Messing Up As A New Nurse

[Ringers]

How to deal with mistakes? I was told to give MOM to a resident to get a faster stool sample, although I knew they had a BM the day before. MOM is mainly used for our facility protocol if no BM in X days. I just listened to the nurse, because I figured they had experience expediting the process for stool. I failed giving the med because the resident kept refusing after attempts at different times and with different people. I didn’t think it was much of a problem if they didn’t receive the MOM as we could always wait until a regular BM. It just happened to be that the day after I didn’t give the MOM was Day 1 they didn’t have a BM. I worked on their Day 2 of no BM. I haven’t been in since. We were given an announcement that we failed to provide proper care because the resident now went X days without a BM. I’m now thinking I messed up on my end by not giving that MOM. I feel like I lacked in following the instruction by the experienced nurse…I feel like I have done such a horrible thing. I feel like fingers can point towards me for withholding that MOM and not communicating appropriately 

[Nurse Beth, MSN]

From what you're saying, you did nothing wrong, but can you share the protocol completely? How many days does "X" represent?

[Ringers]

9 minutes ago, Nurse Beth said:

From what you're saying, you did nothing wrong, but can you share the protocol completely? How many days does "X" represent?

If the resident hasn’t had a BM 3days in a row, you provide MOM. If there’s no result you proceed onto different options. 

[Nurse Beth, MSN]

So you followed the protocol, as you weren't there on Day 3.

It's actually good that you did not administer the MOM when the other nurse told you to, because you did not have an order to do so and the protocol says "Day 3", not "when convenient for collecting a stool sample"

Even if a senior nurse tells you to do something, the responsibility lies with you. Best wishes ?

[JKL33]

On 8/13/2021 at 1:44 AM, Ringers said:

I haven’t been in since. We were given an announcement that we failed to provide proper care because the resident now went X days without a BM.

Well that sounds like the person who was on duty the day that it should have been given didn't give it. So that doesn't have anything to do with you.

There is a different problem, though.

You took an order from a nurse (nurses who are not authorized as providers cannot give medical orders) and attempted to follow that order. The fact that it wasn't accomplished isn't for your lack of trying to accomplish it.

Listening to more experienced nurses is unfortunately not risk-free. You have to know the ground rules and I trust that you do know them. Then you must incorporate them into practice--apply them. If you did not have an order from a provider to use MOM for the purpose you were attempting to use it, that is not allowed. PRN orders (such as your PRN MOM orders at your facility) are to be used only for the reason specified in the order. Remember your Rights of medication administration and follow them strictly. Always. ?  A basic rule of thumb while you are learning and developing your own nursing wisdom is that if you don't have an order of any kind that supports what a nurse is telling you to do with a medication administration, then don't do it (at least until you can verify it or get a new order for what you want to do). You take your medical orders from providers, not peers.

No harm, no foul - - but only if you let this be a wake-up call/learning experience. Learn the lesson then move forward!

??

[Ringers]

7 minutes ago, JKL33 said:

Well that sounds like the person who was on duty the day that it should have been given didn't give it. So that doesn't have anything to do with you.

There is a different problem, though.

You took an order from a nurse (nurses who are not authorized as providers cannot give medical orders) and attempted to follow that order. The fact that it wasn't accomplished isn't for your lack of trying to accomplish it.

Listening to more experienced nurses is unfortunately not risk-free. You have to know the ground rules and I trust that you do know them. Then you must incorporate them into practice--apply them. If you did not have an order from a provider to use MOM for the purpose you were attempting to use it, that is not allowed. PRN orders (such as your PRN MOM orders at your facility) are to be used only for the reason specified in the order. Remember your Rights of medication administration and follow them strictly. Always. ?  A basic rule of thumb while you are learning and developing your own nursing wisdom is that if you don't have an order of any kind that supports what a nurse is telling you to do with a medication administration, then don't do it (at least until you can verify it or get a new order for what you want to do). You take your medical orders from providers, not peers.

No harm, no foul - - but only if you let this be a wake-up call/learning experience. Learn the lesson then move forward!

??

It was a PRN order in their MAR! Although I still questioned about giving it because they weren’t technically constipated yet the days I worked. I will definitely learn from this experience. Thank you ! 

[JKL33]

Just now, Ringers said:

It was a PRN order in their MAR!

Yes. But it is very important to understand that PRN orders are only valid for the reason/indication given in the order--which in your case was the "no BM x 3 days." Someone who is not a provider cannot come along and tell you to give it for a different reason/indication. The reason is part of the order.

Does your PRN order in your MAR include the reason? It most certainly should and if it doesn't it is not a properly-written order. I think you said it does include the reason/indication, though. So always follow those indications just as you would any other part of the order. ?

Everything's obviously okay with the patient and I'm definitely not trying to berate you. I hope that comes through even though I'm kinda straight-forward sometimes. I just don't want you to get into trouble in the future. ??