New Nurse Multiple med errors

[Doll Head]

I have been nursing for 3.5 months now and in that time I have had over 7 medication omissions, and 1 med error where I gave the a med to the wrong person. I have been counseled a couple times and I'm worried that I may be terminated soon if I can't get my act straight. I work in a LTC on the rehab unit. We can have up to 25 patients on the floor at times, but I've never had more then 19 since I've been with them. I work overnight with one aid and I am the only RN in the building, the other staff are LPN's and sometimes they can't answer my questions. When I was hired I was given three weeks of pseudo-orientation where I was working most of the time and not being trained, and my position is on weekends. Sometimes I can get an extra day in but most of the time I'm only there TWO days a week.

Now my first big omission was PO vanco dosing for 10PM and I didn't give it two days in a row, and the next time I came in I didn't give it again. Thats three times in four days that I missed this order. after I was counseled I started sitting down with the MARs and doing a thorough check, or so I thought... This last big omission was for 6Am dose of valium and again three times I didn't give this med. After my review last night I finally registered it and put an incident report on my supervisors desk. I was so scared when I saw that I had missed a med this many times in a row again. I had a panic attack. We put a red dot next to the meds that the night nurse needs to pass, but somehow I passes by it 50 times without "seeing" it.

The wrong pt with a med was when I was on another unit orienting. It was my second orientation day and I had the whole floor passing meds. I thought I knew a resident and gave her a bite of applesauce with metoporol in it, the pt was demented and non-verbal. The orienting nurse saw and stopped me thank god! This was my bad. I have gotten out of the habit of asking people their names and looking at their wrist bands since working here.

Now I know that I needed to straighten out my act, but this last omission killed me. I'm not sure what to do? Or what to say to my supervisor? Is there no excuse for me? Between passing meds and answering call lights, helping people to bed, toileting people, answering the phone, getting meds from pharmacy, and completing treatments I feel so out of my body that when I do review the MAR I don't see things. I don't like that we have a manual system at all, and I take responsibility for what happens, but I can't help resenting the facility for the lack of support as a new nurse and lack of employee safe guards when it comes to passing meds. I also feel like everyone else is doing it right so whats wrong with me? Isn't the med pass supposed to be the "easy" part of nursing? At least I wasn't thinking that it would be one of my greatest challenges. I don't feel like a nurse. I feel like a fraud when I even tell people I'm a nurse.

I want to be excited about my work, I want to be a hospice nurse and I thought I should have a bit of experience with pt care first before I did, I thought rehab nursing would be easy. Now I don't have any confidence with my work, I feel worse then I did when I was in clinicals in nursing school. Is it possible for me to get a job at a hospital with a REAL orientation if I have fudged it up so bad at this place? Can I even use this place as a reference if I've made so many mistakes? Who will hire me with this track record?

I'm also worried that this anxiety and failure is going to follow me to the next place.

I just moved here and I don't really have anyone to talk to please provide any advice.

God Bless.

[Mn nurse 22]

How do the other nurses organize their med pass?

I have worked with paper MARs and electronic ones, and there are advantages to both systems.

Are you always on the same unit? Could you come in early to start going over your MARS? I found a colored paper lip system worked, I started out my shift going over the MARS and used a different color for each separate time, at each patient I still double checked my MARS to make sure I didn't miss anything the first time. I kept notes and tried to remember the old orders do I only had to review the new ones.

Part of our med protocol is to photocopy all new orders and review them at shift change, the evening Nurse tells me all the med changes that day, AND I have to sign off in each chart as the last check.

Do you have CNAs to help with cares? Of course you want to help out, but if your job is to pass all the meds, make that your priority, even if it might make a little extra work for your other staff. Focus on being the nurse and your most important tasks.

hope things work out for you.

[Doll Head]

Thank you for your comment. I spoke with my supervisor today and I got a final written warning the next time I make a med mistake I'll lose my job. He wants me to come in before my shift and do what you had said which is to look at the MAR's and write all the med passes down on my report sheet. I also need to finish a task if I'm at the med cart before I engage in something else. I've started looking for another job, but I need something good to happen so I feel like I can do it. Having this ' one more med mistake and I'm out' over my head makes me feel like everyday I could lose my job.

[Mn nurse 22]

Glad they are giving you one more chance, take some time to really think about why you made your previous errors, were you too busy, did you get interrupted, and try to slow down and focus on your med pass.

As a new grad you should try to stay at your first job for a year, stressful to have something like this happen, but be thankful that no adverse outcomes happened.

