My First Clinical Deficiency (Long)

[WeirdNurseKelly, BSN, RN]

So this is my third term of first year and by the grace of God I haven't gotten one clinical deficiency until now. Just kinda down and need to talk about it. I have talked about it with a few fellow students I am close with, but just thought I would share it with others. Hopefully someone can learn from my mistake like I have.

It was the first time since I have started school that I was to be responsible for 2 patients. My CI said it went really well despite the med error I made.

This is how my day went.

Got to the hospital at 0630, before safety huddle and report I had introduced myself to both pts (one I had the day before) and got a set of vitals on both of them. I actually charted one before getting report.

I got report, charted my assumed care and then went to get pts ready for breakfast. One was a postop pt so he needed frequent pain assessments and administration of pain medication. The morning was going great.

My first pt got his CBG and insulin and a few other morning meds. I checked on my other pt, gave him his 0900 meds around 0830 (we have an hour window before and after the scheduled time). He also wanted a pain pill to, so got that for him. At this point I thought to myself, ok I don't have any more meds to give until lunch time (unless my post op pt needed something for pain).

So I went in to my other pts room did his assessment, then charted. Went to see my post op, gave him a differernt pain med (he was on dilaudid, oxycodone, ibuprofen) and did his assessment. So it is about 1000.

Then my primary nurse has to check my other pts buttocks because he has a reddened raw area he has been scratching at. So we did wound care together. Actually I got to do the wound care with her guidance. That took about 15 to 20 minutes.

So now it's about 1030 and I go check in with my CI. All my morning stuff is done, both assessments are charted and I am feeling pretty good about how things are going. Mentally giving myself a pat on the back for my good job. I was a little nervous at first.

My CI was with another student so I was patiently waiting, then BAM!!!!! I realized I missed 2 meds for my diabetic pt that was to be given at 0900 (he was to get captopril and lantus). I began to kinda freak out mentally, almost started crying.

When I had the attention of my CI and was away from others I mentioned to her that I missed the meds. She calmly asked me what happened. I explained to her that after giving my post op pt his meds I made a mental note that I was done passing meds until noon.

She said ok, lets fix the problem. She notified the pts primary nurse while I got the pts insulin ready for her to check and his BP med. I got a BP and pulse for the pt, pt was resting comfortably and not in any acute distress. He was stable for his condition.

We talked about it and she made me feel more comfortable about my mistake. Not that I want to do it again but that I don't beat myself up about it and really let it get to me.

In a way I feel like a total failure and am beginning to think if I am every going to get through nursing school after this mistake. Its in the back of my mind that I will make the mistake again, but then I say to myself I wont make the mistake again because this time I will be constantly checking and double checking the EMAR to make sure nothing is due for any of my pts.

My CI said overall my day went well and that I performed at 95% of my skill level and what is expected of me. Which makes me feel good but so awful at the same time. This was the first time I had 2 pts and I messed it up. She did say she has every bit of confidence I can take care of 2 pts successfully and not have this happen again.

Just wanted to share my experience with everyone. Thank you for taking the time to read this long post.

[*LadyJane*]

You did a good job, you just stumbled in one spot. Okay? Good all day, missed one (important) spot, but really. Don't beat yourself up about this. Just think, how could you have planned your day to be able to not miss these meds?

You could have taken a few minutes early in your shift to list meds you have to give on some time of little time chart, so that at a glance you know what meds you must give at what time. That's what I do, and it's time well spent.

You can do it! You're going to do great!

[cjcsoon2bnp, MSN, RN, NP]

Hey try not to beat yourself up over it, we all make mistakes and I think now that you've made that mistake you probably won't make it again. I don't know if this will work for you but maybe you could take a few minutes before you start your assignment and make a quick list of the time your at your clinical site and what you need to have done by what time. For example:

7:00 AM - Get assignment for the day. Meet and greet patients.

7:30 AM - Perform assessment on patients and obtain vital signs.

