New Grad Interview - Med Error Learning Experience

[AvidAdvocate]

Hello there allnurses!

I just had a question for some of you experienced RNs out there. I have several interviews for new grad residences coming up before I graduate (this December!); and I know that you are commonly asked to cite an experience in an interview.

I made a med error as a student (beginning of second semester) and was suspended from my nursing program for one semester. I went through remediation, and have done well in school since. I was wondering if talking about that experience would be advisable during an interview?

This is essentially what happened:

I was caring for a patient recovering from a lumbar laminectomy, he had a PMH of Type 2 Diabetes. I administered an infusion of Protonix via the ‘B port' in his IV pump. However, I neglected to look at the expiration date on the tubing before my instructor and I entered the room to administer the medication. Because of this, after hooking up the Protonix to the patient's port, the infusion did not begin because the machine detected an occlusion further down in the tubing.

My instructor and I had to replace the primary tubing and bag of Normal Saline which took longer than it should have had I been more diligent. What I learned from this was to always check the expiration date on the tubing when I go in to take the patient's morning vitals, so if I have to administer an IV medication later I will know if I need to bring in tubing or not.

After the IV debacle, I made a serious error in judgment because I decided to descend into my feelings of shame regarding my perceived incompetence. The same patient who had received the Protonix was due for a glucose check and possible insulin administration around 11AM. I was having trouble with the one touch and getting a blood sugar reading (which I also allowed to contribute to my inner self-deprecation), and asked the nurse if she could do it just so the patient could get to his food faster (the meal trays had come earlier than I was used to). She took the Blood Glucose, and I swore I heard, 278” (come to find out, the blood sugar was actually 238).

In my haste to prove that I was competent in some areas to my instructor, I grabbed the supplies needed for subcutaneous insulin administration and approached her. I drew up three units based on the sliding scale (again, still under the ASSUMPTION that the blood sugar was 278). My instructor and a floor nurse signed off on the removal of insulin from the med-cart. I checked the eMAR to see that the order for insulin was still standing, but neglected to confirm the blood glucose value I thought I had heard. I went to the patient room and administered the insulin. I signed off on the administration and the day nurse signed off on it too (this, too, was an error. There are supposed to be two licensed RN's that sign off on insulin administration that are employed by that facility, and it should be the nurses who signed off on the removal of insulin from the med-cart).

After we both signed off, I double checked the medication order as I felt that I had missed something. I realized that I had never confirmed the blood glucose. Panicking, I told my instructor, and we checked the patient's chart. I administered 3 units of insulin when I should have administered 2 units. He had also received Glyburide earlier that day. The combination of too much insulin and oral anti-hyperglycemics in a post-operative Type 2 Diabetic may precipitate a hypoglycemic crisis. The patient's health was not compromised, thank god.

As a result of this medication error, I was suspended from my nursing program for one semester, and underwent remediation before I was allowed to re-enter into the program. my instructor acted in an ethically correct way by recommending my suspension from the program. During that suspension this instructor oversaw my remediation in medication administration skills, she ensured that before I returned to assigned nursing care in a clinical setting that my skills were sufficient and safe. She demonstrated protection of the patient population through that decision.

I learned that I should always, always, always see the blood sugar on a physical screen in front of me before medication administration, and to always look thoroughly through the eMARs in general. More importantly, I realized that rushing and being in my head (selfishly) can result in serious harm if I ever again let my feelings dictate my actions in the clinical setting.

Throughout school, I 2x and 3x check medication orders (sometimes it irritates the nurse supervising me, as it can take time) because I don't want to repeat that mistake ever again. Also, during my preceptorship, I confirmed an order for an IV bolus with a doctor because it didn't look right to me (the patient was a 2 year old with VSD and heart failure, and the doctor ordered a normal saline bolus of 120mL over 20 minutes). As a result of me bringing this up, the doctor changed the order to 30mL/hour and thanked me for my diligence.

I know that it may look bad to admit to an error while I was in school...but the whole experience definitely led to my betterment as a nurse. Should I mention it in a new grad interview? Or stay away?

[Ruby Vee, BSN]

For the purposes of an interview, I'd eliminate most of that detail.

You learned to always check your IV tubing for expiration date so that you'll know to replace it, bring new tubing to the room so you'll have it and to replace the tubing before you start giving a piggy back. Go ahead and describe that scenario (briefly) and congratulate yourself for learning to check for expiration dates and change the tubing before you have a problem.

As far as the accucheck scenerio, you've learned that when you delegate a task as you did, you need to follow up.

And third, you learned to ensure that you know the protocols of your facility re: who signs what and when. If you're unsure, look it up before doing something wrong. Hopefully, you also learned where to find the protocols and how to look them up.

A fourth lesson that I hope you learned is that the first pulse you check in a code is your own. What that means (to me, anyway) is that when you start to feel anxious or unsure of yourself, take 60 seconds to BREATHE -- or actually check your own pulse -- and to calm down a bit. THEN decide whether you KNOW what you're doing or whether you need to double check a policy or procedure, ask a question or get more information. Anxiety sucks. It helps to keep you safe, but it can also cause you to make a mistake. Learn to manage your anxiety now and it will benefit you through your entire career.

[AvidAdvocate]

Thanks alot RubyVee! That was some well thought out feedback and I appreciate you taking the time to respond (I know I posted a novel, I think I'll edit it down a bit). What you said about checking your own pulse first...that rings so true.

The second I stopped caring what my instructor/mentor would think of me if I asked I clarifying questions or refrained from doing something I wasn't comfortable with (i.e., hadn't had enough practice in a skill), I actually improved a lot because I took care of my own needs and thus was better able to take care of my patients needs.

[Ruby Vee, BSN]

Thanks alot RubyVee! That was some well thought out feedback and I appreciate you taking the time to respond (I know I posted a novel, I think I'll edit it down a bit). What you said about checking your own pulse first...that rings so true.

The second I stopped caring what my instructor/mentor would think of me if I asked I clarifying questions or refrained from doing something I wasn't comfortable with (i.e., hadn't had enough practice in a skill), I actually improved a lot because I took care of my own needs and thus was better able to take care of my patients needs.

Learning is a never ending process. We all have to ask questions and we all have things to learn. As long as you focused your answers on what you learned, need to learn or can teach you'll do fine.