New GraduateWith 3 Incident Reports

Nurses General Nursing

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Hi all, I started working as a RN a month ago and I’m worried that I’m not doing a good job. Last week I got called into the num’s office to do discuss two incidents that occurred a couple of weeks ago. One concerning a doctor complaining about me due to their patient not going to X-ray in time. Another one about a medication chart being filed as finished when the new form had not been filled out correctly ( I would not do this but coped it on the chin). On Friday I made a medication error. My buddy’s patient required some PRN pain relief and I gave them 1g paracetamol not realising that patient was also written for regular paracetamol three times a day. My buddy told me the error and spoke to the charge nurse. I completed a incident report but I am now concerned about the impression I am making at the job. I’m so stressed that my num will feel I am useless. I am extremely worried that I am failing as a nurse. I have booked in time with my facilitator for a debrief but questioning if I approach my num tomorrow about the error as I feel it is the right thing to do but am extremely nervous. I am really looking for any insight into what I should do! At this point I’m questioning my whole career choice!

Preceptor surely is not responsible for this type of action, even if the OP was still paired with him/her. No. If a new nurse happens by and decides to medicate someone else's patient that is on them.

***

Anyway, @Taito29. I agree with previous comments, we have all made mistakes. The error you made with the acetaminophen is easily made, it has been done before and there's no reason that this type of error hasn't been eliminated by our processes and technology. This patient pretty much shouldn't have had a PRN order for this at all if he already gets 3g a day at baseline.

But, even though you are new, you have to take steps to tighten up your own practice. You said

4 hours ago, Taito29 said:

I was in a rush and did not double check

You can't afford to operate this way. There is a lot of pressure on nurses and you have to decide early on that you're not going to compromise patient safety by succumbing to it. You need to understand that much of the pressure on nurses is directly due to decisions that other people have made. We are not on solid footing when we compromise patient safety when we rush around and don't pay attention while trying to make up for others' decisions (like staffing or having an inappropriate orientation). Uphold the basics you were taught in school.

[I commend you for addressing the need you became aware of but you are so new and have had some sort of very short orientation, you're still in the stage where perhaps the best thing you can do about the needs of other nurses' patients is to let the nurse know of the need so you can stay focused on your own patients for now.]

You also said that you copped to an error you didn't make. This, too, reinforces my thought that you're displaying an MO of accepting responsibility for other people's problems, to your own detriment and your patients.'

Take a deep breath. It'll be okay. You need to refocus. Do what you were taught in school. Stand tall, be proactive, don't get distracted trying to do everything and please everyone.

??

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37 minutes ago, JKL33 said:

"Preceptor surely is not responsible for this type of action, even if the OP was still paired with him/her. No. If a new nurse happens by and decides to medicate someone else's patient that is on them."

Must disagree. I made it clear to all of my new grad orientees not to give meds without running it by me. We passed all meds together. We could then discuss the rationale and biological action, and most importantly review the MAR before administering. If they still pushed a pill without me.. still on me for not making my instructions clear enough.

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Specializes in Community Health, Med/Surg, ICU Stepdown.

The error with the parecetomal (is that Tylenol?) was a systems error, not your error alone. Dr. prescribed it that way, pharmacy approved it, MAR did not warn you about the total dose. Our MAR has a warning when you're getting close to exceeding 4g in 24 hrs, and I think they changed it 3g. We are supposed to check it manually as well, but many don't since we have the warning or just don't think to check.

For pt safety and others to learn, bring it up as a systems error. Don't discount your part in it, but don't take full responsibility. Also as a new grad with minimal training (so unfair!) don't try to help out with others' pts. You may feel you're burdening other nurses with questions or needing help, but that is for pt safety. You can help out later! Good luck!

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Reading all the subsequent replies made something jump out at me: one important quality the OP needs to develop is assertiveness.

