Made a mistake as a new nurse...

[AllyRN, BSN]

Hi everyone! This is my first time writing here and I’m here looking for advice or to see if someone had a familiar situation and what their input is on it. I will try my best to describe this event without getting too much into. My patient has a history of a fib, currently sinus bradycardia on the tele monitor. 7-3 nurse tells me that they d/c his metoprolol q 12 hours and decided to start him on a long acting metoprolol schedule for the next day to help control his BP. The 7-3 nurse gave him his first dose and then it was d/c’d. She told me that she text paged the resident and did a chat line to her multiple times to her about creating a one time order for metoprolol at night so he can at least get his last dose. The receipt said that the resident saw it. No order was placed for a one time order. So I stupidly forgot about it. Around 2030 my patient flips into a fib with a controlled rate between 70-100. I paged the night float doctor. The BP was elevated SBP 156, I have given him lisinopril about halfway through my shift ( just a side note). The patient was asymptomatic and baseline confused. The doctor comes down to evaluate and I told him as soon as I remembered about how he didn’t get metoprolol at night because it was no longer an order. He asked me who the resident was and I told him and he said “oh, she’s incompetent”. I felt horrible. He was very annoyed. He ordered a one time dose if metoprolol and I gave it, rechecked his BP (147 SBP) but still in a fib. Told to continue to monitor. I feel like I dropped the ball on this one. I should’ve really made a note to remember and pushed for that dose of metoprolol... I read through his notes and he’s flipped to a fib once before during his stay and he has a history of a fib. Has anyone gone through this before? Could I get written up for it? I really have no excuses, I just feel like a bad nurse and lack so much experience. Thank you all for listening to my rant. I’m praying the patient will be ok..

[Guest219794]

It's a little hard to completely follow your post- paragraphs can help.

But, if I understand.

• BID metoprolol was DC'ed with the intent of starting daily.
• The doc who dc'ed the BID never ordered the daily.
• The prior nurse addressed this, but the doc failed to correct her error.
• You feel like you should have also tried to get the doc to do her job.

So- Yup, it would have been good if you had remembered to prompt the doc to do her job. Maybe next time. And maybe not. Presumably, you had more than this one patient, and weren't sitting around doing nothing, as the resident, who had had multiple prompts, failed to do her job. You can't do everything.

"He asked me who the resident was and I told him and he said “oh, she’s incompetent”. I felt horrible. He was very annoyed. "

Of course he was annoyed. Somebody on his team dropped the ball. Why do you feel horrible?

Relax. No harm done. As far as being "written up"? What for?

Very unlikely a new nurse will get written up for inadequately supervising the doctor.