MedError/Dismissal...What2Do

[DAREINGTX]

u wouldnt normally give it with that BP thats my point. We had 3 pts and it was very busy day

If you feel overwhelmed with three pt's what are you planning to do when

you graduate??

I haven't heard of a nurse having three pt's on any day, much less a busy

one. I know I probably sound harsh, but think about the consequences. There

is a reason nursing school is hard and everyone doesn't make it.

[jeepgirl, LPN, NP]

I have a couple of questions being a nursing student myself.

1. How many patients are they giving you that you could forget to assess

a post op spinal dressing??

2. What have you're instructors been teaching you that you would give

BP meds to a pt with that pressure??

If you feel overwhelmed with three pt's what are you planning to do when

you graduate??

I haven't heard of a nurse having three pt's on any day, much less a busy

one. I know I probably sound harsh, but think about the consequences. There

is a reason nursing school is hard and everyone doesn't make it.

I have a real problem with about two of the above posts in this thread. No, not all of them, but I do think these have nothing constructive to say. Honestly, I do think that while there is room for improvement, I think that the OP knows this. You don't need to be pointing it out to her and being belittling. I know that when I was a student nurse, having three patients was a killer at first.

The tubing thing I do not see what the big deal is... but it is being lumped into together with the other stuff. The point there though is that you ASKED. You didn't just go and do it. A lot of institutions are having tons of meds ran through the same IVPB tubing (much like using dirty toilet paper in my opinion) but it is being done as long as it is flushed / backprimed. Every facility is different. I could easily see myself asking a similar question at some point in time...

When I was a student nurse, at first three patients was very overwhelming to me. If anyone here says that the first few times they took a team wasn't nerve wrecking and challenging, they are lying. And you know what... every single student nurse I know has made a mistake at some point or another. Guess what? If someone says they didn't, they are either too stupid to know that they made the mistakes and didn't catch nor correct them, or they are lying.

It seems like she is on a post op floor, which can be VERY busy, especially if you're taking admissions in addition to your patients.

You know, not everyone is perfect. It is unfortunate but true. Some people own up to it, but some others like to point out other peoples problems so they don't have to look at their own. I see nothing constructive with this post at all. Attacking others is much worst than making honest mistakes, in my opinion.

You've gotten some good advice in the above thread... take that and do what you need to with it.

[LeesieBug]

I AGREE jeepgirl. I've had days with TWO patients that made me absolutely CRAZY. All you need, when you are new, is a crisis with one of your patients to throw you for a major loop. I remember the day I had two, and one patient had a bad reaction to the Phenergan I gave her...AHHH. CHAOS!

I think you got great advice here, OP. The best thing to do is to own up to the errors, explain how they happened, why they were significant, and how you will improve. Then all you can do is know that you did your best, whatever the outcome.

Good luck.

[brotherbear]

I AGREE jeepgirl. I've had days with TWO patients that made me absolutely CRAZY. All you need, when you are new, is a crisis with one of your patients to throw you for a major loop. I remember the day I had two, and one patient had a bad reaction to the Phenergan I gave her...AHHH. CHAOS!

I think you got great advice here, OP. The best thing to do is to own up to the errors, explain how they happened, why they were significant, and how you will improve. Then all you can do is know that you did your best, whatever the outcome.

Good luck.

thanks you guys for all your advice. I definitely feel much better even if I get dismissed tommorrow it makes me feel good that there are people supportive. I dont know if I expressed it correctly but I DO understand the rationale of holding a BP med when the BP is 96/67. What I stressed is that at that time the red flag didnt jump out at me. However, right after giving the med the primary nurse was like "Did you check the BP". I told her I totally forgot and I went back and checked it right then. It was still the same. I checked the BP again 45mins later (PO meds take effect about that time) and it had was 96/66. Barely moved. Anyway, I do know that its not like I'm totally in the dark why BP has to be checked. Anyway, thanks you all. By the way, I'm a guy, not a female ;-)

[SmilingBluEyes]

Good luck tomorrow.

[DAREINGTX]

I have a real problem with about two of the above posts in this thread. No, not all of them, but I do think these have nothing constructive to say. Honestly, I do think that while there is room for improvement, I think that the OP knows this. You don't need to be pointing it out to her and being belittling. I know that when I was a student nurse, having three patients was a killer at first.

The tubing thing I do not see what the big deal is... but it is being lumped into together with the other stuff. The point there though is that you ASKED. You didn't just go and do it. A lot of institutions are having tons of meds ran through the same IVPB tubing (much like using dirty toilet paper in my opinion) but it is being done as long as it is flushed / backprimed. Every facility is different. I could easily see myself asking a similar question at some point in time...

When I was a student nurse, at first three patients was very overwhelming to me. If anyone here says that the first few times they took a team wasn't nerve wrecking and challenging, they are lying. And you know what... every single student nurse I know has made a mistake at some point or another. Guess what? If someone says they didn't, they are either too stupid to know that they made the mistakes and didn't catch nor correct them, or they are lying.

