New Nurse Making Mistakes

[NewNurse_20, BSN, RN]

So, I’m a new grad nurse (I’ve been a nurse for a whopping 4 months now), and I feel like a failure! I’ve made two mistakes now, and I’m freaking out about it. About 2 months ago while on orientation I made a mistake by not properly charting patient care encounters. I was told by management that I had to conference on it (they said they were going easy on me since I was still on orientation). I eventually moved past it and started to feel like I was getting the hang of being an independent nurse. That is until 2 days ago. I was working an extra shift, and at the very end of the shift I had a patient get a bed upstairs. I called report and got ready to send them up. Right as I was about to leave, nuclear medicine called me and told me they need the patient before they go up to their room. No problem, I just had the tech take them there instead and I documented that. I was under the impression that nuclear medicine would get them upstairs from there, but just in case I told the tech that the patient needed to go upstairs as soon as the stress test was done. I had already called report and the patient was ready to go as soon as they were done in nuclear medicine. She said okay and I clocked out. Now I’m freaking out that maybe nuclear medicine didn’t get them upstairs or maybe the tech forgot and I should’ve notified the nurse manager of the situation before I left! All of these what-if’s have been keeping me awake! What if nuclear medicine brought them back to the ER and didn’t tell anyone and they patient sat in their room with no nurse?? What if I get written up or worse reported to the BON for patient abandonment? Is it even abandonment if I called report to the nurse upstairs? I’m just freaking out that I’ve done something wrong, and I’m feeling like the worst nurse ever! I’m starting to doubt my ability to be a good ER nurse if I’ve only been a nurse for 4 months and I’ve already made at least 2 big mistakes! 

[JKL33]

On 5/31/2021 at 3:56 AM, NewNurse_20 said:

About 2 months ago while on orientation I made a mistake by not properly charting patient care encounters. I was told by management that I had to conference on it (they said they were going easy on me since I was still on orientation).

Can you give the basics as far as what you didn't properly chart?

***

General comments:

Everything's okay. Although I have ^ this question, my guess is that there are no big mistakes involved here at all.

With your worries about the nuc med patient you are experiencing a well-known phenomenon known that is part of being a novice/beginner: You have to rely on rules and don't quite have the experience to make your own judgments about things. That can be anxiety producing on it's own but it doesn't mean that you have made big mistakes. It sounds like you mostly covered your bases with the nuc med patient; the one thing you could have done was make sure upstairs knows that the patient is going to nuc med first. That helps with their planning and also keeps everyone in the loop. This doesn't come close to qualifying as a big mistake though.

As a novice/beginner it's also hard to judge the reasons for rules. Newer nurses tend to think that rules are always in place because of laws or ethical reasons or very serious patient jeopardy that could happen if something happens in an alternate way, because it doesn't follow the rules. Understand that there are numerous different reasons for rules, and sometimes they're really disappointing!! Very disappointing! The boss wants something a certain way? Rule. Something seems good for business? Rule. Something makes life easier for someone else? Rule. These things have very little to do with actual excellent nursing care. You will save yourself untold grief if you understand that now.

I have some suspicions about your conference that you had to have with your manager. I should wait for your clarification of how big a goof-up it really was but I can already tell you I don't like the way your manager spoke about it. At baseline it is manipulation ("you did something really darn bad but I'll go easy on you for now...").

Lastly - don't burn yourself out on extra shifts at this stage. I know it's exciting and all, but pace yourself.

[NewNurse_20, BSN, RN]

56 minutes ago, JKL33 said:

Can you give the basics as far as what you didn't properly chart?

***

General comments:

Everything's okay. Although I have ^ this question, my guess is that there are no big mistakes involved here at all.

With your worries about the nuc med patient you are experiencing a well-known phenomenon known that is part of being a novice/beginner: You have to rely on rules and don't quite have the experience to make your own judgments about things. That can be anxiety producing on it's own but it doesn't mean that you have made big mistakes. It sounds like you mostly covered your bases with the nuc med patient; the one thing you could have done was make sure upstairs knows that the patient is going to nuc med first. That helps with their planning and also keeps everyone in the loop. This doesn't come close to qualifying as a big mistake though.

As a novice/beginner it's also hard to judge the reasons for rules. Newer nurses tend to think that rules are always in place because of laws or ethical reasons or very serious patient jeopardy that could happen if something happens in an alternate way, because it doesn't follow the rules. Understand that there are numerous different reasons for rules, and sometimes they're really disappointing!! Very disappointing! The boss wants something a certain way? Rule. Something seems good for business? Rule. Something makes life easier for someone else? Rule. These things have very little to do with actual excellent nursing care. You will save yourself untold grief if you understand that now.