Good luck

[Ruby Vee, BSN]

A new job isn't going to solve your fundamental problem of making the same mistakes over and over again. In fact, it just might make it worse because you're going to be in a new environment with new routines and new paperwork. Not a good idea. If you lose this job, then look for a new one. But concentrate on not losing this job.

Frankly, I'm at a loss as to why you keep making the same mistakes over and over. Are you really paying attention? You know that one more medication error means you lose your job, so you should be concentrating on your medication pass above all else. Delegate everything that you can so that you can concentrate on the med pass.

Please give it some long, hard thought and see if you can figure out why you're not learning from your mistakes. Is it anxiety? Not paying attention? Maybe you secretly want to lose this job? Whatever, perhaps you can figure it out. Then you'll be able to figure out how to make the changes you need to.

[WillyNilly]

Are you overwhelmed with pt load? Are you troubled with time management? Do you have a patient list with med times/orders that you can cross off and notes on it aka a brain sheet to help keep you going?

[chevyv, BSN, RN]

I think you should slow down and really pay attention to your med pass. Is someone interrupting your med pass? Missing times? Sometimes there are a few outliers that you have to mark on your sheets to be sure you don't miss them.

19pts is not bad at all. You should figure out a system that works for you. Maybe make some time sheets, or find one online. Your supervisor is trying to help you succeed. So, take some time to really think about why and how your missing meds.

When I worked in LTC, I had to chart on anyone on the 24hr board which included any pts on ABT. It doesn't sound like you have to do this because you would have caught your vanco miss.

I would not be looking for another job because they are trying to work with you. Until you figure out a system, you will be like this wherever you go. Working only two days is hard because the first day your still getting your footing. Can you pick up days to really get a handle on meds? Ask to come in and shadow someone who has it down so you can maybe see their system. Be proactive in your practice and it will come. Deep breathe and check your mars when your done carefully.

[BuckyBadgerRN, ASN, RN]

Wow. That is quite a few med errors in a short span of time. I know you know this, but wow. I don't know the systems in place in your facility, obviously, but it sounds as though there are some checks/balances missing. Where I work, each med pass has its own assigned colored highlighter. All the 8pm meds for instance are highlighted in pink, makes it harder to miss a dose and certainly not 3 because you'd notice a gaping hole where there was no initials of the person giving the med.

More concerning is that you've been counseled yet still continue to make the same type of mistake. What do YOU think needs to happen to make sure these errors no longer happen? A patient load of your size on a Rehab isn't unreasonable, IMO. I guess my advice is to focus solely on the med pass until it's complete, barring a true emergency of course. Let your aide know s/he is going to have to be your right hand man until you're up to an acceptable, error-free speed. Best of luck to you!

[anon456, BSN, RN]

I don't want to be harsh because it's great that you came her to get advice. You really want to fix this.

Listen to your heart. Maybe this is not the job for you. There are a lot of nursing jobs that don't require you to have 19 patients. Maybe you are great at other things (as evidenced by your manager keeping you on and trying to help you) but maybe you just need a different line of work. We can't all be good at every kind of nursing job. I am thinking something like home health might be more appropriate for you, where you can have one patient at a time. Or maybe be trained to be a wound nurse or colostomy nurse or something like that.

I also wanted to encourage you to think about leaving on your own (you said you are looking for other work) if you think you may be a danger to your patients or might lose your license over this.

And also, have you ever been evaluated for ADD or suspected you might have it? Because what you describe sounds like something a person with this disorder might do. In which case you can seek professional help for this problem and that will improve your work and make you a safer nurse.

[CWONgal]

You should always ask the patient identifiers. Please don't get out of that habit. The patient tells you their name and birth, you don't ask them if they are Martha Stewart or whatever. Print the MARs and color code as was mentioned. One patient at a time and don't allow yourself to be distracted.

[BuckyBadgerRN, ASN, RN]

Her first two big errors were not giving the medication at all. Patient identifiers wouldn't have made a difference. Her error in giving the wrong med to a patient involved someone with dementia---an accurate answer when asking name and DOB is questionable at best in that case sometimes. LTC is a whole different animal...

You should always ask the patient identifiers. Please don't get out of that habit. The patient tells you their name and birth, you don't ask them if they are Martha Stewart or whatever. Print the MARs and color code as was mentioned. One patient at a time and don't allow yourself to be distracted.

[CWONgal]

Point taken....didn't do a good job reading the info regarding the dementia.