i did so many errors today.*needing comfort guys

Trauma Columnist · Feb 17, 2007

Hi chick pea - I'm so sorry for your problems with orientation. As a new grad, its not unreasonable to expect more orientation - in the ER where I used to work, new grads got 12-16 weeks orientation. Maybe sitting down with your manager/'preceptor and figure out what you need to be doing and how you can adequately care for your patients?

steelcityrn, RN · Feb 17, 2007

Even though you were responsible for the errors, no one was hurt. You are still on orientation. It sounds like her being around you may be making you more stressed and confused. Maybe you can talk to the manager and tell her that you will learn from all of these and keep trying your best. But I would also just throw out there( and she probably understands this already) , that although your preceptor is doing a great job, you have been very stressed around her, but you will try very hard to deal with it. This throws out a little hint, but yet does not try to place her in a negative light. Might make things a little easier for you.

Soup Turtle · Feb 17, 2007

It sounds like you got frazzled and are making more errors because of the stress. Take some time to think about how you could do better, but KNOW that you CAN do better! You may be down, but you're not out. Don't let anyone convince you to doubt yourself. These are mistakes that you will learn from and leave behind you.

SharonH, RN · Feb 17, 2007

Awwwww, I feel for you. That first year is so very, very hard. Keep your chin up, I made so many dumb mistakes my first few years that I shudder now when I think of it but we all do it. As for the mistakes you mentioned, I've seen experienced nurses do that and worse.

Scoobiedoo · Feb 18, 2007

hi,

its ironic i saw this this am!

i am a new lpn and will graduate as an rn this may 2007. i oriented last summer as a gpn and was flattered to get off orientation in 4 wks! my step daughter whom is a rn and charge nurse told me don't be in any hurry to get off of orientation b/c once you do get off they are gonna throw 5 patients at you and you'll be overwhelmed! and isn't that exactly what happened to me!

last night i worked and i had 5 patients. i forgot to highlight things like 'sputum sample for c+s' and when the next shift came in and asked about it i was like "huh?" boy did i feel stupid...

so don't feel bad. i have been told it will get better and you just need to find your own way to get organized and find what works for you.

on the other note - i never-ever leave any med(s) in a room even if i have to just leave the room to get the pt a glass of water. take the med(s) with you! i don't even leave saline hl flushes in a room when i'm not.

just do your best to think things thru. also, its sounds like you need a better preceptor!

best of luck!

Mags4711, RN · Feb 18, 2007

I forgot 2 vials of diluded for the PCA in my pts room!Good thing the pt was honest and returned it to me....
...reported me to my manager about the diluded earlier that day i don't know what she's gonna do about those other errors i made later

I know you must be stressed, it's hard when you start your first job. I wish you luck and try to take a deep breath and do the best you can. Days can be very stressful, but you've got to get the routine down before you go to nights. On many units the patient load is even heavier on the night shift and some places there is not as much back-up on nights. Lots of times the night staff is also the most inexperienced staff, so you've got to be pretty sure of what you're doing. I agree with those above that have suggested talking with the manager about extending your orientation. Be pro-active, ask for it yourself before they come to you to tell you you need it. It shows you are aware you need some more guidance and are more than willing to learn as much as you can.

There are many nurses who do seem to want someone to fail, there are threads and thread and threads here about how nurses eat their young, it is an unfortunate fact of life. Perhaps your preceptor is one of those types whether she realizes it or not. Perhaps she's just one of the type who thinks you should come out of nursing school ready to hit the floor running and know all there is to know about nursing. Perhaps she is just not a good fit for you to orient with. Is there a unit educator who sets up orientation? Can you ask that person to assign you to another preceptor? You could approach it that though you think your preceptor is a very knowledgeable nurse, you feel you are just not "meshing" and you have a different learning style than the way she teaches.

One thing, though. And this may seem to some that I am nitpicking, but it's Dilaudid. If you had made spelling error once, I'd have let it go. But you've made it twice and I have to ask how often you look up, or how much you know about the meds you are passing if you don't know the spelling of such a common PCA medication. Especially one that has caused you such problems. You also say "Good thing the pt was honest and returned it to me." Did the pt return the two vials of Dilaudid to you right away after you left it, or had you not noticed it at all and the pt brought it up? Was the Dilaudid for that patient? If so, why did you not just load it in the PCA, how did you come to set it down and leave? Setting down anything, especially two vials of a narcotic and walking away is a pretty big no-no. We all do make mistakes, especially under stress, but please remember never to set anything down that is a med and walk away from it.

