Messing Up

[rnlady112]

I am a new graduate with less than 6 months floor experience. Well, I made my first med mistake. PCA programming gone wrong, patient received a ton more morphine than prescribed. I caught mistake, notified MD, monitored patient, did risk event, notified manager. Patient was stable, and if anything, had an enjoyable 2 hours. My question revolves around feeling better when mistakes happen and not getting discouraged. I am an anxious person by nature, worrying about everything that can happen. Now, I worry that somehow I will be sued for the error. I have looked up statute of limitations, etc. This is my personality- to worry, worry, worry- and I have tried different methods to get it under control. I know new nurses feel unsure, and it's a very scary feeling. I am on a difficult PCU floor, from what I have heard from other RNs. 

In a nutshell, I am looking for advice that this DOES get better. I do not sleep before my shifts, barely sleep after. I also wonder if the floor that I am on/high stress that comes with it is not for me; however, I have very little experience to transfer units. I take accountability for every mistake I have made, hide nothing. Luckily, this patient was okay and there were steps to take if she wasn't. But the feeling of incompetence is driving me crazy! Any advice is appreciated. 

Thank you all in advance. 

Sincerely,

A struggling new grad 

[Jedrnurse, BSN, RN]

I always thought that one of the basic things necessary for a lawsuit to be viable was that some harm had to have happened.

It sounds like there was no adverse effect from your error...

[RNperdiem, RN]

Doesn't a PCA narcotic require a cosign from another nurse? Next time you get a PCA, find your charge nurse and have them check your settings.

Since the patient wasn't harmed, a lawsuit is unlikely.

The feeling of incompetence does get better for most of us. It takes time, experience, and the ability to pick yourself up time after time. To build the resilience a nurse needs to survive, you need to master the art of self care.

Forgive yourself, learn from your mistakes, pick yourself up and take care of yourself.

[JBMmom, MSN, NP]

Mistakes happen. Fortunately this one resulted in no harm, so as has been stated already, no harm means no lawsuit. 

It does get a bit better, but you're going to have to find a way to balance your anxiety with your profession. We are in a profession where mistakes can lead to harm. And even if you don't make a mistake, patients can experience a change in condition and bad things can happen. 

You're not incompetent. You're new with not much experience. Clearly you care about your patients and you will be fine. But it sounds like you're not treating your body well for the long term. If your anxiety is keeping you from sleeping or being able to enjoy your life outside of work, that's not a tradeoff you can make for long without consequences to your mental and physical health. Take care of yourself!

[Nunya, BSN]

6 hours ago, Jedrnurse said:

I always thought that one of the basic things necessary for a lawsuit to be viable was that some harm had to have happened.

It sounds like there was no adverse effect from your error...

And you did say he had an enjoyable two hours...?

[Sour Lemon]

8 hours ago, rnlady112 said:

Hi all- 

I am a new graduate with less than 6 months floor experience. Well, I made my first med mistake. PCA programming gone wrong, patient received a ton more morphine than prescribed. I caught mistake, notified MD, monitored patient, did risk event, notified manager. Patient was stable, and if anything, had an enjoyable 2 hours. My question revolves around feeling better when mistakes happen and not getting discouraged. I am an anxious person by nature, worrying about everything that can happen. Now, I worry that somehow I will be sued for the error. I have looked up statute of limitations, etc. This is my personality- to worry, worry, worry- and I have tried different methods to get it under control. I know new nurses feel unsure, and it's a very scary feeling. I am on a difficult PCU floor, from what I have heard from other RNs. 

In a nutshell, I am looking for advice that this DOES get better. I do not sleep before my shifts, barely sleep after. I also wonder if the floor that I am on/high stress that comes with it is not for me; however, I have very little experience to transfer units. I take accountability for every mistake I have made, hide nothing. Luckily, this patient was okay and there were steps to take if she wasn't. But the feeling of incompetence is driving me crazy! Any advice is appreciated. 

 

Thank you all in advance. 

Sincerely,

A struggling new grad 

I did something really stupid as a new graduate. It's a lonely feeling, because people aren't in a big rush to share the time they did something just as bad or even worse.

Your patient is okay, and you'll be okay too. There's not much you can do about the bad feelings besides ride them out, though.

They say it takes two years to feel alright and seven years to feel competent. If that's true, you only have a year and a half to go before you'll be able to sleep well again. ?