It seems like she is on a post op floor, which can be VERY busy, especially if you're taking admissions in addition to your patients.

You know, not everyone is perfect. It is unfortunate but true. Some people own up to it, but some others like to point out other peoples problems so they don't have to look at their own. I see nothing constructive with this post at all. Attacking others is much worst than making honest mistakes, in my opinion.

You've gotten some good advice in the above thread... take that and do what you need to with it.

I gave my opinion, which is what the OP asked for.

Did you notice that he isn't asking for help with the actual problem, the error's, he's asking for advice on how to get out of it.

If the post was about tips on prioritization, or a better way to reference meds

I could understand your anger, but thats not the case.

It is also stated in the OP that there have been other mistakes in the past, which is probably the reason for the threat of dismissal. These are big mistakes for a student 4 weeks from graduation and I don't think asking how to defend yourself against them rather than how to prevent them should get a lot of sympathy.

[SharonH, RN]

I have a real problem with about two of the above posts in this thread. No, not all of them, but I do think these have nothing constructive to say. Honestly, I do think that while there is room for improvement, I think that the OP knows this. You don't need to be pointing it out to her and being belittling. I know that when I was a student nurse, having three patients was a killer at first.

The tubing thing I do not see what the big deal is... but it is being lumped into together with the other stuff. The point there though is that you ASKED. You didn't just go and do it. A lot of institutions are having tons of meds ran through the same IVPB tubing (much like using dirty toilet paper in my opinion) but it is being done as long as it is flushed / backprimed. Every facility is different. I could easily see myself asking a similar question at some point in time...

When I was a student nurse, at first three patients was very overwhelming to me. If anyone here says that the first few times they took a team wasn't nerve wrecking and challenging, they are lying. And you know what... every single student nurse I know has made a mistake at some point or another. Guess what? If someone says they didn't, they are either too stupid to know that they made the mistakes and didn't catch nor correct them, or they are lying.

It seems like she is on a post op floor, which can be VERY busy, especially if you're taking admissions in addition to your patients.

You know, not everyone is perfect. It is unfortunate but true. Some people own up to it, but some others like to point out other peoples problems so they don't have to look at their own. I see nothing constructive with this post at all. Attacking others is much worst than making honest mistakes, in my opinion.

You've gotten some good advice in the above thread... take that and do what you need to with it.

Isn't this the truth? I've had 3 patients before and been totally blown away, sometimes they can be worse than 10(and I've had as many as 15 patients on my team before). I have also worked a surgical floor and yes, they are very, very busy. The above attitudes are precisely why I have HATED nursing at times. The OP is a student. Now is the time to make mistakes and learn from them, that is the purpose of schooling. I don't know anyone who comes out of school who is totally safe, you can't be. That comes with time and experience. How quickly we forget how overwhelming nursing and school is.

[SharonH, RN]

Hi 50cal,

Every Nurse has made med errors - some of them serious. We are human. If a Nurse ever tells you she has "never, ever, made a med error", she/he is lying.

Whether you are a student nurse or a seasoned nurse with 50 years under your belt...the bottom line will always be: zero tolerance for medication errors. That will never change, for obvious reasons.

You are asking for advice.

1. Own it, without being patronizing and whining. Just own it. "I made a terrible error. This is why I made the error. When I realized I made an error, this is what I did immediately. This is what I could have done to prevent this particular error. This is what I can do in the future to prevent medication errors."

2. Put it all in writing.

3. Put in writing all of the negative outcomes you can think of -or find by researching....regarding your failure to inspect that dressing. Some might be this: I failed to look for - (a) abnormal swelling and/or bleeding at the site, even hemorrhaging into the spinal column, (b) abnormal presence of large amount of "clear" fluid on the dressing - which could be leaking spinal fluid, © green yellow or brown drainage with a fetid odor, indicating infection, (d) the wound has eviscerated - the staple sutures have not held, and the wound is gaping, - these are some of things a Nurse pays attention to with wounds and dressings. Every one of these requires IMMEDIATE intervention. To not inspect a dressing, especially a post-op dressing, immediately, and at regular intervals can lead to disasterous consequences. It is NOT the patient's responsibility to keep us informed.

Treating medications errors lightly, or failing to follow-thru with assessments and treatments is inexcusable. Your instructors are not looking for "excuses" from you. They are looking to see if you are taking this as serious as it is, and have the ability to do the critical thinking required around all of it. They will "size-up" your attitude toward it. Does she SEE the seriousness of this or not? Is she indifferent about it all? Is she more worried about herself than the patients involved? Then they will "size-up" your plan of action regarding both incidents. Did she take IMMEDIATE action to protect the patient, once the error was discovered?

The reason we are "licensed" in the first place is to give evidence to the general public and those we serve, that we have met the minimum standards required by our board of licensure to ensure the safety of the public.

Your instructors will put you on the "hot seat" to test your marketability in terms of the public's safety. Because this is what a Board of Nursing would do as well.

Do keep us informed. Good luck with your future in nursing.

