New RN, already making mistakes

[lillystarrn]

Hello everyone,

I just graduated a BSN program and started my nursing career. I currently work on the med-surg floor with about 3 or 4 other LPNs and 2 other RNs. I feel overwhelmed and like I know absolutely nothing! I've already made 2 mistakes so far. One was a med error: I was to give xanax along with two other pain medications. I was told to hold one of the pain meds for an hour, take the blood pressure and then administer it if was normal since the patient was hypotensive from the meds during the previous shift. Well, I was taking care of another patient, which was total care patient..and forgot to give it. Too much time had lapsed and an incident report was done. This was my first night taking care of two patients (I know, not that much, but I was nervous this being my first time).

My second mistake was a documentation error regarding an assessment that was suppose to be done by the previous shift so I felt it was my responsibility to do it at the beginning of my shift. Well, at this point I'm taking care of 5 patients and still feeling overwhelmed/nervous. I asked the charge nurse about doing the assessment and charting it in the am and they said it was fine to do that. I'm documenting that I will perform the specific assessment in the am (I work 12 hour shifts), ask a nurse if it's right to do that and was told no that if state got a hold of it that it would look bad so I crossed a line through it and wrote error. As I"m doing this, the nurse tries to give me advice to draw a thick line though it...I panic, draw thick lines though it (it's still legible although now it looks like I tried to cover something up...which I guess in a way I did). I showed the charge nurse this and was told to just not do it again.

I'm worried about how this is making me look since this is my first job. All the nurses tell me I'm slow and I've made errors already. The charge nurse has told me that she thinks I'll be fine, just to work on giving medications on time since that's what really slows me down since I'm trying to be cautious.

Any advice or words of wisdom would be greatly appreciated.

[Music in My Heart]

I just graduated ... in December 2010 and started my nursing career in April.

I was to give xanax along with two other pain medications. I (held) one of the pain meds ... and forgot to give it.

I draw thick lines though (chart entry).

I'm worried about how this is making me look...

To me, it makes you look like a new grad. If those are the worst mistakes of your career you'll have done superbly well. Just keep learning and getting better.

All the nurses tell me I'm slow and I've made errors already.

Really, all the nurses do that? That's unfortunate. Grow a thick skin and ignore the tear-you-down comments. I assure you, they've all made their share of those kinds of mistakes.

The charge nurse has told me that she thinks I'll be fine

There's the one to listen to. Believe her and believe in yourself.

You'll be fine.

(and really, those "errors" are small potatoes)

[mama_d, BSN, RN]

Typical orientation at my hospital (for tele floor) is about 12 weeks with a preceptor, about 1/3 of that time is in classes/inservices. I believe the medical floors have at least 8 weeks (as they have fewer classes etc to attend).

Not having a preceptor sounds insane to me, it's like they're setting you up for failure. No wonder you feel overwhelmed! Best of luck in dealing with this...being a new nurse is difficult enough as is. Feel free to keep coming on here for support, since it sounds as if you're not getting much while you're on the clock.

[opossum]

Why were you chewed out by a speech pathologist? Let me guess...something to do with diet, beverage thickner, or HOB elavation? The speech pathologist has no right to chew a nurse out. That person should quietly pull you aside and educate you. If this happens again, you need to go to your nurse manager and write it up. Leave a paper trail. Nurses have to stop letting everyone run all over them. We need to be proactive in getting our coworkers to see it from our point of view. While working we are expected to know everything all the time. It is impossible and we can never know everything.

Good practice: know what diets our patients are on before we adminisiter meds. Take a quick look at the computer, card ex, whatever system your facility has. Good luck.

Yeah, it had to do with the diet - I gave someone water with a straw to take with their PO meds, when they actually had a nectar thick diet. Pt began to cough, etc. In many ways, I'm lucky the SLP was nearby because after she publicly chastised me she gave me some pointers on what they use to thicken things up (I've never used that specific thickening solution before). But that hadn't stopped me from tearing up right there in the pt's room. How embarrassing.

But now I know where to look in the Kardex to see diet orders and I'm learning how to navigate the subpar charting software. Also, my nursing supervisor caught wind of all this and met with me to debrief; she was definitely on my side with the way that whole thing went down and framed it in a way where I took away some learning points. Still, I have to get better about not CRYING when mistakes are made...

