New Nurse, Med Error = Lost Job

[NewRN9423]

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?

[Wuzzie]

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]

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.

[Wuzzie]

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]

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]

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]

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

[JKL33]

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.)?

[Wuzzie]

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.

[canadianedmurse]

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]

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]

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.