Making Mistake During My Orientation

[Starburst, ADN, BSN, CNA]

I got hired into an ICU residency program right after graduating nursing school. I'm currently on week 8 of a 16 weeks orientation where I am working with a preceptor. My manager and preceptors are very supportive, have high expectations and think highly of me maybe because of I graduated top of my class with a 4.0 (They mentioned it often ). Sometimes I don't feel like I deserve the praises, and because of that I'm fear of disappointing them. Anyways, everything has went well, and I felt confident as though I'm enough until my last shift. I had a new preceptor and she is the charge nurse of the unit but not last night. My preceptor asked me if have I been taking care of 2 patients, and I said I have. I have been taking care of 2 patients, and my previous preceptors were always right next to me if I have any question. I usually will tell them what I plan on doing, what I'm doing, report to them, and they watch me. So, last night were my third day on a roll, we got a dying patient, who is max on all pressors (levo quad, neo quad, epi quad, vaso), and another patient who is stable but needed to go to CT during the shift. The dying patient was very acidosis (7.2), so Dr ordered 1L bicarb running at 250 ml/h. The family was in the room asking me all the questions and saying that the patient wasn't so sick and bla bla bla as I was hanging the bicarb so I accidentally set the VTBI as 250 the rate as 970. The CNA was in the room and told me that she had a hard time getting the pt temp, and the family was very upset about that, so I tried helping the CNA to get the temp. The pump beeped and I added the volume but overlooked the rate. It ran for 1 hour instead of 4 hours. The charge nurse, my preceptor and MD made aware. A report is submitted. And I feel horrible about my mistake and recognized how it could have been a detrimental mistake if it were high alert med instead of bicarb. I tried to pull myself together. My preceptor left me for awhile while I was trying to manage the drips, monitor the patients, give schedule meds, draw labs and deal with patient's family members who kept on calling but are not authorized for updates. It was chaotic and I wished my preceptor could have been next to me when I had questions and gave me guidance instead of trying to figure things out as I go. Anyways, somehow I managed to made it through the shift. Then, I had a talked with the charge nurse, and the manager about the bicarb thing. I told them what happened, admitted my mistake, identified the cause and what I will do to not make the same mistake in the future. They said they were not mad, and mistakes happened. But I feel incredibly disappointed of myself and feel so bad that I probably disappointed them. I felt like I failed my patient, myself and their trust. I went to the car and cried my eyes out. 

It is half way through the orientation already, but I still feel like I need my preceptor to be next to me to give guidance and check after me. I always feel anxious and worried of doing something wrong. Well now I actually did something wrong. I'm wondering if I am behind, if I could ever be competent enough to work independently without fear and anxiety. Is it normal to feel this way? Can someone give me some advice or share with me your experiences of being a new nurse? 

[CrunchRN, ADN, RN]

It is all part of the process to get you independent eventually. You are not expected to be perfect yet.

 

[RuralMOSchoolRN, ADN, RN]

I can be hard to leave the safety blanket of a preceptor.  Honestly half way through you probably have the knowledge and ability to take care of your two patients.  If you have specific questions, need help troubleshooting, or want your preceptor to observe a procedure that you are still learning then just ask her for that.  If you feel like you are drowning then let your preceptor know.  When I was a new nurse in the ER with a preceptor I always felt like I was on my tippy toes in the deep end-the water wasn't quite over my head but almost.  I learned that my preceptor would never let me drown but part of her job was to get me prepared to be on my own and that can be a pretty anxious spot for ME but overall made me stronger and more confident as time went on.  And I was never totally alone and my preceptor always jumped in if I really needed it.

You did everything right regarding your mistake.  Remember not to let other things divert your attention until you have completed your current task (Like programming the pump).  Tell whoever that you can help in a minute but need to complete x first.  

[Mr. Murse]

I don't say this to worsen your anxiety.......but this won't be the last mistake you ever make. In fact if you're human like most of us, it will be one of many. All you can do is learn from them and move forward using it to make you a better and more vigilant nurse. Be grateful it was a relatively minor mistake and let it make you better and stronger and more confident, not beat you down.

On another note, grades don't necessarily correlate to real life scenarios. Often times the top of the class students have a lot of trouble applying their book knowledge to the real world, and students that score lower in the classroom turn out to be great in real life scenarios. It's just the difference in how our minds work.

Not saying you're not good at the bedside, because it sounds like you're doing well, just saying memorizing information and taking tests well doesn't really mean much when you're in the real world applying the information you've memorized. Don't be too hard on yourself.