chick_pea · Feb 18, 2007

I know you must be stressed, it's hard when you start your first job. I wish you luck and try to take a deep breath and do the best you can. Days can be very stressful, but you've got to get the routine down before you go to nights. On many units the patient load is even heavier on the night shift and some places there is not as much back-up on nights. Lots of times the night staff is also the most inexperienced staff, so you've got to be pretty sure of what you're doing. I agree with those above that have suggested talking with the manager about extending your orientation. Be pro-active, ask for it yourself before they come to you to tell you you need it. It shows you are aware you need some more guidance and are more than willing to learn as much as you can.
There are many nurses who do seem to want someone to fail, there are threads and thread and threads here about how nurses eat their young, it is an unfortunate fact of life. Perhaps your preceptor is one of those types whether she realizes it or not. Perhaps she's just one of the type who thinks you should come out of nursing school ready to hit the floor running and know all there is to know about nursing. Perhaps she is just not a good fit for you to orient with. Is there a unit educator who sets up orientation? Can you ask that person to assign you to another preceptor? You could approach it that though you think your preceptor is a very knowledgeable nurse, you feel you are just not "meshing" and you have a different learning style than the way she teaches.
One thing, though. And this may seem to some that I am nitpicking, but it's Dilaudid. If you had made spelling error once, I'd have let it go. But you've made it twice and I have to ask how often you look up, or how much you know about the meds you are passing if you don't know the spelling of such a common PCA medication. Especially one that has caused you such problems. You also say "Good thing the pt was honest and returned it to me." Did the pt return the two vials of Dilaudid to you right away after you left it, or had you not noticed it at all and the pt brought it up? Was the Dilaudid for that patient? If so, why did you not just load it in the PCA, how did you come to set it down and leave? Setting down anything, especially two vials of a narcotic and walking away is a pretty big no-no. We all do make mistakes, especially under stress, but please remember never to set anything down that is a med and walk away from it.

Thanks for the correction.It's well appreciated.Actually i don't really use ' dilaudid' very often i just usually use hydromorphone coz that's what comes up in the pyxis:nuke: this was the first time i handled a pt with a dilaudid PCA.The two vials was suppose to be reserve i requested it early from the pharmacy because it usually takes them a long time to send up a new vial.But i know no amout of rationalization that can justify what i did.

I know leaving narcotics in my pts room was a really huge mistake and boy will i remember this for the rest of my life.My manager told me that after this she was sure that i would be the safest person in giving meds because i sure will remember this.

Trauma Columnist · Feb 18, 2007

I'm terribly sorry but Dilaudid and hydromorphone are the same thing! You truly do need to go back and review what you are doing. I can overlook spelling but its very obvious you have no clue what you are doing with this medication and it has the potential to kill a patient quickly and easily if the PCA isn't set correctly. Please take care but maybe a review of the most common meds that are given on your floor is in order?

psalm, RN · Feb 18, 2007

...a quick question, do you eat before your shift? Coz if you are low on fuel, you are more prone to make mistakes. As for the PCA of dilaudid, we have to order it from pharm and sign for it, so if we order it early and it comes before the pt. needs it, it goes in our pyxis for safe keeping. If I know the pt needs it within 20-30 minutes, it goes into my pocket still in the pharm bag til I put it in the PCA.

Mags4711, RN · Feb 18, 2007

Thanks for the correction.It's well appreciated.Actually i don't really use ' dilaudid' very often i just usually use hydromorphone coz that's what comes up in the pyxis:nuke: this was the first time i handled a pt with a dilaudid PCA.

Sorry to :deadhorse but like TraumaRUs said, they are the same thing, hydromorphone is the generic name and Dilaudid is the trade name. So you've been using hydromorphone "usually" and somehow never knew it was Dilaudid??? I am sorry, we all make mistakes but I would never hang something because "that's what comes up in the pyxis." Drugs have trade and generic names, it's our job to know that, and know what they are. You really do need to start looking up your meds and changing the way you handle them.

My manager told me that after this she was sure that i would be the safest person in giving meds because i sure will remember this.

You are right, you will remember this. I clearly remember the first drug mistake I made. It was potassium chloride, I gave it four times too fast for the floor rate of administration. Boy, did I freak. I put the toddler on a monitor and sat at her bedside (while I wrote myself up) for a couple of hours watching the blips go by until I was sure she was okay. To this day I get a little "hitch" in my breath as I am hanging K+, keeps me grounded.

Mags4711, RN · Feb 18, 2007

And while pockets aren't the Omnicell (or Pyxis), I also use my pocket (but a front one, I've seen someone sit down on a PCA vial before-ouch!) to store something in that I'm going to hang within a half an hour or so. Much better than setting it on the counter.