New Nurse/Forgetting, Mistakes

[KCase, ASN]

I know there are a lot of similar topics on here but I was hoping I could get some advice.

I am a new nurse; I just ended my first week preceptor-ship for the StaRN program on a PCU unit on doing night-shift and I'm feeling a little down. I'm trying not be too hard on myself because I know I am human and I make mistakes, but it is hard not feel like you could do better, especially because a lot of the mistakes I was making were the same kind of mistakes over and over so I felt like I wasn't learning from my mistakes like I should have.

Some of the mistakes I was making was forgetting to get some medications out that I needed to get and my preceptor would end up having to go back and get them; I also dropped a few medications, but I think I'm also just a little nervous with my preceptor standing there because I'm thinking about making a mistake so... then I make one. I'm also having a bit of a hard time getting the medication packets open; some of them are easy and some are not so much. So some I've had to pop them out by pressing on them but then I guess I press to hard and they pop out right on the floor; I've tried doing it over the medicine cup but I don't want to tip the whole thing over and have all my meds going on the floor. I've resorted to using scissors for now to get them open and that seems to work but it takes time. I'm getting the hang of charting but I've made a few mistakes or errors here and there that have taken time to correct. None of these mistakes are too serious but I do feel like my preceptor was getting a little annoyed sometimes at my slow pace and my constant forgetting of certain medications in the pyxis (and this is a big one for me because I really do not one to make a fatal medication error one day so this is something I want to nip in the bud right now). None of the medications I forgot were any major medications and I usually always caught them myself when I went scan them in but there were some that my preceptor had to remind me of.

One other instance that took place was when a patient who was a fall risk and a sun-downer got out of bed and walked into the hall. My preceptor and I got him back into bed but his bed-alarm had not been on. It could have ended badly; he could have fallen. I had been in the room earlier with another nurse trying to fix his telemetry leads because they would not stay on though I hadn't touched the bed alarm. I didn't know if the other nurse had turned it off or if the day-shift nurse had turned it off at some point and it had never been on that night but I hadn't touched it. My preceptor reminded me that the bed alarm should always be on, which I knew and I should have checked it myself earlier before I left the room. There is no excuse for that at all and I will more diligent of that in the future; however, there was a bit of accusation in my preceptors tone, like I had been the one to turn the bed alarm off and forget to turn it back on, and I wasn't sure how I should take that. So I did try to defend myself a bit.

My preceptor is great, don't get me wrong. But I think he is just so good of a nurse and so fast-paced that he does get a little annoyed with me and I really don't want that to happen. In all honesty I turn into a bit of a ditz when I'm there and the things that should be easy to remember or just plain easy seem to get the better of me. I felt like I was looked down upon in nursing school and that a lot of people thought I wouldn't make it so being a good nurse and not making these mistakes is a huge deal to me; I really want to prove to my preceptor and the other nurses on my unit that I can be a good nurse with a little bit of time. I guess it doesn't help that most of the nurses on my unit seem to be older nurses with years of experience or nurses that have been in the field for a few years so I am one of the only new ones and have nobody that can relate.

[JBMmom, MSN, NP]

You're going to be fine, give yourself a break while you're settling into a new position. Little things are easy to fix, for example, I always pop narcs into a clean med cup and then add to the rest. Not that I've never dropped a med, but those narc packages are tricky.

As for the other things, do you have an organized way of tracking your activities during the shift? Some people call them brain sheets. If you have a minute to jot down the meds ahead of time, you'll be less likely to forget. On my sheet I have check boxes for things like fall risk. If it's checked I know I need to check the bed alarm. When I first started I had more check boxes for individual activities and I've updated with fewer boxes as I don't need them.

Attitude is all you. Everyone was new at one point, and your preceptor doesn't expect you to be perfect. If she gets annoyed, unless she offers you feedback about it, just ignore it. Maybe she's annoyed about something else, or having a bad day. People get annoyed, don't take it personally. You can do this, take a deep breath, put a smile on your face, and be the professional nurse that you are. Good luck.

[cayenne06, MSN, CNM]

You're going to be fine, give yourself a break while you're settling into a new position. Little things are easy to fix, for example, I always pop narcs into a clean med cup and then add to the rest.

