One year in, yet still making errors -- stupid ones!

Nurses General Nursing

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Today I had a PCA pump and totally documented it all wrong. I KNEW how to do this, but just didn't remember. We don't do them much -- I probably haven't had a PCA pump in 4-6 months.

I know I should have asked someone, but didn't. Why didn't I? I have no idea.

Also made another error in which I passed on meds to another floor (in trying to keep my pt. safe by not giving digoxin w/ a low HR,) but the nurse on the other floor wrote me up for it -- why I don't know.

At any rate, I felt so confident a while back -- now I feel as if I'm losing confidence for some reason. Is this a common thing in the 2nd year?

Specializes in Peds, Neuro, Psych,Home Health, Telemetr.
Today I had a PCA pump and totally documented it all wrong. I KNEW how to do this, but just didn't remember. We don't do them much -- I probably haven't had a PCA pump in 4-6 months.

I know I should have asked someone, but didn't. Why didn't I? I have no idea.

Also made another error in which I passed on meds to another floor (in trying to keep my pt. safe by not giving digoxin w/ a low HR,) but the nurse on the other floor wrote me up for it -- why I don't know.

At any rate, I felt so confident a while back -- now I feel as if I'm losing confidence for some reason. Is this a common thing in the 2nd year?

Did you document the Dig being held due to low HR and was this an Md order of course following routine protocol of holding it below 62 some say 64...as for making mistakes we all do!!! The thing is always ask questions if your unsure , your pt's life is in your hands!

I recall my first 6 months out of school "man i thought i knew it all , only to discover, i knew barely anything after a few years,lol

I think it takes a good five six years to really become comfortable but then again over confidence is not good either, remember to ALWAYS inquire when you do not know or when in doubt!!! Good Luck! And of course you just learned a valuable lesson for going forward!

When being written up ask WHY, it's your license you have a right to know! You can always dispute the write up.

Specializes in ER/Trauma.
was this an Md order of course following routine protocol of holding it below 62 some say 64
This is why whenever I take verbal/telephone orders, I always write parameters. To me it serves the following purposes:

1. So that when the nurse has to administer the med, s/he has a clear guideline of when to give and when to hold.

2. It also saves the MD a phone call at 0300 in the am from the nurse asking for clarification.

As a former floor nurse now working in the ED, I now make sure that all patients being admitted have:

1. Something ordered for pain

2. If the med ordered is a narcotic, I automatically ask for something for nausea in case the pt. gets nauseous.

3. Some tylenol/motrin for a temperature

cheers,

Specializes in ED, ICU, PSYCH, PP, CEN.

I've been a nurse for 6 years and Roy's list could be mine. In our job it is almost impossible to be perfect. Too much to do, with to little help. Just always be sure to be very careful about meds (do the five). I triple check and sometimes run meds by my coworkers because once you put a med in you can't take it back out.

uhh... about the PCA thing. so what... you documented incorrectly. that happens to new nurses and old ones alike. you'd be a bad nurse if you were making medication orders, transcribing orders incorrectly, or big things like that. you seem like a good nurse, so keep up the good work

Specializes in tele, oncology.
This is why whenever I take verbal/telephone orders, I always write parameters. To me it serves the following purposes:

1. So that when the nurse has to administer the med, s/he has a clear guideline of when to give and when to hold.

2. It also saves the MD a phone call at 0300 in the am from the nurse asking for clarification.

As a former floor nurse now working in the ED, I now make sure that all patients being admitted have:

1. Something ordered for pain

2. If the med ordered is a narcotic, I automatically ask for something for nausea in case the pt. gets nauseous.

3. Some tylenol/motrin for a temperature

cheers,

Roy, could you come and work in our ED? Pretty please? Over half of the crap that I have to deal with straightening out some nights comes from screwed up ED orders on new admits. Things like if you're giving them dilaudid q2 in the ED, give me something besides Tylenol for when they get to the floor.

To OP...

I've been a nurse for nearly a decade and still have plenty of times where I have "conferences" with other nurses on the floor for verification or advice regarding care, meds, what I should ask the doc for, etc. As someone else said earlier, nurses who are 100% sure of themselves all of the time are scary.

They think if they show it to you once, perhaps show you their poster or whatever, that you are supposed to be an expert at it.

That attitude really gets to me!

Well, it takes me learning AT the bedside, perhaps over and over, and I just MAY have to make an error once to really learn it. How is that for a learning style? It's called, being Human.

