4 med errors in one shift... Feeling terrible

Wishinonastar, BSN · Feb 22, 2012

I know I used to dream about this sort of thing. I was always terrified of med errors. I will say that in LTC it is impossible to be on time when you have so many patients on so many meds. When I worked in the hospital it was usually a matter of things being late because of interruptions/emergencies. They gave us 1/2hr before or after the due time to help, but PRNs have to be in the correct time span.

I feel for you and I can see how this could happen on a bad shift. Many times nurses cover up their mistakes unless they endanger the patient. Research has shown this. When you are so overloaded all the time it is hard not to. If everyone reported every little technical med error it would be a nightmare.

These sound like errors from rushing, carelessness. For whatever reason. I hope the DON is understanding with you. Hopefully they will put you on some sort of remediation program. Maybe you do need to reconsider your area though. Some people are better at certain things like juggling med schedules.

Best of luck.

Esme12, ASN, BSN, RN · Feb 22, 2012

Honey, we have all talked with you in the past. You seem to be in trouble, something's wrong. You were a LPN before you were an RN and you have been a RN for about 2 years, right? You have said in the past that you have "serious mental health issues" you need to see your provider. Something is amiss, maybe you need your meds adjusted or changed.

Your anxiety is getting the better of you......I'm concerned :hug:. It seems to be escalating. If you see EAP is should be for your mental health not career counseling. Your have time invested in this career, don't throw it all away. Get healthy! Deal with what has gone awry.

I agree with Merriwhen, you are distracted about something. With the supervisor writing you up they are watching you....you need to act now and get healthy.....find out what is wrong and get better. These mistakes are no big deal IF they were the only ones you have made, but they're not and it was 4 in a shift and if I am reading your post it is 3 prn's involved here. The too can set off red flags with your DON.

We care........get the help you need :hug:

luckynurse_1234 · Feb 22, 2012

I hope everything goes well for you! Although it doesn't erase our personal accountability, I feel like our work environment contributes significantly to us making errors, especially med errors. I have had a lot of days where if I hadn't checked my orders at least 10 times I would have made med errors like confusing whose pain med was due when or the doctor sneaking in an order to change/discontinue the pain med and not seeing it for a few hours. Just know you're not alone. I feel like the worst nurse in the world sometimes and like no other nurse makes mistakes, and we're all so paranoid at my work people would rather die than own up to making mistakes. Best of luck!

Margme · Feb 22, 2012

Wow Meriwhen...I wish I had gotten this advice some 30 years ago it would have saved me much heartbreak! I had those issues you mentioned and should have taken time off to address them and give myself needed healing time but alas the 20s decade must keep moving! Even if I had spent 6 months in one place nurturing myself the way I should have been would have helped. Wise advise!

NewGoalRN · Feb 22, 2012

I haven't seen the OP posts before concerning other problems but from what you've written besides the obvious of seeking personal help for whatever anxiety issues you have, I see a time management problem and a focusing problem.

I am terrified, terrified of making med errors. All through nursing school and clinicals this always stayed in the back of my mind to the point of overchecking things sometimes.

You may want to model after some nurses who get their meds done on time or/and come up with a routine for you to accomplish this. I know with the patient load sometimes it's impossible.

Check, check and triple check your orders. Make it a routine to check the pt chart for doctors orders, i.e specifically changes, it's ok not to respond to others when pulling meds, distractions can cause you to make an error.

I've seen nurses take out meds for more than one patient and put them in their pockets (not saying that you did that) but focus on one pat at a time

I don't know your method but try to rexamine your method when pulling and giving meds and see if you can improve it.

Regarding the supervisor, odds are they are or will be watching you closely. it's ok to ask for clarification of an order is not clear.

Feel better and try not to beat yourself up too much but definitely use this opportunity to figure out what's wrong and to improve.

