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New Nurse, Med Error = Lost Job

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NewRN9423 NewRN9423 (New) New Nurse

Has 1 years experience.

I am a new nursing working on a neuro med surg unit. I just came off of orientation about 2 weeks ago, and I made a med error where I gave two doses of an IV medication too close together. When I discovered my error, I quickly stopped the IV and only half of the infusion had been given to the patient. I immediately informed my supervisor and the doctor, and then filled out an incident report. To make a long story short, I lost my job as a result of this. My manager stated that I did not make the transition from a task-oriented focus to a critical-thinking focus. I want to improve my critical thinking skills, but I am not finding much out there. Can anyone recommend a critical thinking course, or books I can read to improve my skills before I search for a new job?

Critical thinking isn't really something you can learn from a book. Why don't you walk us through the events from the shift and we can maybe help you see where you went wrong (other than the obvious) and how to do better next time.

Sorry you were fired. That seems a bit heavy-handed if this was your first issue.

NewRN9423

Has 1 years experience.

I was on night shift and had a total of 6 patients. I had to finish the admission of the previous nurse, and I had a second admission. I had been writing down all of my meds and times for each patient, but I have been receiving feedback that I was too slow and could not get everything completed on time. After a discussion with my nurse educator, we decided I would only write down the med times only, and access the omnicell using the scheduled meds view. Last night was my second day using this process, and I thought I was doing much better. Until late in the shift. My patient was on a strong IV antibiotic Q12. I gave a dose at 0330, and then the MAR prompted me for another dose at 0630 and I gave it. After much introspection, I made many mistakes to cause this to happen. First, I did not check when the previous dose had been given - I was so busy that I would hang meds and go onto the next task. I was so worried I was not moving fast enough - mostly because this has been the most frequent feedback given to me. In the midst of trying to get everything done faster, I neglected to follow my five rights of medication administration. My second mistake was that I was distracted by the patient while I was in Epic, scanning the med and my ID. As a result, the scan ID screen timed out and I did not realize it. I went and hung the med, and went to do the next patient. It was right before report, and I realized my mistake at about 0710 and immediately reported to my supervisor. I later found out that there were two other instances where I gave antibiotics 2 hours early, so I was let go for patient safety. I am now so afraid of what other mistakes I will make because I lack critical thinking skills.

OK, I'm not so sure you lack critical thinking skills as much as you lack organization and time management skills which is resulting in you apparently taking short-cuts that you now know you should not be taking. 6 patients on a neuro-surg floor is a lot even for seasoned nurses. Also, I'm not sure I see the wisdom in writing down random times with no med name attached to them. How long was your orientation? What was it like?

NewRN9423

Has 1 years experience.

My orientation was one week of classes, then 10 weeks with a bunch of different preceptors. I asked for an additional 2 weeks with my preceptor, because I was still uncomfortable. I take full responsibility for my mistakes, but I can’t help but think that there were systems errors involved here also.

NewRN9423

Has 1 years experience.

I am definitely planning on taking some time management CEU classes while I am looking for a new job. Right now, I am grappling with what type of nursing job I would be good at. I can’t help but feel I am not cut out to be a nurse.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 18 years experience.

44 minutes ago, NewRN9423 said:

I am definitely planning on taking some time management CEU classes while I am looking for a new job. Right now, I am grappling with what type of nursing job I would be good at. I can’t help but feel I am not cut out to be a nurse.

Don't throw in the towel yet! Will right more when I get off work

On 11/4/2019 at 7:47 AM, NewRN9423 said:

I gave a dose at 0330, and then the MAR prompted me for another dose at 0630

Why? How did this happen?

On 11/4/2019 at 7:47 AM, NewRN9423 said:

In the midst of trying to get everything done faster, I neglected to follow my five rights of medication administration.

Can you specifically state how? Are you referring to the fact that this was not a "right time" for this medication and you did not recognize this because you did not catch something amiss with the pharmacy-EMR interaction that resulted in the med being scheduled for both 0330 and 0630? Or are you not trying to work your way through the 5Rs at all?

