new grad & written up for the first time today at work :/

CompleteUnknown · Oct 29, 2011

or atleast a verbal warning/ write up as the don called it? it was due to a missed dressing change ( not intentionally, it seems like i missed it on the treatment record, and so it wasnt done. i was just hired at the nursing home i work at, and everything is computerized, so its taking a while for me to get acquainted with the system.) apparently the patient had a drs appt to have the wound looked at and debrided soon after, and because the drssg had not been changed & stuck to the wound, it was very painful for the doc to remove it. its understandable for the doc and fam to be very upset as a result of inaction on my part, and all the DON told me was to "make sure it doesn't happen again".
now im sitting here completely distraught! this past month and a half has been so overwhelming, have 30 pts in the rehab sec. of the nursinghome, & feel so stupid sometimes because im making alot of mistakes...and its also taking alot out of me physically and emotionally (was planning to continue in the nursing field but thinking about switching majors. its too stressful :/) and for this to happen worries me even more, esp knowing that the fam got involved and i could possibly be named in a lawsuit in the future?
just in writing this, its hard to hold back tears. not only am i genuinely worried about the pts well being, but the fact 'that my license is basically on the line for any harm that the pt suffered from the drssng removal is driving me into a hole of depression & guilt (these days my stomach is always turning and i think im losing my appetite to even eat well).
im just asking anyone here for any helpful advice/suggestions for me in this situation, please. -Cherie

OP, I think you need to relax and calm down a bit. You missed a dressing change, that's all. These things happen! It's a long way from the end of the world and yes, it would be nice if you were perfect but you're not, and you never will be. None of us are.

If it was me, I would apologise to the patient and family and move on. There's not much more you can do. I suppose anything is possible, but I think it's extremely unlikely that anyone would lose their licence over a missed dressing change. If I'm reading your post correctly, the dressing was changed at the appointment, it's not like it was left for days on end, so in terms of possible harm to the patient, I really can't see any.

Debbierose, RN · Oct 29, 2011

Chalk this off to learning. You won't make this mistake again will you? I have to tell you-my first several months as a new nurse I felt stupid and/or inept frequently. It'll get better...and so will your skills and confidence. I promise you-it will get better. But you have to be diligent. Remember to check and then recheck to ensure nothing was missed. Good luck to you.

rainfallrx · Oct 29, 2011

Honey, you will be okay! Once you make a mistake and it bothers you that much, you are more than likely never to repeat it. In the scheme of things, its not a big deal. The dressing was changed. Don't beat yourself up! I also find it very helpful to write down things that I have to do. I was a med/surg nurse for 5 yrs and now work in LTC. Its a lot of responsibilty, a lot of residents. You got 4 freakin days of orientation L that wasn't fair to you). It will get better. You just need to find your own way of organizing yourself because time management is very important. Take bits and pieces from what others do and make it your own. Once you organize yourself, you will be less likely to miss anything and that also helps when emergencies come up. You can't depend on your memory. As far as having ur lisence taken, no way. Relax. Its done. You've learned. Next please. Lol. Don't give up, we need good nurses! Hope that helps u! :nurse:

Lifeofanurse · Oct 29, 2011

I'm in the camp as it being a paperwork issue rather than a nursing one...sort of.

I'm a new grad LVN. No job yet...but have shadowed a job which I knew would be too much for me in a LTC and said so in the followup interview.

This was the EXACT reason I felt it would not be right for me beiing so new.

There is a huge binder of all my residents treatements...resident by resident. Every medication is listed and the time to be admiinistered as well as treatments such as nebs and wound care.

There isn't a master list...so you constantly are going back to the book and having to go patient by patient...and if it's say...1000 and they have a 1200 med to be given..I would need to pass it up..go to the next client..handle their wound care...and whatever else is needed...and then REMEMBER to go back to the previous patients..who have meds due... it would be a constant ..one step forward and two back...to backtrack checking every pt on my halls...that's almost 30 people!

I just couldn't figure out how the nurses were keeping it all straight. I saw lots of false documentation going on.

signing off on a pt...even just their outward appearance/demeanor... and never even seeing that pt that day yet because they don't have any treatments scheduled is just as illegal as documenting that you gave/didn't give a medication. Wrong is just wrong...there is no leeway.

Time management is a skill to be learned but there surely is a better way to keep track of it all then thumbing through that huge binder every 5 minutes and praying you don't 'miss' something.

