New nurse- bad nursing judgement

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Hi all,

First, I'm so grateful for this forum. I know there are a lot of forums about med errors, but this is a nursing judgment lapse.

So, I'm 3 weeks off of orientation. We JUST learned how, when and why to do bedside swallow evals, and somehow my thick skull didn't apply it to my patient this weekend. Long story short, I should have done one, and he ended up aspirating on my second med pass. He was taking pills whole at home, and on a regular diet, but his presentation definitely warranted an eval, in retrospect. I had tunnel vision and only thought "meds due- must pass" I'm absolutely beating myself up for not doing a bedside swallow eval in the first place. DUHHHH! then I gave him his meds again??? how dumb am I? I told the doctor, and he ordered a swallow eval, NPO until then. The doc also said he sounded wheezy in the RLL, put him on antibiotics. I just can't get over it. My grandma died from aspiration pneumonia, and I can't believe I didn't do anything to prevent this.

I'm devastated. I know I'm a new nurse, but I feel like I don't have any common sense, and I now am responsible for this huge error in judgment. I feel like I'm quite possibly the worst nurse, and anyone else would have done a better job with this poor guy. Am I alone? Should I just quit while I'm ahead? I don't know... I don't have any perspective, and this seems like a huge deal.

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Specializes in Childbirth Educator, Birth Doula.

You might get some different insight from experienced nurses in this forum, but as a new grad myself, I would be wary about posting any details regarding a potential incident in a public forum. Maybe this is overly cautious, but it's the first place my mind goes.

Can you reach out to your management or supervisor?

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Hi all,

First, I'm so grateful for this forum. I know there are a lot of forums about med errors, but this is a nursing judgment lapse.

So, I'm 3 weeks off of orientation. We JUST learned how, when and why to do bedside swallow evals, and somehow my thick skull didn't apply it to my patient this weekend. Long story short, I should have done one, and he ended up aspirating on my second med pass. He was taking pills whole at home, and on a regular diet, but his presentation definitely warranted an eval, in retrospect. I had tunnel vision and only thought "meds due- must pass" I'm absolutely beating myself up for not doing a bedside swallow eval in the first place. DUHHHH! then I gave him his meds again??? how dumb am I? I told the doctor, and he ordered a swallow eval, NPO until then. The doc also said he sounded wheezy in the RLL, put him on antibiotics. I just can't get over it. My grandma died from aspiration pneumonia, and I can't believe I didn't do anything to prevent this.

I'm devastated. I know I'm a new nurse, but I feel like I don't have any common sense, and I now am responsible for this huge error in judgment. I feel like I'm quite possibly the worst nurse, and anyone else would have done a better job with this poor guy. Am I alone? Should I just quit while I'm ahead? I don't know... I don't have any perspective, and this seems like a huge deal.

You're new, you're not perfect. Not a surprise. No one has ever gotten through life (or a first year of nursing) without making mistakes. We ALL make mistakes. Every single one of us. What is important is that we realize this so that we recognize a mistake when we make one. And then we can set about mitigating the harm to the patient.

You made a mistake, you told the physician and he ordered a swallow eval. Good for you! You might have made a mistake, but you did everything else right. Quit kicking yourself. As far as I can see, you're just a normal newbie. You make mistakes. Lots of them, probably but some (like this one) bigger than others. I made lots of mistakes when I was a newbie, too. There are whole threads of us crusty old bats confessing the stupid mistakes we've made in our day. And most of us went on to become competent nurses.

As a newbie, you are still developing your nursing judgement. Recognizing and admitting a mistake is no small thing . . . that's GOOD nursing judgement.

The first year of nursing is rough -- it's miserable for all of us. (Well, MOST of us, anyway.) You feel like a walking example of what NOT to do. At least I did. Somewhere after six months to a year, you'll start feeling like you know at least some of the answers. And as time goes on, you'll feel like you know half of the answers and most of the questions. After a couple of years, you'll realize that you'll be able to handle most of what gets thrown at you and know who can help you when you can't. And then you'll be a competent nurse. In the mean time, the only way to get through that miserable first year is to GO through it. Good luck!

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RubyVee, thank you!

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Would it make you feel better if I said I did not know

when and why to do bedside swallow evals

I am also a new nurse. Would you be willing to share what you know about when and why to do a swallow eval? I work LTC and get next to nothing as far as training/orientation. I'm always picking other nurses' brains.

I feel like I'm constantly making mistakes. Not really big mistakes, but stupid ones. I hate being new at this. I just want to fast forward to the point where I'm experienced and confident. Anyway, I think you are being too hard on yourself.

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Thanks tsm007... Now I won't be able to sleep b/c of chwcbesteph's post...

We were trained to do them pretty much prior to any oral meds. This patient didn't seem to have any issues with my first med pass, but if I had been more on the ball, I would have done one.

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