Medication Errors

[AdultHealthCNS]

I have practiced as a nurse for 6 years and only had 2 medication errors. However, in the last year of employment at my previous organization, I ended up making several more over a 7 month period. Prior to that, I had not had any in 2 or more years. I have done work-life counseling, analyzed the issues thoroughly and thought about multiple ways to keep this from happening again. I believe they were due in part to 1. the environment of my unit changed drastically in the last year I worked there (it became very punitive and management was firing nurses left and right for any little mistake; this caused me to be very stressed and feel pressured at work all the time; they also short staffed us and put us in unsafe situations) and 2. I was dealing with multiple life stresses outside of work that were causing me to be really anxious.

I left this job last year to go on the mission field. I had been planning to leave for 2 years prior, so the mistakes I made were not why I quit.

I recently applied for a position as a CNS and was offered a job. During my hiring process, when they asked why I left my old job I was honest in telling them I was ready to transition from the bedside since I had received my master's to be a nurse educator and that I had been planning to perform medical mission work.

No one asked me about any performance issues I had or whether I had made any errors at work. They only required you to report on the application if any disciplinary action had been taken against you or if you were forced to resign/terminated from a position. I didn't disclose the information about the errors. I had previously talked to my previous manager extensively about them and he stated he did not feel I was an unsafe or incompetent nurse, and told me he thought I was a good nurse and would hire me back. Also, the life stresses that I was dealing with at that time have resolved and I am not under any stress that I feel would compromise my ability to safely practice. I am concerned he may have to share this information about my performance with my new employer and that it may mean they rescind the job offer. Although I took the job, it is contingent on my references.

I have two questions:

1. I was told by several recruiters and experienced nurses/managers that I was not obligated to disclose this information, but am now questioning whether that was an ethical decision. You hear so much information nowadays about unsafe nurses being allowed to practice. I do all I can to protect my patients and intervene immediately if I think anything adverse is happening to them, and don't feel I am unsafe. I have just carried so much guilt and shame over these mistakes. Should I have made it a point to talk about them even thought I wasn't asked?

2. How should I handle the situation if my previous employer shares this information with my future employer?

[Rose_Queen, BSN, MSN, RN]

The vast majority of medication errors are related more to systems issues than to a single nurse. Unless your medication errors contributed to major adverse outcomes such as loss of life or limb that would cause you to be reported to the BON, there's really nothing unethical about not disclosing them. However, I would hope that these incidents have affected your practice in that you are diligent about the 5 (or whatever we're up to now) rights of medication administration. I would be more concerned about the nurse who is blasé about medications errors. Many safe, competent nurses have made medication errors, and I would venture to say that any nurse who tells you they've never made an error either is lying, never realized it, or doesn't deal with many meds.

As for disclosure by your previous employer, they are allowed to say anything that is factual by law. However, many will have a policy of only stating dates of employment and eligibility for rehire status.