On 11/4/2019 at 7:47 AM, NewRN9423 said:

My second mistake was that I was distracted by the patient while I was in Epic, scanning the med and my ID.

This is worth analyzing. What was the nature of the distraction? Basic conversation? Asking for another need to be met while you were trying to administer medications (toileting, water, etc.)?

52 minutes ago, NewRN9423 said:

My orientation was one week of classes, then 10 weeks with a bunch of different preceptors. I asked for an additional 2 weeks with my preceptor, because I was still uncomfortable. I take full responsibility for my mistakes, but I can’t help but think that there were systems errors involved here also. 

Kudos for recognizing that 10 weeks was not enough. Do you think an additional 2 weeks would have made a difference? Not being mean just trying to get an idea of where you are. A well-run residency would probably have been beneficial. Not sure if that ship has sailed. The CEU's are a good idea going forward for interview purposes. You need to start applying for new jobs like yesterday.

Don't get ahead of yourself, we all make mistakes. Being a new nurse is stressful. Moving forward, safety should be made your number 1 priority. I myself made a med error and caught myself with a near miss when I started - this caused me to become paranoid with med administration. The key is to ensure you are present in each moment and properly follow protocol (5 rights) with administration so you can rest easy afterwards. It is always better to be slower and remain safe. Speed with these things take time and can't be rushed.

I too am concerned about the fact that these errors in administration have occured 3 times with IV Abx. I am not familar with Epic but know the interaction with staggered dosing and EMR charting can be a real pain; I hope you were taught appropriatly and understand how to work the MAR.

"nursy", RN

Specializes in ICU, ER, Home Health, Corrections, School Nurse. Has 40 years experience.

One of the best time management tools is a "brain". This is a cheat sheet, where you have all your patient notes, and scheduled meds and procedures like dressing changes, iv site care etc. Basically you have a template (of which you make a new copy for every shift) and then fill it in as you get report. I used to make my own, but you can google examples of different ones to give you a baseline. Then you just have to get in a routine of using it. It helps to write things down, because you can never remember everything in your head. I agree with previous poster, that this is a time management issue, not a critical thinking issue.

Having said all that, it takes a year for a newbie to start feeling comfortable on whatever unit they have started on. So be prepared even with your next job, give yourself that year before feeling like you're not cut out to be a nurse. Good luck!

NewRN9423

Has 1 years experience.

54 minutes ago, JKL33 said:

Can you specifically state how? Are you referring to the fact that this was not a "right time" for this medication and you did not recognize this because you did not catch something amiss with the pharmacy-EMR interaction that resulted in the med being scheduled for both 0330 and 0630? Or are you not trying to work your way through the 5Rs at all?

I was referring to the “right time”. I did not catch that the two doses were so close together. I always scan the patient, ask their name/birth date, double check the delivery method and dose/expiration date. I have forgotten to scan a med (especially flushes) and had to go back and do it in the past, but I have been working on improving in this area.

NewRN9423

Has 1 years experience.

1 hour ago, JKL33 said:

This is worth analyzing. What was the nature of the distraction? Basic conversation? Asking for another need to be met while you were trying to administer medications (toileting, water, etc.)?

The patient would constantly ask for something while a nurse or aide was in the room. I was already stressed because I was trying to get everything done prior to report, and I turned to fulfill the request, which led to another request, etc. Stupid me, I forgot to go back to complete the transaction in the MAR, and when I later went into the MAR to figure out what happened, it said “incomplete” where it usually says “given”. I made so many mistakes that I regret.

9 minutes ago, NewRN9423 said:

I made so many mistakes that I regret.

Yes, you did. You've owned it now quit beating yourself up and do better.

Nurse SMS, MSN, RN

Specializes in Critical Care; Cardiac; Professional Development. Has 9 years experience.

First and foremost, no patient harm happened. Your intentions were good. It is difficult when all muddied up with grief, embarrassment, shame, self recrimination, frustration etc....but you will have to square your shoulders, dust yourself off and get right back up on that horse.