I totally read this as "give yourself a break while you are settling in to a new position. For example I always pop a narc." Ha!!

I am impressed with your level of personal responsibility here. It sounds like you are aware of the issues you need to address- can you think of a plan to work on them? I would come to your precepter, tell him frankly what you need to work on, the goals you have set for yourself and your plan for achieving them. Ask him for constructive feedback on your strategy to address your weak areas.

It sounds like confidence is a part of it. What do you think you can do to help you feel less nervous when you are in a room with your preceptor? Do you guys talk through the case before you walk in the door? How do the two of you interact in the room? Do you need more freedom to work things through yourself, without him jumping in to remind you? Or do you feel you need more proactive guidance?

I precept all the time, and sometimes I forget that *my* style of teaching, which is to guide from behind as much as humanly possible, does not work for everyone. I was kind of flustered the first time I had a new grad CNM who really needed more hands on guidance from me. To me the only way to learn is to get your hands dirty and work through problems yourself, with the safety of knowing I am there to keep you from killing anyone. My point being that precepting is a skill too, and don't hesitate to give feedback on how the relationship is working for you. I am really glad this midwife felt comfortable telling me what she needed, because it helped me become better at teaching.

And YES. A cheat sheet. Check lists for all the things you need to remember.

[NightNerd, MSN, RN]

Honestly, it sounds like you are doing great! The fact that you recognize these issues that you're having is a big thing in and of itself, and you seem very conscientious and thoughtful. ALL of this gets easier with time and practice. It's really okay with the opening the meds thing - it's like they specifically make certain packets to be impenetrable. Don't feel bad about repeating little mistakes a few times. It took me at least a couple of months to learn how to hang IVs without the tubing looking like a damn pretzel. Especially when it comes to dexterity, it WILL improve the more time you spend using different strategies.

For remembering all the meds to give, it might help to just do a quick inventory of what is due at that time and what you have gotten before you enter the patient's room. I do a quick double check over everything after I've done my five rights and whatnot. This also helps you make sure you've got whatever supplies you need (e.g., multiple flushes, syringes, blunts, water cup), and you can verify whether you need more than one pull to make a full dose; sometimes you may need to split a pill. It seems like this might take a lot of time, but it will save you much more in the long run.

Totally agree with whoever said not to take your preceptor's alleged annoyance too personally. As a newly minted preceptor, I have caught myself being impatient a couple times, and then I think to myself, "You were dealing with the same challenges a year ago!" We are all new and awkward and forgetful ay some point; lots of us just prefer to forget. Don't pay it any mind when you start to perceive those reactions. This is your time to learn and to be cautious and develop your skills and critical thinking. No one else's attitude should interfere with that.

Finally, as far as the fall risk thing, make it a habit to round on your patients as soon as you finish report. "Hello, I'm CaseyKay, I'll be your nurse tonight. Is there anything you need right now? I'll be back soon with your medicines for the evening." *Look at bed alarm, look for non-skid socks, etc.* Make it part of the very first interaction with your patients, and it should soon be an instinct every time you go in the room.

You are doing just fine! Keep learning, and keep up the good work. You will be great.

[oceangirl1234]

Things like popping pills into the pill cup will come with time. It's kind of like inserting IV's, irrigating catheters, packing wounds, and basically anything that requires dexterity. (Although I haven't seen anyone use scissors yet...that might make things longer if you have numerous patients with a bunch of 0800 meds or something).

And patient safety is so so important. Every time you are in the room you should be checking oxygen/suction, call bell position, pain level of the patient/any immediate needs, bed rails/position/alarm, IV lines, etc. (You should also be doing this at the beginning of each shift when you go introduce yourself to your patients). You may have not turned it off but it was still your responsibility to ensure it was on unfortunately. But luckily nothing happened and this is a learning experience.

And a cheat sheet is imperative if your new. I have one and for each patient I list:

-Name, code status, Dr., allergies, diagnosis

-Diet

-Activitiy

-Vitals

-IV therapy

-Medication times

-Procedures/Treatments