Take care.

[Tweety, BSN, RN]

It does get better.

You say you're already anxious, don't sleep, and are stressed out all of which might have been a factor in having your guard fall and make a mistake.

This will get better, but while looking at your error and how not to repeat it, you need to look into how can you make your life a little less miserable without buying into the idea "this is how I am".  You don't have to live like that.

All the best.

[OyWithThePoodles, RN]

The hospital I used to work at required another nurse to verify and electronically sign their 3-4 ID in the computer. If this isn't in place at your facility, maybe this is a good change that will come. With every incident report filed they should be doing a risk analysis, a way to see if the incident could have been avoided and how to prevent it from happening again. If something like this isn't in place, maybe you could suggest it. 

But worry not, we have ALL made mistakes. Some big, some little. But we always learn from them. And usually don't make the same mistake twice because the first time scared the **** out of us. 

[UrbanHealthRN, BSN, RN]

Once upon a time I worked night shift at a pedi hospital. I was probably a year into my job when one night I took care of a little boy who had pneumonia. 

Despite my insect brain level of nursing knowledge at that time, I actually managed to catch this kiddo's increasing respiratory rate and labored breathing that nobody else had seemed to notice. I felt good about that. Soooo good, that when I went to hook him up to oxygen, I set the O2 to 0.2 L instead of 2 L. Couldn't figure out why he wasn't improving until the sun came up in his hospital room window and I saw my mistake, clear as day, with the oncoming nurse. 

OP, one way or another, it will get better if you want it to. Don't be afraid to double check your work, ask questions, ask for help, whatever it takes to keep your patients safe. I think some of my early anxiety came from wanting to look as good as the other nurses around me, when in reality all that mattered was what was on my own plate. 

[sleepwalker, MSN, NP]

Was the order checked, verified and co-signed? Way too easy to program a wrong bolus, incorrect infusion rate, allow a pt self-bolus that's not ordered, etc. leading to a rapid response situation or worse.

Always verify and obtain a co-sign with PCA pumps

[0.9%NormalSarah, BSN, RN]

Like others have said, no harm came. These mistakes happen no matter how new you are. Don’t give up and leave your floor, you should try and stick it out. The first year sucks. Just try and manage your anxiety and sleep as best you can with therapy or a conversation with your doctor, and know that for most nurses it gets better with time. 
 

I’ve made a couple mistakes (the ones I know of!) that didn’t result in harm, and felt terrible afterward. I’ve been working on a technique: think through the management of the problem if it HAD resulted in harm. For this, you followed protocol and if RR had dropped significantly or patient was too somnolent, what would you do? Give some narcan! Work through scenarios, problems and solutions in your head when you consider potential mistakes. This may help you to be a better responder when things do go wrong, and can hopefully alleviate some of the anxiety you feel when things go wrong. It’s been working for me, a highly anxious person who started in critical care as a new grad. I feel your anxiety! 

[Hannahbanana, BSN, MSN]

I made a dreadful error in my first months out of school, gave a medication as I and several others heard the chief of surgery give to the intern (what we now call first-yr residents) in an emergency situation. No time to look it up, chief is breathing fire to get this BP down stat stat stat, dictates to intern to write it. Intern stands next to me the whole time. Give q5 min IV push until BP in acceptable range. She got five doses. 
Well, the BP went down alright. And down, and down, and down, and down, sweet jayzus, until the pt nodded off, stroked, and never woke up again.  I was beside myself when I looked it up later ... and saw it had a delayed onset of up to 15 minutes. Devastating. 
Chief came back and blamed the intern, who was also devastated. My head nurse, who saw the whole thing, said not to blame myself. It’s been a lot of years and I still remember seeing that pt on a guerney in the hall a few weeks later, still ... gone. 
I learned that you never trust even the chief of service on a drug or treatment you don’t know until you look it up, or hand it to him to give (it’s almost always a him, isn’t it?). 
Any nurse who tells you that she has never made a mistake is lying. But I hope you hear enough of these to avoid the really bad ones.

Good advice about keeping your cool and thinking about mitigation. In my case, in those yrs, there was none. But two very common errors:quick fixes?

Insulin OD: D50W

Opioids: naloxone (Narcan)

No harm/injury, no basis for lawsuit, so rest easy on that one.