i did so many errors today.*needing comfort guys

[chick_pea]

i'm a new grad and i've been orienting for about 8 weeks now.I should hve been starting my night orientation 2 weeks ago but i guess i'm not doing well so my preceptor suggested to my manager that it would be best to keep me orienting on day shift bef i finally start nights. Today i guess i made the biggest error ever. I forgot 2 vials of diluded for the PCA in my pts room!Good thing the pt was honest and returned it to me. My preceptor saw this and she reported this to my manager.My manager then called me and told me that such an act is a valid ground for termination, but since i'm still orienting she will let it pass. Earlier that day i forgot 1 med tablet in my pts room.i was suppose to give it but then she was sleeping so i left it in the table so i can give it to her later ( bad move).And to top all that the pts iv line has air in it so i disconected it and tried flushing the bubbles out from tubbing but i forgot to close the antibiotic line so i almost emptied all of it! and it was only a 50 cc rocephin. There's just too many things goin on that i forget things. And my preceptor is the kind that well not let anything go.She 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 that day. And to think she was in the room while i was doing this.I wonder why she did not say anything?I've had other preceptors before her but she seems to be the only one making such a big fuss out of this.I mean don't get me wrong i learn from her but she makes me feel so inadequate.I mean i have seen a lot of nurses who forgot to open antibiotic lines.*sigh*i guess i'll just expect for the worse.

[Ann RN]

Nurses who "pocket" narcotics can be accused of diversion. Everyone should know this. Nurses that do divert often put narcs in their pocket, later claiming that they "forgot". So be careful. The excuse "I forgot" may not be good enough.

[PANurseRN1]

So? She hadn't done a dilaudid PCA before, so what? She's probably given it IV. I've never done a dilaudid PCA yet because we haven't switched to that yet, but I give it IV all the time.

Anyone can make an absent minded mistake like this once. She's new and has a nitpicky preceptor breathing down her neck. I'll bet she never does it again!

I disagree. Those were not "nitpicky" mistakes. Almost bolusing someone with an IV abx? Leaving controlled substances at the bedside? You'd better believe that preceptor has a right to be watching the OP like a hawk. If anything adverse were to happen, the preceptor could get caught up in the mess that ensued.

I think the OP needs some remedial education. Maybe she'd feel less stressed with a new preceptor, but I absolutely disagree that the preceptor is unduly giving her a hard time.

[PANurseRN1]

This how I read it as well.

No, because she pointed out that while she was familiar with hydromorphone, this was the "first time" she'd ever worked with a Dilaudid PCA.

I don't understand that at all. And leaving that aside, there remains the issue that she was willing to prepare a PCA with a drug she was unfamiliar with. Big no-no. You never give a drug if you don't know it...period. There are no exceptions, ever, to that.

[PANurseRN1]

I just thought that she meant she hasn't used dilaudid/hydrmorphone on a PCA pump before, not that she hadn't given it via other routes.

If she was unfamiliar with this, then she should have asked for help.

[Imafloat, BSN, RN]

Nurses who "pocket" narcotics can be accused of diversion. Everyone should know this. Nurses that do divert often put narcs in their pocket, later claiming that they "forgot". So be careful. The excuse "I forgot" may not be good enough.

I work in an open unit and I am so paranoid about narcotics that I make sure they are always in plain sight once they are in my custody. I make sure that someone reads the label and watches me waste before asking them to sign that they witnessed. I work in the NICU and the amounts we give are almost nothing (I gave 0.014 mg of a sedative last week) but I never want there to be a question as far as me and drugs are concerned.

[dijaqrn]

Chick pea I hope you're taking these posts to heart. Remember to breathe and review all of your rights before giving any medication and NEVER place a narc anywhere it doesn't belong. Patients love to take their meds "later"...put them away where they belong. If you actually didn't know what Dilaudid is please take a review course for pharm and/or carry a drug book on you. Being suspected of diversion is scary and not many other nurses or managers want to be involved. You are very lucky you had an understanding manager. Good luck, practice safely.

