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.
I agree with other postings that you need to take responsibility in getting your med pass under control. Write the times on your report sheets then cross them off or highlight them as given/not given.
LTC has monster med passes. We have 34-38 patients on midnight shifts, sometimes on more than one floor. It feels really unsafe, but, it is acceptable by state standards. The big medpass on midnights are 0000, which is lighter, and 0600, which is heavy. Then you factor in PRN's for various reasons, medicare charting, ABT charting, Vital Signs, Scan & Cath, Tube Feedings, and any fall charting, the night flies by.
If you want to move on or avoid further discipline you have to get your medpasses under control. Have you asked any other nurses for advice? If you work with your manager it shows your manager that you are interested in improving and are invested in your workplace.
Where I work, each medication card has been color coded in the top right corner. Days and evenings get two colors and nights get one as it is broken down to time of shift. When I was working evenings, at the end of last med pass, I would go through each patient's section and make sure that all the cards for that shift had been moved to the back of their section, leaving the morning ones in front. This way, if I missed any, I could go back and give it.
As far as narcs, we have a locked drawer for them and there are dividers for each resident, then each card is marked as to when that particular one is administered.
I agree with going in and writing down who gets what before the shift starts. After a while, you will then know each person's routine and you will only need to ask about and check the MAR for any changes.
Specializes in Psych, Addictions, SOL (Student of Life).
I haven't read all the answers so I apologize if this has already been said. Most if not all Medication errors are the result of system errors so you really have to look into how you do things. What you have to do is look at your system for passing medication. If you are using a computer based MAR it may have built in tools to help you prioritize your med pass. Also be aware of what meds may not be kept on the cart. I once missed a PO Vanco dose because it was not on the cart so "Assumed" we didn't have it. The bottle was in the med room refrigerator. So I updated to MAR to indicate that the medication was refrigerated in the med room so it wouldn't happen again. Try not to let yourself get distracted during med pass let other caregivers on your staff attend to those issues that don't require a licensed professional. Don't get me wrong I'll jump in and clean up a code brown (Just did one last night) but I had to first pass the med in my hand and lock down my cart. Are you doing the very basic Five checks for each pass? It may seem redundant and time consuming but it really takes very little time to do it right. If you work in constant terror of making a mistake you will make a mistake. Plant that smile on your face, keep your head high and you will get this. If for some reason you do lose this position you really should list the job on your resume. As a new nurse you need to show work history. While there are no specific laws in the US about what a previous employer can say about you most limit themselves to date of hire and date of separation. They are just too afraid of litigation. Even when they are sure they will win - litigation is costly. If asked about the job simple state "It wasn't a good fit" and you are excited about a new challenge.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I agree with other postings that you need to take responsibility in getting your med pass under control. Write the times on your report sheets then cross them off or highlight them as given/not given.
LTC has monster med passes. We have 34-38 patients on midnight shifts, sometimes on more than one floor. It feels really unsafe, but, it is acceptable by state standards. The big medpass on midnights are 0000, which is lighter, and 0600, which is heavy. Then you factor in PRN's for various reasons, medicare charting, ABT charting, Vital Signs, Scan & Cath, Tube Feedings, and any fall charting, the night flies by.
If you want to move on or avoid further discipline you have to get your medpasses under control. Have you asked any other nurses for advice? If you work with your manager it shows your manager that you are interested in improving and are invested in your workplace.
Best Wishes.
You know you're posting on a two year old thread, right?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I haven't read all the answers so I apologize if this has already been said. Most if not all Medication errors are the result of system errors so you really have to look into how you do things. What you have to do is look at your system for passing medication. If you are using a computer based MAR it may have built in tools to help you prioritize your med pass. Also be aware of what meds may not be kept on the cart. I once missed a PO Vanco dose because it was not on the cart so "Assumed" we didn't have it. The bottle was in the med room refrigerator. So I updated to MAR to indicate that the medication was refrigerated in the med room so it wouldn't happen again. Try not to let yourself get distracted during med pass let other caregivers on your staff attend to those issues that don't require a licensed professional. Don't get me wrong I'll jump in and clean up a code brown (Just did one last night) but I had to first pass the med in my hand and lock down my cart. Are you doing the very basic Five checks for each pass? It may seem redundant and time consuming but it really takes very little time to do it right. If you work in constant terror of making a mistake you will make a mistake. Plant that smile on your face, keep your head high and you will get this. If for some reason you do lose this position you really should list the job on your resume. As a new nurse you need to show work history. While there are no specific laws in the US about what a previous employer can say about you most limit themselves to date of hire and date of separation. They are just too afraid of litigation. Even when they are sure they will win - litigation is costly. If asked about the job simple state "It wasn't a good fit" and you are excited about a new challenge.
Hope this helps
Hppy
After two years, I'm sure the OP has moved past this error, or past this job.
You might consider using paragraphs in future posts.
Here.I.Stand, BSN, RN
5,047 Posts
Five rights. Wait, it's 7 now. But those cards are clearly labeled w/ resident's name, drug name, and dosage.