New nurse missing something I should have caught

[DLMJ]

I'm a new nurse and received a patient to my unit with what seemed to be a fairly easy issue to handle (bowel impaction). That's really all the nurse giving report harped on and mentioned they got all these meds ordered for it. Anyway, I was so caught up with that that a much larger finding I looked right over. This was a complete accident. Giving report the nurse was like "he has that?! And no orders for this or that?" I work night shift and tried calling the doctor to ask about adding some orders but aside from one that was pertinent to the large finding, nothing else crossed my mind. I know now to question everything and make sure that all the orders are correct/whether we need more, but I feel so horrible. My patient was good for me overnight no issues but what if something happens to him during the dayshift and they look back and see I essentially did nothing about it. Again, I didn't mean to neglect this issue I just didn't realize the gravity of it until the nurse questioned me in report. I'm just so afraid that if something happens to him today they'll look back that I didn't get things ordered and it's all my fault. The nurse who took over is experienced and great so I know she will pick up where my mistake left off and he will get what needs but I'm so upset with myself over this. I value the opinions of the nurses I work with and I just don't want them thinking wow what an idiot she didn't even get orders for this! I want to be a great nurse and have my peers feel that I've got it handled but after today I just feel incompetent. sorry just needed to vent :/

[Libby1987]

You're coming from wrong mindset for catching significant findings in your patients.

[cleback]

What was the issue you overlooked? Why do you think you overlooked it?

All you can do is learn from your mistakes. Be open to constructive criticism from your coworkers.

[Been there,done that, ASN, RN]

"Anyway, I was so caught up with that that a much larger finding I looked right over. This was a complete accident. "

There are no complete accidents. It does not matter what the nurse giving report "harped on". You need to expect report on ALL patient problems.

Mind telling us what the bigger issue was?

[NurseCard, ADN]

Yes, really curious to know what the other issue was!

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

When they call to give you report, if at all possible, never take report right then. Take the patient's name down, go to a computer where you can sit down and open up that patient's file, and look over things while you are calling them back(hopefully your facility is computerized). I am really ashamed of my hospital's first line of defense: ER department. Once again during my only shift for the week, they tried to pass off a patient with a critically-high BP and a critically low electrolyte. The physician had ordered meds on arrival to address these issues, but the nurse, for whatever reason, 8 hours later, still had not given the meds. The sad thing is that as I'm questioning the nurse during the report, I'm also verifying one deliberate LIE right behind the other.

This angers me because I bust my *** trying the get the patient stable, and I waste a lot of time overriding and explaining through the computer-built-in HARD STOPS (safety feature) to get to those long overdue medications just so they can be released and at times, reissued by the pharmacy so that these meds can finally reach the patient. Then, I'm sometimes met with "this medication costs $$$$ per dose and the previously issued dose was sent to station XYZ (we have a huge ER with multiple dispensing stations ((aka chutes)) and I don't have time to track down a drug that was issued hours before I even heard of this patient) and cannot be reissued until the other one is located and returned".

Seeing as though this happens every single time I'm sent there, and in receiving report from different nurses and on different patients, this is accepted practice, as I've reported this, as have my other float pool colleagues, and absolutely nothing is done about it.

It's so sad to advise you of this. But you really need to get into the habit of not trusting what you're told by any nurse, experienced or not, until you've checked it out for yourself....especially if a report seems very cut-n-dry. These tend to be the patients/issues that another nurse either does not want to deal with, afraid to call the doctor about, or does not know how to deal with but is afraid to admit as much to co-workers. And yes, there is the occasional, honest-to-goodness oversight; but with oversights being the shield for sorry-*** nurses, it's hard to know the difference without having witnessed one's performance firsthand. As a new nurse, unfortunately, you may have quite a few lesson-learned-the-hard-way experiences.