mistakes made during your first year...

SoundofMusic · Jul 29, 2008

With your med errors, just do your triple checks. Once while pulling them out of the machine, again, at the counter, and again, at the bedside. Properly ID the patient and you really should catch most of them. Always watch the ones that have to be split in half . ..those get me sometimes.

Always remember to verify insulins ...you wont' believe how fast you get going and forget to do this - and you NEED to do it because you can make errors.

Look up drugs you'renot familiar with -- always. Never give smething you're not sure of.

I ask patients also -- is this your normal dose? Is this when you take this?, etc, etc -- sometimes they know more than we do!

I am BAD at remembering 6 a.m. meds on night shift. I am so involved in labs and new admits, I forget I have those meds and am always scurrying to get them done.

I think I'm worse at remembering to give meds on time, rather than making errors with them.

I've caught pharmacy errors also, just by paying attention to the MAG. Just pay attention -- every patient, every time.

lvs2nrs3535 · Jul 29, 2008

Those half dose at bedtime insulins are a killer, especially if you are not used to second shift....

always recheck your insulins.

Also, my biggest failing? Letting patients or other staff distract me when making a med pass. I beat myself up worse for those than any others. But what do you do when your charge nurse overloads you, and you end up making med errors because you are simply ridiculously overloaded? I was working as a rehab nurse, and with the high acuity patients we get now, (some are coming straight from the operating room now, directly from the ER after MVAs)...I have pts with picc lines, G tubes, IV's, trachs, amputations, huge wounds....anything and everything. Which is wonderful, as a newer nurse this was excellent training. But 7 patients is good. 8 was brutal. 10 impossible for anyone to handle. I was given ten. Theres just no way! I made a med error one night because of that...and Im so frustrated!!!!!

Its my own fault...the MAR read 1 15mg dose, and 30 mg dose, with no 1 or 2 in front of it. Having so many people on narcotics which are 1 pill for 5mg dose, and 2pills for the ten....I took out two pills for the 30 mg dose. And they were 30 mg pills!!!!!!! As I said...there was NO one in front of the thirty, never mind a two...but that should have cued me in. I was running my butt off trying to keep up with the demands of ten high acuity patients, 7 of them diabetic, and I made a med error. Thank GOD the patient was not harmed. He was actually a very happy patient.

But still.

How do you fight back when they overload you like that? I ended p looking bad, no two ways about it...it was a flat our error. Most other med errors were actually documentation errors. Working with brain injured patients you often have to make multiple attempts to give them meds. I know I was written up at least four times for leaving meds in the drawer after I had attempted to give them three or four times. What I forgot to do was circle them and write pt refused, and dump the meds! But I was still written up. I stopped trying to give my pts meds after the fourth time. You refuse? Fine you refuse. But :banghead: how fair is that to the brain injured pts?

I just dont know anymore. I feel so discouraged.

I ended up leaving my job because of it. And I loved my job....Im so depressed. I have been working agency since so I can get day shifts......

arrrrgh....

any advice?

DreamingTree · Jul 29, 2008

lvs2nrs3535, I think you made a good decision quitting your job. Although I'm new to nursing, I have enough life experience to realize that some environments will not change. You were being given too many patients, and it wasn't safe -- end of story. Who wouldn't have errors under those circumstances? You seem to be a very caring person, and as a result, it seems that you are being too hard on yourself. My advice is to be glad that you knew when to remove yourself from the situation. You made the right decision and can hold your head high.

NurseBrittney · Jul 31, 2008

I've been orienting about 4 weeks now. I have 4 more left. I'm on 3 pts by myself at this point and feel I'm doing ok. But... I am just so nervous about everything. I'm terrofied of making a mistake. My time management is not what it needs to be and I really disapoints me when I forget to do things. I just don't see how my preceptor keeps all these things in her brain. I have a work sheet and try to follow it but it seems to take me twice the time to do things that it does the other nurses. I really hope its because I am new. I want to do everything right. I do not want to make any mistakes. I want everyone to be comfortable.

My biggest fear is causing someone pain or harm... even IV sticks hurt my heart because I don't want to 'hurt' my patients even though I know I have to.

I hope I get stronger, bolder, braver, and more efficient with time.

emtb2rn, BSN, RN, EMT-B · Aug 24, 2008

Made an insulin error on Friday evening. Sugar was 321, looked at sliding scale and there were 2 orders (we are totally electronic) that conflicted with each other. I got distracted by verifying the orders, transposed one of the cut-offs (351) for the actual 321 and so gave 12 units instead of 10. Had 2 RN verify the dose as 12 but not the order. The pt was unresponsive, intubated/vented, DNR with unilateral decerebrate posturing and headed for the unit where they'd be checking her BS qH. I didn't realize my error until I sat straight up in bed at 0330 that night. Called my NM at 0800 and left her a message about what happened. From now on I will prevent this type of error by doing a final cross-reference of BS vs the sliding scale and having another RN verify the order as well as the dose. Not sure what will happen tomorrow. 1st error, nervous. Feel like an idiot.