GREAT ADVICE.

[fab4fan]

As a former clinical instructor, I would like to make a few observations.

1. A student that does not know the possible negative outcomes of giving medication to a patient with a pressure of 96/61 RED FLAG.

2. A student that forgets to assess a spinal dressing RED FLAG

3. A student who forgets to inform a charge nurse of a pressure of 96/61 RED FLAG.

4. A student that forgets a patient diagnosis RED FLAG.

5. A student that ask about the compatibility regarding two different drugs and not apparently looking up the information possible RED FLAG.

I am sorry but as a former clinical instructor, your alleged five incidents would make myself seriously question your safety in a clinical setting. At best, I would recommend you repeat the entire semester. At worse, dismissal.

To receive the first outcome, you need to owe up to your alleged mistakes. You need to explain your apparent failure to look up and know the drug reactions and when to administer certain drugs. You need to explain why you failed to monitor the postop patient and his dressing. You need to take responsibility for your alleged failures and I do mean take responsibility. Do not blame the business of the day or others.

I am not criticizing you but merely making observations. Similar observations that the faculty of your program are presently making. We have the responsibility to ensure that all of our students practice in a safe manner. An error or two is forgivable. Five is an indication of serious problems and presents serious safety considerations, for the instructor, other students, patients and the program.

You make take or leave my observations and recommendations, as you wish. They are presented in hopes of helping you to recognize and correct your errors.

Grannynurse :balloons:

I have to agree with this post. These are serious errors, especially from someone about to graduate.

Re the IV tubing: Yes, it is a big deal. Rule #1...if you don't know, look it up. Suppose the person you ask is wrong; then what?

Everyone makes a mistake from time to time, even "supernurses." It's the type of mistakes that I think grannynurseFNP and some others (myself included) find concerning.

I agree that you need to have well thought out answers as to why these mistakes occurred, and how you will avoid making them in the future. Have you had problems in your other rotations over the course of your program? It seems odd that someone would all of a sudden start making mistakes like this right before graduation. Perhaps there are personal issues that are distracting you; not that that is an excuse. I guess I'm trying to understand how you got this close to graduating and suddenly had problems.

I'm not trying to criticize. I dropped out of nursing school three weeks before the end of my freshman year; I panicked when I saw how sick the pt. was who I was supposed to care for the next day.

I went back the next year to complete that semester, and my first day on clinical I made a med error. It wasn't serious, but it sure shot my confidence to pieces. Fortunately, my instructor sat down with me and we discussed it and I was able to move on.

If you're offered the option of repeating the semester, you should do it. I think it might help you gain some confidence and have more time to work on prioritizing and organizing your day.

[rach_nc_03]

Why where you allowed to pass meds with out an instructor or a preceptor?

we didn't need an instructor or coassigned nurse present to pass meds in our final 2 semesters.

[mugwump]

I know I am out of line here but giving a patient a blook pressure med that is 90's over 60's depending on the patient I do it all the time. Granted i work on an antepartum floor and we give nifedapind aka (procardia) for patients with preterm labor. We also have to remember we have to think about the patients and what is going on with them. Why they are also getting the meds. I know we are getting her side of the story as she is writting it. Was the patient with bladder cancer there for bladder cancer or was it part of her history. I'm also curious did this all happen in one day or a couple of them.Anyway I wish you luck tomorrow.

[NeoNurseChic]

I know I am out of line here but giving a patient a blook pressure med that is 90's over 60's depending on the patient I do it all the time. Granted i work on an antepartum floor and we give nifedapind aka (procardia) for patients with preterm labor. We also have to remember we have to think about the patients and what is going on with them. Why they are also getting the meds.

That's a good call :) Can speak for that one personally at least. I take 120mg's of Verapamil 4 times a day. I'm 24...and I do have hypertension, tachycardia - but primarily...Verapamil for me is used to treat cluster headaches. That means...unless I'm dying from hypoperfusion, I want my med. LOL During my last hospital stay for surgery, they sent in a couple different docs to see me just because I was on so much verapamil and they weren't comfortable with it. So..we did drop the dose to 120mg BID, but I have been as high (at one point) as 960mg a day. At that point, it was definitely not good! BP 60/40, HR 40s. So...one can only compromise so much.

There still is no escaping responsibility for med errors - I've learned this as both a student and a patient, but at the same time...it doesn't *have* to be the death of your career, depending on how you handle it. During some of my self-experienced med errors, I would have been slightly less upset if someone had just said, "I'm sorry." Apologies are everything sometimes! :)

A nurse I was working with one day switched 2 IV meds...one was for BP and one was for pain. The patient who mistakenly was started on the IV BP med did not suffer any ill-effects, and she really was quite pleasant about the entire thing. The nurse was upset, and in the end...everything was handled the way it should have been handled.

I do think that when med errors (or any errors) are committed...the very best thing that a person can do (no matter how tough) is to admit it and follow the appropriate steps to ensure that the patient is as safe as possible.

Take good care,

carrie :)