New Nurse, Med Error = Lost Job

NewRN9423 · Nov 4, 2019

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.

Wuzzie · Nov 4, 2019

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.

allnurses Guide · Nov 4, 2019

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 · Nov 4, 2019

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 · Nov 4, 2019

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.

caliotter3 · Nov 4, 2019

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.

Cowboyardee · Nov 6, 2019

I think your attitude of trying to learn from this and improve your practice is commendable. So please bear that in mind and try not to be offended by what I'm about to suggest.

Replacing a new hire after weeks of orientation is expensive. Also, the kind of error you describe, though dangerous and indicative of disorganized care, is common enough that I'll go out on a limb and say that there's as much luck as skill involved in any given new grad not making a comparable error in their first 6 months as a working nurse. It doesn't sound like you did anything terrible in terms of hiding the error, mis-reporting it, or deflecting blame, either (though correct me if im wrong). When I consider these factors together, it leads me to two possible conclusions:

1) your facility was already strongly considering getting rid of you before this error happened, and this error just gave them the excuse they needed.

Or

2) your facility was being stupid in axing you.

So...

Either option is a legit possibility. But if you really want to learn from this, it would help to know which one it was. A lot of times, fired nurses go into a kind of hiding and don't talk to anyone they worked with out of embarassment. This is usually a bit of a mistake. If you became friendly with a preceptor or anyone from your old job, I would suggest texting or calling them to thank them for the guidance they gave you, ask to keep in touch, and ask what their HONEST impression of your situation was. That will give you the best and most reliable information you can have and use moving forward. It may also prove to be an enduring connection.

Best wishes.

Orion81RN · Nov 6, 2019

I think the critical thinking aspect comes into play with hanging the 6:30 abt and not questioning "why am I already giving this abt when I just gave it 3 hours ago?" However, even seasoned nurses with great critical thinking skills could overlook this when bogged down by too much. It really sounds like any new grad would be overwhelmed in this environment and make these kinds of mistakes. You don't have time management skills yet to help avoid them. I'm getting angry just thinking about how much of a problem this is in mpst hospitals today. Understaffed and overworked.

NewRN9423 · Nov 6, 2019

To everyone, thank you for your advice. I am taking everything into consideration as I plan my next steps. One thing I forgot to mention is that we had no PCA on the unit, which did not help my situation.

I have been looking at the jobs out there, and there is not much. I am afraid to take another med/surg job, as I might again end up overwhelmed with too many patients. I see a lot of LTC/rehab openings, but I have heard horror stories about the nursing environment in these type of facilities. Any insight out there regarding jobs for a new grad RN with 3 months of experience?

subee, MSN, CRNA · Nov 6, 2019

What a lousy hospital culture that fires someone for reporting an error. Good riddance.

ThatChickOmi, ADN, RN · Nov 6, 2019

We use Epic at my hospital too. Did Epic not prompt you that the meds were administered too closely to each other? It'll have a pop-up and you need to select "RN Reviewed/Dose Appropriate". I can understand maybe being 1.5-2 hours off but the screen will tell you, and you'll presumably be like "Oh, right. I'll push the admin time to a later time." but less than 3 hours after the last dose.

ThatChickOmi, ADN, RN · Nov 6, 2019

I'm basically 3 weeks off orientation myself. I'll admit that there have been times where I thought I scanned a med and I apparently didn't, sometimes the screen times out and the administration is incomplete. Nobody is perfect. You didn't hurt anybody. Sorry this happened to you.