Your time management skills need help. You have identified that. Excellent.

Your attention to safety checks needs to be more assiduous. You have identified that too. Excellent.

You also need to recognize that you will, as a nurse, need to set appropriate boundaries around things. Learning to stall a patient, call a tech or otherwise protect your work flow is imperative. "I will take you to the bathroom as soon as I am finished prepping your medications". "Let me call your tech to see if he/she can adjust your pillows/bring you juice/etcetcetc". "It is really important I finish this first so that I don't make any mistakes with your medications. Bear with me just a few minutes more and then I will take care of that".

This feels like crap right now. It will never, ever feel good - but it has incredible potential to revolutionize your nursing practice if you let it teach you. You won't begin to be able to let it do that until you accept you made mistakes but that it doesn't mean you are horrible at nursing. You aren't. You are extremely new at nursing. There is a difference.

jag nurse, RN

Has 16 years experience.

6 hours ago, NewRN9423 said:

I am a new nursing working on a neuro med surg unit. I just came off of orientation about 2 weeks ago, and I made a med error where I gave two doses of an IV medication too close together. When I discovered my error, I quickly stopped the IV and only half of the infusion had been given to the patient. I immediately informed my supervisor and the doctor, and then filled out an incident report. To make a long story short, I lost my job as a result of this. My manager stated that I did not make the transition from a task-oriented focus to a critical-thinking focus. I want to improve my critical thinking skills, but I am not finding much out there. Can anyone recommend a critical thinking course, or books I can read to improve my skills before I search for a new job?

I wish I could give you a big hug. First of all, I admire your accountability. Secondly, time management comes with time, unfortunately, and asking for tips just like you're doing. Third, bedside nursing is like that. A ton is thrown at you, and you're expected to get it all done, done correctly, and done on time.

I can see that you were really trying. You were trying to get it all correct. IMO, they should ease new nurses in. There is so much to learn; it takes a long long time. Fourth, for me the MAR trumps the Omnicell or Pyxis. The machine is not always correct (I, too, work the night shift). You still have to watch the MAR. If the previous shift gave a med late and didn't retime it, that can get you. I always look at the time given, even if the MAR says it is due now, then I calculate when it is actually due. I don't know how many times the medication wasn't retimed by the previous shift (who was also so busy they couldn't get to everything). It also seems that there may be a system glitch, where you work. Our system will not allow a med to be given, if the time spacing isn't correct. A warning pops up, and that warning does NOT time out. Fifth, unless it's urgent, don't converse with the patient while readying your medications. After they are all verified and scanned in, of course let them know what they're getting and why, etc. But, it's too distracting to have a conversation when your mind needs to be on what you're doing. Lastly, please don't beat yourself up. You have a willing heart, no one was hurt, and you are looking at how you can change. Best of luck to you. : )

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 10 years experience.

7 hours ago, NewRN9423 said:

To make a long story short, I lost my job as a result of this. My manager stated that I did not make the transition from a task-oriented focus to a critical-thinking focus.

At less than three months in....NONE of us have made the transition from task-oriented to critical thinking. Not a one of us. I am sorry this happened. Did other events occur that cumulated in your being dismissed or does this hospital have waaaay more nurses than they know what to do with? I find this...disturbing to say the least.

Things you need to find out: Were you let go during your probationary period? Are you rehireable? Can you go somewhere else in the hospital? The first question is particularly important.

Things you need to know: It's an unrealistic expectation that we will all be ready to go in 12 weeks. When you're asked about why you left, you can say that you decided that you were not comfortable with a 10-week orientation and things did not improve after 12 weeks.

Good luck! I promise things will be different five years down the road.

Having read your second post quickly, what jumped out at me is that you focus on the criticism that you are too slow. I start out ‘slow’ myself especially with physical skills. You can’t push yourself to go any faster than what allows you to remain safe. I would rather be canned because I was not fast enough for someone else than to make serious mistakes because I didn’t take the time to think things through before acting. We all build speed at our own pace.