NurseBrittney · Aug 25, 2008

I really dont think your 2 extra units sent this person the the unit...

Tina1639 · Aug 25, 2008

I just graduated nursing school in Decemeber but I didn't start working until March because I moved to a different state. I work in a Cardiac ICU and I was on orientation for about 3 months before I finally was on my own. I had such a hard time adjusting because I was all by myself in a new town, learning a new job at a new hospital. I have only been on my own for about a month and a half now and I CONSTANTLY ask the senior nurses questions. I'm an OCD freak and if I have the slightest doubt, I'm gonna ask someone!!

Some of my mistakes aren't that drastic but I still felt stupid regardless.

I have HORRIBLE skills....I've never perfected things like starting an IV and I had a patient whose existing IV wouldn't draw and was told in report he was a hard stick. I had lab work to do on him so I grabbed all my supplies and was gonna start an IV on him rather than just using a butterfly since he had future lab work due too. Well I got the vein and a good return but it wouldn't thread and whatever I was doing hurt this guys so bad and so when I got ready to take everything out I retracted the needle and forgot to put pressure on the catheter and blood shot out at me and all over the floor and my pants and it scared me so bad that I just pulled the catheter out without putting pressure on it and he yelled in pain.....and continued to bleed all over the floor. It wasn't until then that I realized I never grabbed any gauze so the only thing in my reach was his used dinner napkin off his tray...I was mortified - another nurse came in and in less than 10 secs got the IV and walked out.

And for the others who have posted about being scared about going in....you're not alone. There are days I have bawled my eyes out about having to go in, I've even thought about changing departments because I stay so stressed and nervous. But the only thing I can say is using the senior staff to help you with new situations/questions is the best thing you can do - never be afraid to ask questions. Everyone was new at some point (although some nurses seem to forget that)!

Good luck to everyone with their new jobs!!!

Imafloat, BSN, RN · Aug 25, 2008

I am still on classroom orientation for another 2 weeks and I am just soooo nervous for the first time with my preceptor or the 1st time I am going to by myself. I know that I am not perfect and that I will make mistakes but the thought of making med errors is just looming over me everytime I even think about work. I know that it will ahppen, but I`m scared about that first time!!!!

Double and triple check your meds. We just had a patient get 5 times her dose of medicine because her name and another patients name were one letter apart and they both happened to be on the same med, just different doses.

glamgalRN · Aug 25, 2008

In the 5 days I've been on the floor I have already made sooo many mistakes. But here is one of my "lighter mistakes."

It was my third day on the unit and I was assigned to a stable patient who was being transfered to stepdown. She was an elderly woman with a thick jamaican accent who fell and hit her head the night before. She had an IV running and was on the monitor. She also had SCDs on.

I was in her room doing my assessment and I heard a beeping that occured about every 15 seconds. I had no idea where it was coming from. So I figured I'm going to figure this out by myself and pretty much refused to get my preceptor. I first stood next to the monitor for a few minutes and figured out the beeping was not coming from that area of the room. Then I went to the other side of the patient's bed where her IV pump was and stood there for a few minutes and figured out the beeping wasn't coming from there either. At this point, the patient must have thought I was crazy. She kept looking at me like "where is that noise coming from?!" Then I think to myself, "omg, I hope it's not the fire alarm!" So then I start freaking out in my head and looking at the ceiling to find the smoke alarm. Meanwhile the unit clerk is looking in the room the whole time watching me go crazy, she must think I'm the biggest idiot! After a few minutes I ruled out the fire alarm. Then, over a half hour later, I realized that it was her SCD machine! I didn't even know those things could beep!!! DUH!!!:selfbonk:

I seriously can't wait for the day when I feel comfortable on the unit and know what I'm doing!!

NurseBrittney · Aug 25, 2008

by day 5 you really shouldnt expect yourself to know everything yet

autumnleaf · Aug 25, 2008

My biggest mistake in my first year was not speaking up. I should say screaming up. Often it is hard to be heard . I had a doctor that just was not taking me serious about a patient. She barely looked at him when I said he was acting like he was having a stroke. The next day same thing I finnaly had to get another doctor and right away he took notice. I learned real quick from then on to not be timid and speak up. Dont be afraid to ask questions and dont be afraid to ask for more time to be trained. If a facility can get off giving you only a couple days of traning they will but if you ask for more they will give it. This will help with jitters.

juliek391 · Aug 29, 2008

I work in a nursing home, and I found a resident on the floor right before change of shift one morning. She has dementia and was giggling like nothing was wrong, so I got her up and checked her out, and she seemed fine except that she said her inner thigh hurt a little bit, and she had a hard time bending her knee. I told her to relax in bed for a bit, and I would come in and check on her before I left. I filled out all the paperwork for a fall, told the nurse coming in for the next shift, and checked on her again. She was still giggly and seemed fine, just maybe like she twisted her knee or bruised her thigh. Well, that night I came in for my shift, and saw on report that the first shift nurse sent her to the ER, and she had a broken hip! I never would have sent her out. She seemed fine! So now I know, when in doubt, send em out. And dementia sure is a great analgesic. Yikes.