[Ubernurse]

:redbeathe So when I first started some months ago I felt inadequate. I felt like I wasn't catching on to my patient's diseases and making mistakes. Another nurse told me something that really put me at ease. She said you can't do everything and at the end of the day ask yourself "is my patient still alive?" If the answer is yes, she said I should continue. Just shake it off and take your time the next shift. :redbeathe

[linzz]

I too had some pretty rough times with a preceptor that thought that new nurses should not get any precepting or orientation, just learn as you go! So that was a real treat. Although I have only worked LTC as an LPN, the other posters are right about leaving pills, although I am sure that you just made an honest mistake. I will not leave pills for residents, they take them or I chart as refused. I worked at an assisted living facility and as some of the residents declined in mental abilties, they would stuff pills in their dresser drawers or under the pillow or mattress. One day I found that a lady had saved a days worth of regular timed oxycontin tablets and these were not charted as refused and she could not remember when she took her pills last:eek:.

[rose1135]

I am in my second week of orientation in the ER. This is a little off the original subject, but I am having trouble with the trade/generic name. I have been doing narcotic count, and feel kinda ignorant that I don't recognize a certain drug by its generic name, but I just keep asking!! And when transcribing meds, I get on the computer and look up other names, and indications, instead of just asking another nurse. This has really helped me to learn several drugs in a short period of time.

I have also felt overwhelmed at my job. I had a pt. yesterday, and the pain was increasing, so the doc ordered morphine. After taking FOREVER to get it prepared (cause I am kinda slow!! :) ) I go to the room, get ready to give the pt the med, and after verifying her name and asking her allergies, she says "I am allergic to Morphine, I told you that!!" I then had to get a new order, and take even longer getting it ready. I eventually asked another nurse to administer the drug because I felt this pt was becoming frustrated with me!! I am just so glad I asked her to repeat her allergies!!!

[cuddlebug]

ok. You must really be so nervous or hypoglycemic from not eating that you are doing these things. I had an instructor once who was hard on me.

She made me nervous so nervous I didn't think clearly. What i learned is that before you do something, say to yourself-ok what am i going to do? Am I leaving the patient's room with everything I came in with? Also, if you don't know what the med is- what for, side effects, contraindications, how to administer, safe range then look it up. Yes, it takes more time but it makes you safe. Be safe. Be organized. Be calm and incontrol.

[DutchgirlRN, ASN, RN]

Even though you were responsible for the errors, no one was hurt.

That was just luck IMO. It sounds that besides being nervous this new grad needs some extra time with just meds. Why on earth have 2 vials of PCA Dilaudid on you for back up? Makes no sense. When the pump begins to alarm that the medication is getting low, then you call and request a refill vial if there's not one in the pyxis. Never ever order two at a time! When it's delievered you keep it locked in the med room.

Never leave pain medications or any other kind of medication in the patients room. If they don't take it, waste it, whatever it is. These issues seem so basic nursing to me.

If you haven't grasped these concepts yet then you shouldn't be practicing on your own just yet. This is not a slam in anyway, it is good sound advice for the patients safety and your license. Everyone learns at a different pace. It takes some grads longer than others. Discuss this with your manager. I don't know what your facilities policy is but never refill a PCA or change the settings without the presence of another RN. I've been doing this for 31 years and still don't do it alone. It's too easy to get distracted with too many things on your mind and set it for Dilaudid when you're really inserting Morphine. Two heads, in this case, are better than one.

Good Luck!

[nj1grlcrus]

I am still a nursing student, but I will pass on what my clinical instructor told us Thursday night. She said, "I think some of you are confused over my role as your instructor. I am not here to test your clinical skills, we do that in class, I am here to help you. You can ask questions, and admit that you don't know how to do something, that's why we are here to work TOGETHER." I am still wrapping my mind around that, but it is a much less stressful situation than to think I am constantly being judged. I think you should ask for more time in orientation, and take the additude that you are working together, not that you are performing a job with a critic watching your every move for a mistake. When unsure, fell comfortable asking questions, ask for help if you feel overwhelmed, take a deep breath, and don't worry if the other nurses are laughing, you will be laughing about yourself, too, when you are more experienced. That was the second point the instrustor mentioned. She said, "Just think of how much more you know now, than when we first started." She seemed like such a hard-ss, but she is really on our side. So is your preceptor.