The doctor grousing about when someone gets taken to x-ray? Tough beans. Looking after someone else's patients during orientation? "Sorry, I'll get my preceptor." Never take a patient's word for what meds they've already had. Regular acetaminophen plus a PRN that exceeds daily limit? Bad order that needs to be addressed.

Someone pegged it right. The OP is busy trying to please everyone. Great way to get thrown under one bus or another.

OP: while you're developing your nurse brain, don't neglect your nurse spine. You will need it every bit as much.

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Specializes in Tele, ICU, Staff Development.

If I were your unit educator, first of all, I'd be honored, because you sound wonderful. You are not blaming others and you are learning from your experiences. Best wishes and believe in yourself.

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Specializes in ICU, LTACH, Internal Medicine.
1 hour ago, TriciaJ said:

The OP is busy trying to please everyone. Great way to get thrown under one bus or another.

1000%

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Specializes in Med Surg, Tele, PH, CM.

Organization of time is one of the biggest challenges to a new nurse. And they don't teach it realistically in school. My question is why are you on the floor by yourself with just one month of experience? My daughter was required to complete a six-month orientation on a Med/Surg floor as a new grad. You are not a bad nurse, you are just too new. If you have the option, I would look for a Magnet hospital that has an adequate orientation program.

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On 5/31/2020 at 3:35 AM, Taito29 said:

Hi all, I started working as a RN a month ago and I’m worried that I’m not doing a good job. Last week I got called into the num’s office to do discuss two incidents that occurred a couple of weeks ago. One concerning a doctor complaining about me due to their patient not going to X-ray in time. Another one about a medication chart being filed as finished when the new form had not been filled out correctly ( I would not do this but coped it on the chin). On Friday I made a medication error. My buddy’s patient required some PRN pain relief and I gave them 1g paracetamol not realising that patient was also written for regular paracetamol three times a day. My buddy told me the error and spoke to the charge nurse. I completed a incident report but I am now concerned about the impression I am making at the job. I’m so stressed that my num will feel I am useless. I am extremely worried that I am failing as a nurse. I have booked in time with my facilitator for a debrief but questioning if I approach my num tomorrow about the error as I feel it is the right thing to do but am extremely nervous. I am really looking for any insight into what I should do! At this point I’m questioning my whole career choice!

Did you have any health care experience before you started? I wanted to initially apply for PA school and needed patient hours so I got a medical assistant certificate and started working for a surgeon. It was incredibly exciting and I even assisted in surgery but it was incredibly stressful. The job stressed me out so much that instead of being there for 1 year and apply to PA school I ended up staying and put off my PA school application. Now I just want to get an associate in nursing and then a BSN because I am not willing to continue with the stress any longer. I do hope that RN will be OK for me because I have worked for very very difficult people.

If you did not have prior experience maybe it's just about the learning curve for you and may be normal to feel like this in the beginning...

Good luck

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These are small incidences. Don’t be discouraged. at the end of my shifts... I always ask myself... did any of my patients die? Did I do the best that I could do with the given situation? Don’t worry about it. My manager always picked on new grads too for minor mistakes.

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On 5/31/2020 at 9:09 AM, Been there,done that said:

OP, why was it supposedly your fault that a pt didn't get to X Ray on time?

BTDT, were you to have knocked them in the head to make it clear? Some people are just hot shots and jump in too fast, despite perfectly adequate teaching.

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1 hour ago, Kooky Korky said:

BTDT, were you to have knocked them in the head to make it clear? Some people are just hot shots and jump in too fast, despite perfectly adequate teaching.

Guess I must have knocked a few heads. Or we were lucky. None of my orientees did something stupid. Please forgive me for repeating myself. But we were joined at the hip.. so they didn't. I felt anything my orientee was on me.

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On 5/31/2020 at 6:08 AM, VivaLasViejas said:

There are two kinds of nurses: those who have made med errors, and those who will.

As a new nurse I just wanted to say thank you ❤️

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