was supposed to be med pass heavy but the instructor I got was brand new and there were a lot of issues (she ultimately was forced to resign at the end of the semester) I only got to pass meds twice with her.
Now it's term 3 (last term) and we all do "leadership" which means that one student is responsible for selecting all of the patients, making the assignments for other students, and then passing all of the meds. this is great experience for the leader but means that the other students dont get to do med passes at all unless until it's their turn for leader. Most students get 4 or 5 patients to do all the meds on, but because I went on a weekend no other students were out on rotations so I had all 8.
I went into it really nervous. I'm a really good student and really wanted to nail this. I was super nervous at first but eventually I got into the swing of it. My instructor watched me pop all the meds for the 4pm round but let me go into the rooms alone which was nice.
For the 8pm meds she watched me draw up 100u of lantus on a pt and administer it since she had never seen me do one before. all was well.
My last pt also needed Lantus. There was an issue with her meds where some meds were in one cart and some were in another, so i got distracted drawing up her Lantus. In any case, i drew it all up and felt confident and went down and gave her all her meds. I stopped by the nurses station where my instructor was to let her know I was giving another insulin and to ask if she wanted to come. she said she was all set.
Afterward, I came back to the nurse's station to document and was feeling over the moon and so relieved.
My nursing instructor just happened to look over my shoulder when i finished documenting and said "she didn't get 100u of lantus" I was so sure. So, So sure. That i proudly pulled up her chart to show her. And then I saw it too... Lantus 100u... ADMINISTER 46 UNITS.
i immediately wanted to die. just wanted to throw up and die.
My nursing instructor calmly said "did you really give her 100u?" and i said yes. she had me give her a glass of apple juice and then she sent the rest of the class down and stayed behind to talk to me. it was really painful. as it should be.
I got home that night and didn't sleep. I was absolutely terrified that she was going to die. Her BS before i gave her the lantus was 305, so there was that. I have never been so absolutely physically ill and devastated in my life.
We had clinicals again the next day and i went in early to take a peek at her chart and see how her night was. No issues, uneventful night, BS was 214 that morning.
I kept it together throughout clinical until our break, at which point i snuck outside to take a little walk and absolutely bawl my eyes out. How could i make such a stupid mistake?????? i did all my checks.... but missed that second line. and i guess 100u made sense to me because the other one i did was 100u. i messed up INSULIN!!!!! how could i mess up INSULIN!?!?!?!?!?!
when i came back from bawling we finished out the night but my instructor could obviously tell i was struggling (but we weren't on the floor at all that day... it was all post conference) She pulled me aside again after everyone left and asked if i was ok and i couldnt stop crying... i felt like such an idiot. but she was extremely kind (which i never would have guessed from her tough teaching style) and said that i made a mistake and that it's ok. the patient is fine and i will never make this mistake again. that i'm a good student and really smart and of course i should still be a nurse. that i will learn from it, the hard way- unfortunately.
I know i couldnt have asked for a better outcome. the patient was fine, i wasn't dismissed from the program, and my instructor was very supportive. i just feel like absolute crap and i just cant get past it. it makes me never want to give meds again. to make myself feel better i started looking up other med errors nurses have made, and instead of feeling like less of an idiot i'm now just horrified by how common it is.

Just be glad you made a med error as a student rather than a licensed nurse. This might not win me a popularity contest here but I also feel that whoever was supervising you is also at fault. Where I did clinicals for nursing school, insulin was/is always signed off by another RN before given. So I as a student would draw up the correct amount of insulin, my preceptor would check it and then another nurse would sign off on it. Since this mistake scared the life out of you, I bet you won't do it again. Learn from it and move on.