Any new grads on here have a problem with tears flowing during stress?

[nurse.sandi]

Yeah, it had to do with the diet - I gave someone water with a straw to take with their PO meds, when they actually had a nectar thick diet. Pt began to cough, etc. In many ways, I'm lucky the SLP was nearby because after she publicly chastised me she gave me some pointers on what they use to thicken things up (I've never used that specific thickening solution before). But that hadn't stopped me from tearing up right there in the pt's room. How embarrassing.

But now I know where to look in the Kardex to see diet orders and I'm learning how to navigate the subpar charting software. Also, my nursing supervisor caught wind of all this and met with me to debrief; she was definitely on my side with the way that whole thing went down and framed it in a way where I took away some learning points. Still, I have to get better about not CRYING when mistakes are made...

Any new grads on here have a problem with tears flowing during stress?

I would of passed this information on in my change of shift report. Also, I am old schooled...back in the day we never ever gave a stroke patient a straw even if they were on thin liquids. At my last job the speech therapist said it was ok. But I did not trust that. I worked the stroke unit. I just made it a habit to avoid straws. I think air gets sucked up along with the fluid. But of course..follow your hospital's policies and procedures.

It is all good that we share info here..but I want to stress you must follow your own facilities' guidelines.

As far as being a new grad and crying...I am an old grad and I still cry. That is how some people cope with stress. I would excuse myself from the room and get into the bathroom of the breakroom where it can be done in private. Actually when I was newer I had thicker skin. I seem to have softened up quite a bit in the last 10 years. Life takes its toll.

Anyway, good luck. You will do great.

I was just using stroke as an example, because one second a stroke victim could be able to drink, swallow, etc, and the next they may not be able to. Patient's conditions change quickly and sometimes in a split second. Just something to think about.

:)

[opossum]

I would of passed this information on in my change of shift report. Also, I am old schooled...back in the day we never ever gave a stroke patient a straw even if they were on thin liquids. At my last job the speech therapist said it was ok. But I did not trust that. I worked the stroke unit. I just made it a habit to avoid straws. I think air gets sucked up along with the fluid. But of course..follow your hospital's policies and procedures.

It is all good that we share info here..but I want to stress you must follow your own facilities' guidelines.

As far as being a new grad and crying...I am an old grad and I still cry. That is how some people cope with stress. I would excuse myself from the room and get into the bathroom of the breakroom where it can be done in private. Actually when I was newer I had thicker skin. I seem to have softened up quite a bit in the last 10 years. Life takes its toll.

Anyway, good luck. You will do great.

I was just using stroke as an example, because one second a stroke victim could be able to drink, swallow, etc, and the next they may not be able to. Patient's conditions change quickly and sometimes in a split second. Just something to think about.

:)

That's good advice - this pt wasn't a stroke victim, but you never know in ICU. I think PO meds are sketchy for anyone in ICU, but that's just how I feel.

I really do need to get more acquainted with policies and procedures...as a new grad, there's so much to get used to. Even just simple, selfish things like, where do I put my food (duh, in the fridge) or where should I make myself "comfortable"?

[SWS RN, ASN, RN]

I am planing on moving to florida, I am a med-surg with tele exp. How is the market for nurses downthere. I heard the pay is horrible but i do not have a job now. And also i now want to stay closer to my family. I was fired from my previous job. My patient came out of surgery with some complication. this particular doctor always have patient with complication post surgery. You call him he could care less . I heard that He does his robotic prostate surgery unassisted..It was my first job i learn from my mistake. It is challenge to explain being fired to potential employer.

I would like to comment on two points to you.

The job market in South East Fl is pretty tight, especially if you are not very experienced, or not veryspecialized. It's very competitive here with an overabundance of nurses and there are nursing schools turning out new nurses faster than they can be employed. 12 years ago there were 2 nursing schools in my county, now there are 8.

My other concern, and I may be wrong and just reading this incorrectly, but are you blaming the doctor for your being fired?....also, the circumstances sound rather vague, and if you need to disclose any information to a perspective employer, perhaps saying that this surgeon always has a complication and that he could care less is not in your best interest. I say this because this could really come back to haunt you. You need to examine your part in what happened to get you terminated and own it, then fix it so it does not happen again. Next, please do not say anything about this doctor around your previous hospital or co workers...you really could be sued for slander, and it could really turn into something ugly.