GitanoRN, BSN, MSN, RN · Feb 22, 2012

First of all, receive a warm hug from across the miles...:hug: I'm very concern on your behalf after reading all previous post. Therefore, I would seriously suggest to please take care of yourself first, in order to take care of others. Having said that, obviously, you have admitted that you have a problem with concentration when other people distract you, while your dealing with patients meds. However, whatever the case maybe, you need to slow down and try to get a better routine while dealing with meds. In addition, don't forget to seek counseling or whatever you chose, in order to have a better grasp of your situation. Lastly, always remember the Golden Rules when administering meds. please keep us up to date on your progress... Always wishing you the very best...Aloha~

Psychtrish39, BSN, RN · Feb 22, 2012

NurseLoveJoy,

It may be the area you are working in as well it sounds like LTC . I started to have issues like this when I was becoming ill ( just thought I was tired due to workload) and what helped me is that I got out of bedside staff nursing. I am an oversight RN at a facility and do testing for home care aides and while it is not hands on care per se with medication admin and treatments my years of experience as a staff nurse gave me great assessment skills. I am not making the money I was when working LTC or in the hospitals but I am still helping patients and residents and healthcare and feeling good about my career again . I was to the point of not wanting to be a nurse anymore. I realize now my mind was not suited to the pace and distraction of constant interruptions. That is what causes medication errors nine times out of ten.

To give you a frame of reference my last LTC job I fainted at work due to being anemic was sent out by my coworkers to local ER for evaluation and I was wrote up for 2 med errors because I did not give a medication because I was not there to give it I was in the ER and did not return to work that shift. The nurse that took my patients the rest of the shift didn't catch it either but why would she with her 26 and then my 26 when management wouldn't come in and help. I guess what I am saying look at the big picture and change the environment if getting help for yourself doesnt help you. I am loving nursing again and why I became a nurse. Good luck to you and keep us updated. :heartbeat

nurseprnRN, BSN, RN · Feb 22, 2012

you don't want to keep getting this kind of attention.

no matter what the work situation is, what you are (again) describing has nothing to do with it. i am assuming that all the other nurses in your cohort are not making errors at this rate; if they were, the managers would be making wholesale changes. i understand the kind impulse to say, "honey, it's not your fault, the work situation is to blame, work on your basic med administration skills," but that is not therapeutic communication, and we'd never let ourselves do it with an identified patient; no growth or movement towards health will come of moving the focus of attention away from the identified patient. at this point, that's you.

i agree that the eap is a place to start, but i also agree that it is not career counseling you need. if ever in your past counseling history you learned to look honestly at yourself, now is the time to pull out that skill and apply it again. it does sound as if you cannot do this yourself, without professional help. take the attention you got from this experience as a wake-up call, a learning experience, a red flag, or a warning, and do so seriously.

good luck, and let us hear that you are taking positive steps with the right kind of help, in person, with someone who can see your face and hear the timbre of your voice. while we might care, we cannot care for you. see someone who can.

FutureRN_NP · Feb 22, 2012

today the nursing supervisor wrote me up for 4 med errors i made in one shift. i feel incompetent, stupid, and sad at the same time. i don't believe the errors were life threatening but still nervous that it may cost me my job and possibly my lic. i'm distraught.

here were my errors:
1. i transcribed an order incorrectly
2. i gave a prn med too early.
3. i was accused of giving a pain med too early ( not sure this is founded as i remember having to explain to my patient that i could not give the med until the exact time it is due).
4. same patient as # 3. the patient had a new order to decrease pain med dosage. i noted the order but then gave her the dose that was previously ordered.

all four mistakes could have been avoided if i just would have taken my time and paid closer attention. now i'm faced with a write up and possibly loosing my job and even worse consequences. sometimes i feel like a great nurse who is competent and compassionate. then there are days like today where i question my ability to be a nurse. i pray that nothing went wrong with the patients and secondly that i still have my career.

are you new? i am new been a nurse just under 4 months. i made a med error once gave two pain meds instead of one as md's order due to pressure (pt's screaming and yelling). i told my supervisor thought she would fix it while i was running around like a chicken with a head cut off. the second error was didn't call in x-ray lab during my shift and the third failed to do a complete assessment. i didn't turn the pt look under her bottom to ensure there is or isn't a skin breakdown. later they found she had a skin breakdown on her buttock. great! i didn't do it because pt was overly obese and was in so much pain to even lift her leg. i got written up by the don and got counsel. i didn't get fired but was told not to make these error again. what i have learned?

