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

[cherielpn23]

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

[cherielpn23]

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!

i really i appreciate you response. its just i really want to become the best nurse that i can be, without any of my patients having to suffer because of MY stupid mistakes....i know im not perfect, but theres seems to be x number of mistakes that can be made until a)someone gets hurt or b)you realize this kind of professon is just not for you. but as for myself, im willing to get thru the mistakes to learn from them, but it seems like the stress and anxiety combo. is not doing me any good. but i really want to stick it, given that i JUST started. as far as the ltc setting, im sure theres a certain amount of yrs recommended to gain exp before moving on, if i am correct?

[SuesquatchRN, BSN, RN]

Honey, hang in. It takes a year to feel confident. And your orientation was lacking. In the extreme.

[bebu]

When I began my first job it wasn't at a SNF--I could smell trouble there a mile away! The ratio, the training... sound exhausting.

To be in it for the long haul and survive (without ulcers, without becoming jaded/hardened), I think you have to think about how you are going to evaluate your work. Is it by the current DON? The Board of Nursing? The nursing school instructors who seem to linger in your head?

You need these for knowing the standards of care for you to improve upon, but I think that, in the end, you are going to have to look at yourself in the mirror each night. And if you can say to yourself, with God keeping you honest, that you did your best to give the best care considering all the circumstances, then you have the right to sleep with peace of mind. And that trumps everything else, even if others don't understand or agree.

The good news is that you care. Skills added to that over time will turn you into a great nurse. And I bet that when you see other struggling new nurses, you will be a real encouragement for them when they feel overwhelmed, so this experience will not be lost.

[CoffeeRTC, BSN, RN]

Honey, hang in. It takes a year to feel confident. And your orientation was lacking. In the extreme.

Since the doc and family were involved, they needed to do the right thing and make sure it won't happen again.

As the supervisor or DON, I would have just talked to you and probably tried to help or find out why it was missed and tried to help you come up with a way to prevent it from happening again.

Time is always an issue and some days things don't get done. I've missed dressings or just not gotten to them. Things happen and they are only 8hrs shifts. Prioritize...doing CPR on a resident is more important that a dressing change or cream...duh! Passing meds and sending someone out is going to get done first, then I do treatments. If you didn't get to the dressing, and it is a bid or weekly or something that really needs to be done...PASS it on to the next shift. No one likes this, but nursing is 24hrs. Make sure you cirlce it or do what ever your facility policy is for refused, missed treatments or meds.

If you overlooked it...what can you do to prevent this from happening again? I flag all of my treatments that need to be done, some people write a list...do what ever you need to do.

Confidence comes with time.

[Sun0408, ASN, RN]

Dressing change only twice a WEEK... I would double check that, most are for twice a day or at least daily.. That does not sound right at all.. Of course I don't know the type of wound or tx but still that sounds like a huge risk for infection to the pt.. All of our dressings are changed daily if not BID.

[TheCommuter, BSN, RN]

Dressing change only twice a WEEK... I would double check that, most are for twice a day or at least daily.. That does not sound right at all.. Of course I don't know the type of wound or tx but still that sounds like a huge risk for infection to the pt.. All of our dressings are changed daily if not BID.

I see that you work in a critical care unit of some type. The OP works in a nursing home/LTC facility. I worked in nursing homes and LTC facilities for more than five years, and it was very normal to have dressing changes ordered once every 3 days, every 5 days, or so forth, due to the paper-thin skin of the residents. Typically the dressings were the transparent or translucent types that you'd leave on for several days (Duoderm, Tegaderm, Allevyn, Opsite, etc.).

[sleepyface]

We all make mistakes in the beginning, I know how you feel because when I first came out of school and started working in a nursing home I felt like I was retarded I mean really. I could barely keep my head above water and it seemed impossible to get all my work done. I used to feel like my head was spinning. used to take me 4 and a half hours to do my morning med pass. But it DOES get better. I have been working in nursing homes for three years now and I feel pretty confident in my skills. Just relax and dont give up on LTC just because its overwhelming, you WILL get the hand of it and you will learn so much and youo really learn how to multitask. Thats my opinion, and dont be too hard on yourself for the dressing thing. Good luck

[9livesRN, BSN, RN]

They will wright you p like there is no tomorrow... Get used to it, often they would not take it for real since you are new, and would learn from it. Get a schedule, write it down, come to work 1/2 hour early to write your meds, treatments before report!

[9livesRN, BSN, RN]

I did all my dressing changes right after report, so I knew they were ok, I did after assessing the patients but prior to meds and accuchecks I could chart them and on them! If they messed up after therapy and I had time, I'd fix it if not, there is always another shift right after you....

[hardware syndrome]

u know what just do the right thing always and if you think your boss is not supportive of you always ask your colleague if you have questions or not sure of what to do. remember....management is not a bad word it's that bad people make it worst.

[AJPV]

I think one of the biggest issues in finding a good job is finding a great manager to work for (mine is great). To me, this is more important than the "reputation" the hospital has or how many awards they have won.

[PsychNurseWannaBe, BSN, RN]

You said that everything is computerized... does this mean your MAR/TAR also? Most programs will inform the user if you are past due on something... like an exception report. To bad a fellow coworker didn't catch it for you and did it. It happens. I don't normally write someone up for this unless they demonstrate a pattern. Don't beat yourself up. Take it as a lesson learned. Flag your treatments if you can. It is very challenging with the normally high ratio and less then stellar orientation time. If it makes you feel better, I had passed my NCLEX and before I got my license in the mail... I did a med error. I was so upset. We are humans and we make mistakes. Hang in there!!