New Graduate RN Error -- Nervous wreck

[BeccaB2014]

Let me preface this saying that I graduated from a BSN program this past year and I started working at my current hospital soon after. I had 3 weeks of classroom orientation, 3 weeks in a MS floor, and 2 weeks in CC before coming to the ER which I have been in for about a month. We have 6 months of orientation. Furthermore, this is an extremely high volume ER.

Just last week I made an error and co-signed on a mislabeled a type and screen for a patient that was possibly going to be transfused. It wasn't my fault, apparently, but it was still me who co-signed on it. In the end it was caught, the patient wasn't transfused, and I was informed that there wasn't a write up yet, but things are in limbo with this. When this happened I explained the error to my manager, said it wouldn't happen again, and re-educated myself on the policies and procedures. This was my first error, and it was a serious one. Since then I was extra cautious to label the T+S tubes correctly.

Despite this, today, I mislabeled a specimen for CBC/BMP by swapping labels (both patients names started with the same letter and ended with the same letter). I sent it and my preceptor and I realized the error within 10 minutes and called to rectify it, but it was already processed by the lab under the wrong patient so I had to complete an incident report. I went in to the DON of the ED this morning to mention what happened, and was informed that I have also been taking too large of a patient load for a new grad which is probably what contributed to the error (not as serious as a T+S one, but an error nonetheless). The DON emphasized that it was the second time and I need to be more careful. I apologized for the mistake and promised to exercise even more caution (a given).

Both of these occurrences are seriously giving my confidence as a new grad a beating. I have been feeling really overwhelmed and stressed at work, especially since things are seriously crazy in my ER with patient ratios of up to 20 for our preceptors. Ergo, they don't have much time to supervise us or offer tidbits of knowledge so it's a pretty challenging place to learn in. However, I felt pretty similarly on the MS floor and CC units that I was on. I am such a nervous wreck about this and am worried that it's going to be a three strikes and you're out type situation. I've been losing sleep over it and know if have to take things slower and double check myself, but it's so hard to avoid moving quickly in such an environment. Despite all this, I love working in the ED am excited to come in to work all the time. I feel like I am making a difference, and couldn't imagine myself anywhere else. Working with a really awesome group of people doesn't hurt either.

Is it normal to feel overwhelmed like this on a near constant basis as a new grad? Does anyone have any advice they could offer?

[Liddle Noodnik]

I graduated in 81 and have made serious errors from time to time, even in the last year that I worked. I don't minimize it and I'm glad to see that you don't. But it is also not unique to you. We all mess up sometimes. The fear is that we will harm someone and that's possible! Nursing is a tremendous responsibility! I love your response to both mistakes, the studying up, the owning of your mistake, etc...

Meanwhile your confidence will grow and the mistakes will be fewer. Give yourself a hug and continue to carry on - you are definitely not washed up and you are definitely not alone.

[NotReady4PrimeTime, RN]

The day they require perfection and automatonic behaviour from nurses, I'll have to quit. Making mistakes is part of the human condition. We aren't machines; we have an advantage over machines in that we are able to learn from our mistakes and sometimes apply that learning to other situations. The two "huge errors" you made are errors I've made. I've only validated one incorrect T&S, but I've mislabeled specimens, sent specimens to the lab without labels, sent requisitions without labels and almost given a med to the wrong patient. I've also made a number of more serious errors. I was never treated as though I was a failure, but was expected to learn from my mistakes and not make them again.

This statement just jumped out at me from your post: I went in to the DON ... and was informed that I have also been taking too large of a patient load for a new grad which is probably what contributed to the error.

It set off all kinds of bells in my head. So. The DON has acknowledged that you were being put in a position where you were in over your head, but made no effort to change it. In future, I recommend you ask to have such remarks made part of the record. If it ever came down you defending yourself over an error and someone in a supervisory position KNEW you were overwhelmed but didn't do anything to alleviate the situation, you'd have a much stronger position.

I work in a crazily hectic ICU where we have a lot of new grads in your exact situation. They haven't the experience or the knowledge base to care for the patients they're assigned and make errors, sometimes very serious errors. To me, ultimately, the blame has to lie with the ones responsible for ensuring our patients have the right nurse, with the right education and experience, at the right time. And that's not the new nurse's job - administration has to take some responsibility for staffing decisions. We just show up when we're scheduled to work...

[SubSippi]

The first thing you need to do is learn to forgive yourself for making mistakes. EVERYONE makes mistakes, and beating yourself up over it won't make you a better nurse.

My second piece of advice, is for you to make an effort to slow yourself down, especially for the next couple months. You need to start double checking, because that is really the best way to prevent yourself from making a similar mistake in the future. Like I said, people screw up all the time. But the best nurses...while they may make a mistake from time to time...they are NOT going to make the same mistake twice.

You're a new grad, you're still learning. Your managers and coworkers will understand if things take you a little longer, they probably even expect it. So with that in mind, if I were you, I would make a special effort to slow it down, and make sure I'm getting the little things right. Because, while the DON has probably already forgotten you mislabeled the labs, if you do something like that again soon, I think it could cause you some problems.

Quit worrying. Just do you best, pay attention, be helpful to your coworkers, and one day you'll leave work and realize you've finally gotten the hang of it.

[dah doh, BSN, RN]

Mistakes happen! Please don't berate yourself, instead learn from them! Slow down! As a newer nurse, your expectation is that you are safe in everything you do; whether it's labeling labs, giving meds, etc. but that you will be a bit slower. Speed will come with experience.

[RunBabyRN]

I agree about slowing down. It's easy to get caught up in the pressure to keep up, but safety is more important than speed. Advocate for yourself and your patients- if you have too large of a load, speak up! Ask your charge for help.

I think it's normal to feel overwhelmed and nervous as a new grad. Let that humility HELP you, rather than hurt you. Take extra steps to ensure safety as needed.