8:00 AM - Administer meds. to Patient A. (Drug A, Drug B & Drug C)

8:30 AM - Administer meds. to Patient B. (Drug A, Drug B, Drug C & Drug D)

I think you get the idea, you make a rough game plan ahead of time and then if you get busy you won't forget things because they are already on paper. Then when your done with a task you should put the actual time you did it in parentheses on the end and put a line through it, which can serve as an unofficial record but a useful tool. Good luck!

!Chris

[DaFreak71]

So ya made a mistake. Welcome to nursing school. Actually, welcome to nursing lol. You did a very good job aside from that one error! I'm glad your CI was so understanding.

Don't beat yourself up. You're a student and you are NOT expected to do everything perfectly. You're allowed to make mistakes and learn from them. If that's the only mistake you make in clinical...I'm jealous!

[NursingRocks1998]

Your clinical instructor sounds like a fabulous person! :) Don't give up.

[goodstudentnowRN]

God bless a clinical instructor who is understanding! You did well, you stumbled and now you have learned from your mistakes. This is a happy ending when the instructor is not about craving for importance by failing students. I am very happy for you.

[Ladypie]

At my school, our instructor is next to us when it is time for meds. I am first year, but only just finished our first semester. From what I understand, we are never allowed to give meds independently, even in our last year. We would not have access to the med cart on our own.

I think you did a fine job, and your instructor was kind about it. I'd be more worried if you tried to make excuses or acted like it wasn't a big deal. Your concern over it means you will make a great nurse!

[jaysmom]

You were able to spot your mistake, admit to it for the pt's sake, and fix it. You will probably never forget that mistake and never make it again. We're in school to learn and it sounds like you sure did. Your CI seems really understanding, and like another PP said, in our class we can't open the med cart or pass meds without our instructor present for at least one or two of the three checks. We have to tell her what meds are being given, the action, what they are for, side effects, nursing concerns, and she has already been in the chart to pre check what we are supposed to be doing.

Something that helps me, I write a little to do list on an index card for myself to carry around. I keep it in my back pocket and when no COW is available or I think of something I write it down. Sometimes just the act of writing it out makes it set in stone in my mind. If not I can pull that out and review all day anytime I want to check myself. We are all human and human error is unavoidable.

[WeirdNurseKelly, BSN, RN]

Thanks for all of your encouraging words. I have only had one clinical day since the med error and it went really well. I have my last two clinical days of the term next week.

During my clinical day I was double checking and triple checking the MAR and the EMAR. I was scared about making the mistake again. I was so nervous. Towards the end of my day things were great. I was much more confident than I was when I first arrived there.

Last term (2nd term) was our first term passing meds. We had our instructor with us for a few times when we passed meds, then we were on our own. We still need our CI present for things like IV flushes, hanging abx PB, and fluids, among many others.

I can't wait to tackle the 2 days next week. Wish me luck and again thanks for the encouragement. It has helped a lot.

[truern]

KellT, you need a "brain"

Seriously, first thing I do each morning is take a piece of paper and fold it into fourths. I take a patient label and put in each square. Then I put pertinent history, reason for this admission, etc in blue/black ink. Then I put times meds are due in green and also any orders I need to "go" do...thus the green. As I "go" do, I mark it out. Along the bottom I write any pain/nausea meds I give with the time so I have a handy reference when patients ask for more. Anything I want to include in report I write in red. I would be lost without my "brain".

You made a mistake, but you caught it and you owned it. That's HUGE in nursing.

[WeirdNurseKelly, BSN, RN]

We get brains. But the brains we get contain information for all of the patients on the floor.

I used a form that the hospital supplies to the RNs. It was the first time I had used the form because I had 2 patients. It seemed pretty self explainitory. I guess it wasn't. My CI and I went over it together. Made so much more sense.

I am not giving up on the form that the newer RNs use just yet.

[2BSure]

I don't even know you but I am extremely proud of you. Yes you made an error but to have owned up to it quickly a mistake is 100 percent the right thing to do and you seemed to have no reservation in doing that. Thank goodness you are coming into nursing...we always need people who can take responsibility. Also important was that your clinical instructor did not have a fit. Just don't make that particular mistake again