Making a Mistake as a Nurse

llg, PhD, RN · Jan 23, 2017

You are right in that nursing is a profession with a low tolerance for error. Without knowing the type of errors you are making, it's impossible for me to tell whether you boss is over-reacting or not. Is she treating your colleagues the same way? Or is it just you? How many previous bosses have you had? How different is the new boss different from previous bosses?-- or is your experience limited to only 1 or 2 previous bosses? etc.

KRSRN0930 · Jan 23, 2017

Her personality is one that I think is generally nasty and unpleasant. I think she likes to assert her position of power. I think she likes to assert her dominance especially with me, so I think she is extra nasty with me. I have had other supervisors before. Its hard to explain the type of errors that are made being that I don't work in a traditional hospital setting. She accused me of not reading a pt's MAR bc the pt's medicine was with the 8p and not 8a. Come to find out the medicine time was changed and she didn't read the MAR. She apologized. As I write this, I don't think I'm really making mistakes as she likes to micromanage and just constantly pick with any and everything. It's giving me anxiety!

MrChicagoRN, RN · Jan 23, 2017

Every place I've worked subscribes to a "Just Culture" paradigm.

Many mistakes are actually system errors that lead the clinician to err. As long as that particular system is in place, that error is likely to be repeated.

There are clinician errors that require reeducation or coaching. After the reeducation, if the error recurs, they are subject to progressive disciplinary action.

And then there are willful violation. I KNOW I wasn't supposed to do it that way, but I did it anyway. Often egregious acts. May result in immediate disciplinary action.

Keep in mind that if someone knows they will be punished for any error, no errors will be reported, and are often repeated, because no one ever fixed the problem.

HouTx, BSN, MSN, EdD · Jan 23, 2017

Sounds to me like you need to sit down with her and clarify your roles, responsibilities & priorities. If she has overall responsibility for oversight of nursing practice (like her title seems to imply), your 'nursing practice' role would report to her. Your "Higher Status" work (I admit, I have a real problem with that phrase because it sounds very condescending toward the lowly patient care providers) may very well be under a completely different reporting line such as Quality, Safety, etc. This is not at all uncommon in a matrix organization.

Respectful discourse is the way to go. You may need to take the first step, particularly if she feels any condescension on your part.

KRSRN0930 · Jan 24, 2017

Your "Higher Status" work (I admit, I have a real problem with that phrase because it sounds very condescending toward the lowly patient care providers) may very well be under a completely different reporting line such as Quality, Safety, etc. This is not at all uncommon in a matrix organization.

HouTx, you are correct in understanding my dual role. Sorry, I didn't mean to offend by using the term "higher status," I used it to explain the hierarchy. Actually, I am still one of the lowly patient care providers. She is in charge of nursing but I oversee the organization which includes nursing. Yes, I agree with you! I am trying really hard to define my role, responsibilities and priorities; so I guess I'm on the right track! I just need the support of her and my superiors which has been the challenging part. I feel this woman has a need to be in control and assert her dominance. That is not me, I am not power hungry or ego driven (at least I try not to be).

MrChicagoRN, yes my work environment is so error prone. This woman does not seem to be into education or teaching-only writing up. I am so not trying to negligent or have an "oh well" type of attitude. I do have to admit, I am starting to get a knot in my stomach everyday I see her because I feel like what is she going to find to reprimand me today. I don't think that many nurses willfully try to make mistakes or errors, but I do agree with you, they will not disclose mistakes If they know they will face some kind of disciplinary action.

Thank you all for your feedback!

Libby1987 · Jan 24, 2017

Whether you report directly to her or she reports to you I would still approach it in the same manner as we are all wintegral parts of the whole.

I go into these things, or at least I try really hard, first determining what outcome I'm looking for. If it's anything remotely like validation I check myself and realign. Once I know I sincerely want the outcome to be say a good working relationship that benefits everyone then I know I'm ready.

"Can we talk about how to handle errors and disagreements in our practice? You bring a lot of experience to glean from and I would like for us to be able to give feedback without either of us feeling like crap and I tend to have a negative gut reaction to criticism that feels personal and/or punitive. On the flip side I respond well to suggestions of how to achieve a better outcome.."

For that to work you have to be able to check your pride, not throw up in your mouth as you say it and be able to be strong while simultaneoulsy being soft, it's all about what you want the end result to be and how to get it. Give her a road map she can follow and invite her to take responsibility to communicate better herself. This will decrease defensiveness and direct the attention off of you and back to the collective goals.

CoffeeRTC, BSN, RN · Jan 24, 2017

Sounds like this can be a LTC facility? I'm still trying to figure out your other role.

Have you approached her directly? If this is LTC, there should be an administrator or even executive director. If you've already approached her, then I would move on up the chain.