i have learned to say "no" to pt who asks for pain med that is not due or more than prescribed. i normally do not give at the exact 4 prn. i turn every patient who i admit and check everyone of them from head to toe. i have learned to check all new written orders and take the ones that need immediate attention such as reduce or increase med dosage, stat lab and so on and so forth. for rehap written orders i leave them until i get to sit down and transcribe them.

ultimately, what i really learned is that it is your license and your career. you cannot give in to patients who would otherwise cost everything you worked hard for. so, if you are not fired for these mistakes, learn from it and be careful next time. take your time making sure you cover everything. good luck! i know how it feels because i was there just two months ago.

rn/writer, RN · Feb 22, 2012

When I suggested you seek out the EAP, I wasn't suggesting that you consult them for career counseling, but rather that you should ask for help in identifying what has you so off balance and how to fix, or at least contain, whatever is troubling you. Like some of the others members, I recall earlier posts from you that sound as if you are experiencing anxiety/mental health issues and possibly ADD challenges, as well. Working in a stressful environment can aggravate and intensify any internal pressure you're already feeling.

That isn't to say you should quit your job. Only that it looks like you're going to need help in managing your anxiety level, your thought processes, and the way you're functioning on the job.

There's no shame in having problems. We all have our tender areas. But you do have a responsibility, both to your patients and to yourself, to make sure your practice is safe. If the job you are in is creating too much inner turmoil and pressure, it might be better to find something with a more realistic time frame and patient load.

Then again, there may be ways to help you ramp up your ability to handle your current job.

Either way, something is obviously amiss and it's making you unhappy and unsure of yourself. EAP counseling can help you identify what's causing this, whether it's mental health issues or ADD or a combination of the two. That kind of assessment is the beginning of getting help.

You were fortunate that no one was hurt by the errors you made. Please, take care of yourself and start looking seriously at what you need to function well so that you don't ever have to feel guilty for causing real harm.

I wish you the best.

Long Term Care Columnist / Guide · Feb 22, 2012

NurseLoveJoy:

I'm going to be as gently honest with you here as I can be without sugarcoating the message.

I can't overemphasize the need for you to pay attention to what's going on inside you, as so many others have said so well. Career counseling is not going to help unravel the mystery of confusion, agitation, distractibility, and inability to focus that is causing your work difficulties; eventually it may cost you your career if you continue to look outside yourself for the answers to your inner turmoil.

You see, I know a little bit about what you're going through, because I myself have suffered greatly from repeated mistakes during the course of my life. In my nursing career alone, I've had 12 jobs in 15 years and been unable to settle down for more than 2 years, despite my best efforts. Thankfully, my primary care MD demanded a psych consult, and at long last I finally discovered what was wrong all these years: I have bipolar (AKA manic-depressive) disorder, which disrupts my brain chemistry to the point that I am sometimes extremely anxious, other times depressed, and still other times I'm alternately irritable, hostile, flighty, expansive, happy, breezy, energetic, and impulsive by turns......or sometimes they're all combined. And when that happens, I am horrible to deal with. I am a successful nurse-administrator only because I've learned how to channel whatever energies I have on a given day into doing what I am capable of, and not forcing myself to do what I cannot when I'm in that particular 'mode'.

I'm also fortunate in that my job gives me some flexibility to do that. Your job, not so much. That is NOT to suggest that you should quit, and I would never presume to diagnose anyone with any sort of illness; that's far beyond my scope of practice! What I am saying is, I think you have a great deal to learn about yourself, and if you quit or lose your job now, it will be a lost opportunity to find out what really does make you tick. All of the problems you are having with this job will be carried with you into the next one, and the next one, and the one after that if you don't get to the bottom of what's eating you up on the inside.

I know it's scary.......when you first seek help, it feels like stepping out into mid-air blindly and on faith, not knowing if you'll land somewhere soft or fall to your death. But believe me, you can't fix something if you don't know what's wrong. Knowledge is indeed power.:redbeathe

dvano · Feb 22, 2012

Take a deep breath. We have all made errors, some worse than others. I do have to agree that is alot in one shift.

If you are having anxiety, EAP sounds like an excellent place to star't. Also discuss with the DOn/HR about a change in position. Can't hurt and may help.

Best wishes and keep your chin up