I have some suspicions about your conference that you had to have with your manager. I should wait for your clarification of how big a goof-up it really was but I can already tell you I don't like the way your manager spoke about it. At baseline it is manipulation ("you did something really darn bad but I'll go easy on you for now...").

Lastly - don't burn yourself out on extra shifts at this stage. I know it's exciting and all, but pace yourself.

So I can provide clarification on all accounts now! As far as the incident goes while I was on orientation, I forgot to chart that I emptied the patient’s bedside commode (I definitely did on multiple occasions). Apparently after the other shift arrived (and after I gave bedside report), the bedside commode had fallen over. The patient was upset about it, so they called the other shift’s charge nurse. Essentially he told me that because I didn’t chart that I had changed the bedside commode, it appeared I didn't do anything for the patient and that it was my fault. Ultimately, nothing came of that issue aside from the conference I had with that charge nurse. The ED manager told me it was fine, just try to remember to chart my patient care encounters better. 
The issue I wrote the post about: it turns out I had a whole anxiety attack over nothing! I went and spoke with the ED manager about it because I was freaking out, and she told me I didn’t make some huge mistake. I gave report and documented it all and that was all that was needed. The only thing she told me was that for future reference the patient doesn’t actually have to go anywhere once they have been assigned a room. I was just told that by nuc med because it’s faster for them if the patient comes from the ED rather than the floor! So all in all, everything has worked out fine. I’m not in any trouble, although I did miss out on some sleep due to my anxiety! It turns out (according to my manager and a few coworkers) that I’m doing better than I thought. The ED is just a really stressful department, and the facility I work at is a pretty large facility. I was just incredibly stressed, and I freaked out! So for now, I’ll probably chill out on the extra shifts and try to cut myself some slack. Thanks for the response! 

[Nurse Beth, MSN]

What great advice you got from JKL33. I'm so glad you gained some perspective! We are here for you at allnurses ?

[MD married to RN]

From the OP's post, there as an absolute gem hidden within:

 "I was working an extra shift, and at the very end of the shift..."

EM professionals, be they nurse, app, or doctor can often set themselves up for failure with scheduling. EM schedules are flexible which can be a very bad thing. 

I have colleagues who work six 12s in a row in order to get eight days off. Many are not nearly as efficient nor personable on shifts five and six. Now add an extra shift to that (especially where one might feel entitled because they are 'helping'), and danger abounds. The peril (or just the anxiety) multiplies if these shifts are graveyards which I suspect was the case for the OP.

I can recall a time when I was least happy in my own profession. I felt the pressure to make money, but working more made me less good, less fast, and less nice ironically risking my livelihood.

We are mostly well compensated professionals; it should not be too difficult to live within our means. Yes, one might need to slow the pace of paying off student loans or buying the big house/nice car. But sleep will allow for much happier shifts and more importantly better interactions with those we love.

Smiles!

 

 

[JKL33]

On 6/3/2021 at 10:10 AM, NewNurse_20 said:

So for now, I’ll probably chill out on the extra shifts and try to cut myself some slack.

Perfect.

Another great lesson:

On 6/3/2021 at 10:10 AM, NewNurse_20 said:

I forgot to chart that I emptied the patient’s bedside commode (I definitely did on multiple occasions). Apparently after the other shift arrived (and after I gave bedside report), the bedside commode had fallen over. The patient was upset about it, so they called the other shift’s charge nurse. Essentially he told me that because I didn’t chart that I had changed the bedside commode, it appeared I didn't do anything for the patient and that it was my fault.

See - now you know this is bull. This and every other drama like it. Never underestimate others' penchant for drama.

I know it is very nerve-wracking being new. But overall try to maintain kind of a battle face, so-to-speak (that's not the right word, what I mean is just professionalism as opposed to emotionalism). Do the basics: Stand up straight, move quickly (don't dilly-dally), make good eye contact, stay calm inside when communicating with others, don't panic/don't be quick to react to others' drama. As I said, these things are really just professionalism at a basic level, but taken together they are also very effective for letting others know that it won't be easy to pick you off with drama. 

Anyway, keep going and good luck. ??

 

[canoehead, BSN, RN]

FYI I've been a nurse over thirty years and I make some kind of screw up every single shift. Apologize, fix whatever you did, and be gracious when others screw up too. It's life, we're not perfect.

[Christine Kropf]

Take a deep breath those are hardly any big mistakes it sounds like you followed through quite well. We all make mistakes and anyone that says they don't isn't telling the truth. The important thing is to always own up to your mistake no matter what it is and learn from it. That's how you become a confident nurse in your abilities. And if you're ever not sure about something don't do it until you to ask another nurse for their opinion always double-check before you do something you're not sure of there's no wrong in that. Stick with it you've got this