I wish they would print out a master list.... one that lists each patient and then has their meds given on that shift (when and how..too), their treatments that you need to administer AND any appts/consults that they have. This would make the day much easier to manage and make sure things aren't missed and make it easier to prioritize if you have it all right in front of you in an easy to read/find format.

I don't know if anyone does it this way? The place I shadowed sure didn't. I just didn't think I could figure out a good way to handle it as a new grad and not risk my license.

46oldnewrn · Oct 30, 2011

That is ridiculous that you only orientated for 4 days. I had four weeks of orientation, I would have made so many med errors with only 4 days. Also the "Doctor" should have soaked it first to allow it to come out easier, so it is okay for you to cause pain to the resident, but not the doctor???? Run like double hockey sticks sister!!

FutureNurse_203 · Oct 30, 2011

Cherielpn23,

Im a new grad LVN and work in LTC. I received 5 weeks of orientation and I am still making mistakes! On average I have to pass meds and do treaments on 30 patients. If I take a break, I will get wayyyyy behind. Although I am still working at the LTC facility, I am filling out applications elsewhere. After 2 months of LTC, I realize that LTC is not what I want to do. Its wearing me down being on my feet so many hours so dont feel bad! And with only a couple of days of orientation, they should be thankful a dressing change is the only thing you forgot. Good Luck from one new nurse to another!

CharlieTaco · Oct 30, 2011

lol, forgetting to change a dressing is probably the smallest mistake you could possibly make. If its supposed to be changed every 12 hours and you didn't do it, it was still changed that day. The Dr was blaming it on you because he didn't want to make it seem like he was the one causing the pt pain. It would have hurt either way. The pt isnt going to die because you didn't change the bandage so just keep trying to get better. With more experience you will get your task done faster and be able to complete them all and take your breaks. If you don't, you'll burn out.

TheCommuter, BSN, RN · Oct 30, 2011

like anyone, i just dont wanna end up screwing myself over, losing my license, getting sued and jailed.

This is not a lawsuit-worthy issue. You may wish to take a course in nursing and the law just to become assured regarding what patients and families can and cannot sue for. In order for an individual to sue, (s)he must have a cause of action. If you or the facility have not been found guilty of a tort (civil wrong), then any action to sue you or the facility would likely be dismissed if it ever was filed. Personal injury suits are extremely risky and tremendously expensive for lawyers, so generally they do not take the case unless there is a clear cause of action and a large amount of monetary recovery is likely.

Furthermore, I have never heard of any nurse losing a license or going to jail over a missed dressing change. Usually, the incidents that involve loss of licensure and jail time revolve around truly serious issues such as working while impaired, narcotic diversion, and so forth.

OhioCCRN, MSN, NP · Oct 30, 2011

I also received 4 days of orientation at my facility.

Word of advice... start applying to a hospital STAT!!!

6-12 complex patients is better than 25-40 NH patients.

LTC is a lawsuit waiting to happen to a new grad.

Im about to start my 12 WEEK orientation at an amazing hospital.

Take it like this: LTC was hardening you for nursing, because its a trial by fire if i ever saw one!

AJPV · Oct 30, 2011

If you want to calm your nerves about losing your license, read your state board's disciplinary actions (usually listed in the BON newsletter - available online). You will see that your "offense" is in a different universe than those that lead to actual license suspension/revocation. I've even seen in these newsletters that nurses whose actions directly lead to a patient's demise often receive a mere censure or short suspension! Now that's unbelievable. I wish the BONs would focus on bigger issues - like getting truly dangerous nurses out of the profession quickly (ie, not taking 2-5 years to revoke licenses of those convicted of major felonies, abuse, sex crimes, etc.)

Ginger's Mom, MSN, RN · Oct 30, 2011

As others have stated, look for another position ASAP. You expressed the need for more orientation and they pushed you on the floor, only to write you up !?

cherielpn23 · Oct 31, 2011

lol, forgetting to change a dressing is probably the smallest mistake you could possibly make. If its supposed to be changed every 12 hours and you didn't do it, it was still changed that day. The Dr was blaming it on you because he didn't want to make it seem like he was the one causing the pt pain. It would have hurt either way. The pt isnt going to die because you didn't change the bandage so just keep trying to get better. With more experience you will get your task done faster and be able to complete them all and take your breaks. If you don't, you'll burn out.

for the particular pt i had, the drssng had to be done twice a week...so missing the change meant that it was left on for approx. 3-4days, give the fact i worked on only one of the days the change was scheduled....thats what concerned me