Medication errors- is nursing for me?

[Simonesays, BSN, RN]

Here's my story. I moved from Canada to the US about 6 months ago to be with my long-term boyfriend. It was a big change/adjustment and I am just now beginning to feel settled. I loved my job in Canada and it was VERY hard for me to leave. I felt fulfilled doing what I did. However, I am so happy to be in the same city as my boyfriend again.

I know that I am lucky to work where I do. The market is competitive here and I am a non-US citizen. I have had really thorough training and my manager is very supportive. However, I made a stupid mistake during orientation involving a narcotic medication. The patient changed her mind and only wanted one out of the two narcotics I had brought her. When I returned the extra medication to the drawer, I put both back. Meaning the patient did not get any narcotic medication at this time, even though I had scanned one of the pills. This was chalked up to learning (electronic system vs paper charting where I had come from, busy day with lots going on) and I reflected on the factors that caused me to make this error.

Three months later, I am off of orientation and I just made another narcotic error. The narcotic count was off and it was discovered that my patient was given double the amount of her narcotic (which was already a high dose). A message popped up in the system at this time, but there had been messages that popped up each time I gave this medication as she had a cross-allergy. I know why I did this (rushing at the end of my shift, a busy night, tired, the patient had a dose range and the higher dose was one pill, not two of the lower dose pills). Most importantly the patient was okay. However, I have now demonstrated a pattern of error and am thinking it is likely I will be fired. And I am questioning if nursing is for me here. I certainly don't want to harm my patients and these types of careless errors could have caused serious harm.

My practice was certainly not perfect in Canada, but I didn't make these types of errors. I had a similar number of patients, who were more acute than the patients I work with now, and I didn't make these types of mistakes. My visa is contingent on me having this job so there is that factor (and added pressure). I don't know what to do. Although I might not have a choice, as I am working this weekend and then have a meeting with my manager on Monday.

Any comments/advice are much appreciated.

[nutella, MSN, RN]

Everybody makes mistakes, we are human beings. Important is that the patient is ok and you seem to feel accountable.

We know that when mistakes happen that there are usually underlying system failures that contribute to the mistake or other circumstances that make it easier for a nurse to make a mistake. We can not expect to be perfect but we have to be diligent enough and also not negligent.

The first mistake was when you were new and there is a lot of pressure in your situation.

With the second mistake, a root cause analysis would be good to determine everything that contributed to the error. In your case it sounds that it was night, you were tired, stressed, and the patient had multiple orders for one medication or a range. In addition, it seems that you have "pop-up window fatigue" - it is a real thing now with computer charting and electronic medication management. I know of places where staff requested changes because nobody would pay attention to the pop up windows anymore. If the patient was not able to engage in medication verification or could not give input changes of an error are higher, also if you are distracted by noise or conversations while pulling meds.

I think you have a huge learning curve including culture, nursing, electronic systems. Plus you work nights. When people get fired because of a mistake they are often put on leave right away. The fact that they did not do that and you are allowed to work means that they deem you safe enough to work. My hope is that your manager will call you into the office and conduct a root cause analysis. Perhaps you will get a warning or written up but it might not happen - it depends a little bit on how your workplace deals with the "culture of safety". Bedside nursing has become very stressful and it is easy to make a mistake although we have more technology now and there are system improvements.

Be accountable when you talk to your manager, say that you are sorry, reflect on what contributed to the error. Perhaps there is something you can do to improve your focus at nights and make suggestions to the manager like making sure you are not distracted when you pull meds, stick to reading all warnings and pop up windows and do not try to get around the system. If you are working 3 times 12 perhaps working 5 times 8 would be better.

I am sorry that this happened to you - it does not mean that nursing is not for you. It means that you are human and go through an adjustment period. If they sponsored a work visa for you, it is unlikely that they will fire you easily as they have invested in you. Every nurse makes mistakes and I do not know anybody who never made one... perhaps those that never worked bedside,not sure.

[Simonesays, BSN, RN]

Thank-you so much for your thoughtful response. I really appreciate your feedback. I generally tend to be pretty hard on myself and am trying not to worry myself too much over what happened as I can't change it now. I can only learn from what I have done and if allowed another chance, put a plan in place to keep my patients safe and keep this from happening again. I'm going to email my manager tomorrow with said plan. The only good thing about these mistakes is that my patients were ok. Thanks again, Nutella!

[nutella, MSN, RN]

Thank-you so much for your thoughtful response. I really appreciate your feedback. I generally tend to be pretty hard on myself and am trying not to worry myself too much over what happened as I can't change it now. I can only learn from what I have done and if allowed another chance, put a plan in place to keep my patients safe and keep this from happening again. I'm going to email my manager tomorrow with said plan. The only good thing about these mistakes is that my patients were ok. Thanks again, Nutella!

I hope things will work out for you! I suggest that before you sit down and write an email to actually sit down and journal about the whole experience, your thoughts and where you are at. That process could help you to sort out your thoughts and emotions and gain a deeper understanding of what you would like to achieve and what your goals are. Your employer should be happy to have a nurse who is actually taking the time to reflect on an error in a meaningful way and feels accountable.

[sallyrnrrt, ADN, RN]

I truly hope for the best....

in my 44.5 years as a RN, I have made mistakes, I used the majority as learning or teaching moments.... Meaning good practice can come from a mistake with the correct reaction, response, and efforts to learn from it

[Ruby Vee, BSN]

We ALL make mistakes. Every single one of us. Two mistakes can be a pattern, but what your superiors are going to be watching for is what you do after you've made the mistake. If you admit the mistake, immediately set about to minimize or mitigate the harm to the patient, inform the patient's doctor and write up the appropriate paperwork it's going to be clear that you're not trying to cover anything up. Then make sure that your manager finds out from YOU rather than from someone else, and make sure she understands that you realize the potential ramifications to the patient and you will do anything in your power to prevent it from happening again. As my then-boss told me years ago, "It's really hard to beat you up over a mistake when you're already clearly beating yourself up."

"They" may be watching you for awhile, but it sounds as though you've done all the right things. Try to forgive yourself.

[quiltynurse56, LPN, LVN]

Where I work, we are to fill out a med error report when a med error is found. I have had to report myself a couple of times. I write what contributed to the error as well as what I could do to prevent a like error. When an error has been brought to me, I have to think back and can usually figure out what went wrong. I have always owned up to my mistakes. Thankfully I worked for a place that was more than willing to work with new nurses as I was at the time.

It sounds to me like you are owning up to your mistakes and have figured out what happened. This is a good thing and in your favor.

[Simonesays, BSN, RN]

Thanks so much to everyone who responded. I had my meeting earlier this week. My manager is looking into the incident further and then we'll have another meeting later in the week. She is being very fair. I still am not totally sure as to what the outcome will be in terms of my job, but I know that I am going to change my practice and I will be a better and safer nurse because of these errors. I also reflected on why I was making these mistakes and realized that part of the reason is ongoing stress from so many life changes at once that I haven't properly dealt with. I am taking steps to more effectively manage my anxiety/stress so that it doesn't spill over into my work. Thanks again!!

[loriangel14, RN]

I really don't think that two mistakes constitutes a "pattern". Everyone makes mistakes. Where I work you don't get punished for making med errors.