Mistakes

mzloco · Jan 6, 2009

find a mentor....A nurse that you get along with and trust on the unit....run things by her ( or him). ask a lot of questions.... Don't worry...i have 17 years experience and i still need to run things by others.

UM Review RN, ASN, RN · Jan 6, 2009

Ok I have read some posts and understand everyone makes mistakes and we just need to learn from them, but I still question my ability to be a good nurse. I have made some little minor mistakes that have been able to be fixed then I made a big med error giving meds to wrong patient, then Ianother time I gave lopressor when I most likely shouldn't have because it was border line to hold it or not, but the patient was fine bp never went to low or anything, but I just feel incompent. How can I take extra precautions to miss a drug and then have to go back and give it a half hour later or not sign one off but then can't remeber if I gave it. I just feel scatter brained and don't know what to do to make myself feel like I am a good nurse that is safe? Any advice is greatly appreciated.

These things happen, but instead of looking at yourself as a failure, try looking at yourself as a work in process and try to critique the things that need changing.

For instance, you say you feel scattered. The solution to that would be to develop a process for each patient. Part of that process needs to address the medications. For instance, when I do my first assessment I note everything -- right down to the dentures, glasses, hearing aids -- and if I know I have BP meds, I'll take a quick manual BP.

That's part of my initial process. On that same cheat sheet, I have med times in plain view. I start my med pass a few minutes before the allowed time -- we have one hour before and after, which means that if a med is due at 9, I can give it at 8.

Meds, as you have learned, are too important to race through. Take the pills and the MAR into the patient's room. Check the patient's armband against the MAR. Read the order out loud as you check the pill package. That's your opportunity to explain what the pill is for and answer any questions before the patient gets the pill. It's time-consuming and redundant for a reason. The reason is to slow you down at that point so you'll really LOOK. Go over the 5 rights EACH TIME you give a med. Don't get careless at the end of the shift, just because you want to get out on time or because you're running very late. Your patients' safety is your first priority.

Most patients just want their meds so they can go back to whatever they were doing anyhow. But you'll rest easy knowing you completed all the required steps each time.

As far as the blood pressure goes ... a crashing blood pressure is relative. If it's on a med-surg floor, bad, but we can always give a bolus of a few hundred mls of NS and/or ship the patient to ICU. If your patient's blood pressure is 90 and you're hesitant to give the med, try waiting till the end of the med pass and check pressure manually again. If you're still reluctant to give the med, call the doc. Especially if the patient's blood pressure goes very low within a few hours of having a BP med. You have to be a little bit of a detective and check over all the previous blood pressures. Does Pt tend to go way down, stay the same, fluctuate?

I had on LOL once whose BP had to be kept at the 180's systolic because she had such bad orthostatic hypotension that it would drop to the 40's SBP if she had any more than her usual meds. The docs were completely perplexed over that one.

My point is this: if you cannot give a blood pressure med, you need to brace yourself, call the doc and discuss it with him. He truly might not know. Be polite, don't be afraid to tell him you're new and you're learning (it scrapes the crust off some of them ). Some will say, "I don't care if he's 78/39, he's always that way, give the med." Others will whine about being called and your stock answer will be, "Sorry, doctor, it's policy to call when I have a blood pressure med to give and the patient's blood pressure is consistently not supportive of giving it. Did you want to change the dose or give us parameters for giving the med?"

Then carefully chart it to cover your backside. Such as: "Pt's BP was 89/40 at start of med pass and 78/40 manually at end of med pass, so med was held and a call placed to the doctor. Orders received."

In the orders you would write: "Give ___ med now. Only hold if

Of course, you'd want to check the BP again before you gave the med. So suppose the BP dropped more. Then yes, call the doc right back and notify your charge, because the patient's going into a bad place there and might need a fluid bolus.

rnsrgr8t · Jan 6, 2009

I agree with Angie O'Plasty's excellent post. When I was a new nurse, I felt very scatterbrained too and tended to rush things (b/c I was nervous) and make mistakes. I cannot stress enough how important it is to have a process for each patient, procedure, med pass etc that you repeat EACH time. Even if in the beginning, it feels redundant, it will save you from making mistakes. As you progress and get busier, your process is locked in your brain and it will make you stop and catch something as you try to multitask (has to me SO many times). Also, when you start to feel that nervous, flustered, scatterbrained feeling, that is your signal to STOP right then, take a breath and review what you are doing. I have been a nurse for 10 years and can multitask like a pro... but whenever I get that feeling, I know I need to stop whatever it is I am doing, and reassess because that feeling causes me to make errors. It is my brain's signal to me that there is too much going on and I am not adequately giving my attention to whatever it is that I am doing (normally b/c I am trying to do 10 things at once). Although it is uncomfortable and takes awhile to get used to, what you are feeling, in my opinion, is a good thing and you can use it to your advantage as you learn and progress. Also, start watching the other nurses you trust and see what their processes are... I have learned so much from my mentors and the way they do things. It is those little pearls that you don't get in school, are only learned by experience and get passed on from nurse to nurse. Back when I was a floor nurse (a LONG time ago;)), I used to run things by my charge nurse all the time, if I should call the MD, what my patient was doing, could she come and assess herself etc. Also use them to give you feedback on your progress! Be patient with yourself!