What you say here makes perfect sense to me! It can take doing something OVER and OVER several times before I feel competent at it. And it seems that some things just aren't learned well UNTIL a mistake is made. That's no excuse to not try one's best, but as a perfectionist, I can really use some help differentiating what is REALLY meant when told "Don't do X." I need to know where on the spectrum it falls... from "It's generally a good idea if you don't do X but it doesn't really make that big of difference one way or another" to "If you do X, you will be doing drastic, irreperable damage to someone's physiologic well-being." Sure, some things are pretty clear and I can use my head to make the determination of how important this or that is (I don't need someone to spell out why using Drano in a IV flush isn't a good idea), but there are SOOOO many different needs to juggle in floor nursing and SOOOOO many variables, that it's incredibly easy for someone without experience to get side-tracked by something not so important or to overlook something that would be a flashing red light to someone with experience. Yet so many experienced nurses (not all!) will immediately chastise a newbie for "not using critical thinking", for "not managing time well", for "not asking for help" (when you didn't yet realize you needed it!), for "not being confident enough" (when asking for help a lot)... instead of simply giving the concrete assistance required so that the newbie has one more experience under their belt to draw upon in the future.

In general, I find it very demoralizing and not at all helpful if I make a mistake to be lectured about "prioritization" or "critical thinking"... making mistakes (or near misses) ARE part of the process... and it's impossible to NEVER make mistakes... so what IS the point of telling someone who made such a mistake "You SHOULD'VE known better...."?

And I don't find it helpful to think that mistakes are okay as long as you "never make the same mistake twice"... chances are I WILL make the same mistake more than once. Probably not a totally identical action, but if the problem is that I'm being too rushed... well, I WILL be too rushed again at some point... probably right after being criticized for having been too slow!!!

Just venting... and hoping that my vent is also supportive of the OP... that it's okay and normal for it take time before one really gets something. You often emphasize that most nurses are working in a team environment and have each other to help, to share experience and strengths between... that you're not alone and will "watch each other's backs" making sure that at least the most important stuff is covered despite whatever any one individual's weaknesses are.

Specializes in ER/Trauma.
Roy, could you come and work in our ED? Pretty please? Over half of the crap that I have to deal with straightening out some nights comes from screwed up ED orders on new admits. Things like if you're giving them dilaudid q2 in the ED, give me something besides Tylenol for when they get to the floor.
Humble suggestion:

The next time you're taking report, ask the nurse giving report what the pt. has ordered for pain/anxiety/nausea/fever etc. If you feel something is lacking, just ask (hey, chances are I've overlooked something too!) :) I accommodate most requests within reasonable limits.

"Could you please do me a favor and get some kind of bridging orders for pain/nausea from the ED/ER doc in charge of this case?" or

"Hey, I noticed you've been giving him Dilaudid in the ED but all I have from the admitting Doc is some Tylenol. It's 0230 in the am. Do you mind asking the ED doc to write for some morphine/dilaudid and some zofran to cover till the AM when the admitting doc gets here? Thanks!"

Sometimes in the mad rush of working in The Pit, we nurses forget to look out for such things.

cheers,

PS: I learned my lesson the same way you did. Too many patients coming up to my floor with screwed up orders. So when I became an ER/ED nurse, I resolved to do my best to never be "that nurse". 'Pay it forward!' ;)

Specializes in Med/Surg, ICU, educator.

Like you Roy, I've learned the golden rule of making sure I address pain, headache and nausea, plus anything that has to do with diagnosis--I've had patients admitted for tachycardia and HTN, and absolutely NO BP meds!

Thank goodness you're taking on the job of doing it the right way--it makes it easier for those who are getting the patient. Bless ya!

Specializes in Med/Surg, ICU, educator.

also thought I'd suggest keeping a small notebook of "major" mistakes and ways to avoid/fix them, and review it weekly/monthly (whatever works for you). It's what I did the first couple of years, and it really seemed to help.

Specializes in Community, OB, Nursery.

It's been 8 years, and I still make mistakes. My coworkers with twice and three times that still make mistakes. It's called being human....but I'd be willing to bet none of us have made the same mistake twice!

It's been 8 years, and I still make mistakes. My coworkers with twice and three times that still make mistakes. It's called being human....but I'd be willing to bet none of us have made the same mistake twice!

I appreciate your sentiment!

I did want to reiterate that I don't tend to find it reassuring when someone says "Well, you'll never make THAT mistake again!" After all, I made that mistake once despite doing my absolute best to do the right thing, so it's not impossible that I WILL make the same mistake more than once. Probably not a TOTALLY IDENTICAL action, but if the problem is that I'm being too rushed... well, I WILL be too rushed again at some point... probably right after being criticized for having been too slow!!!

I also wanted to ask how you (or anyone else) accept what seems contradictory to my literal, over-analytic mind... the advice that "we're human, we WILL make mistakes, so it's not the end of the world if you make a mistake" and the criticism one may receive that "You *shouldn't've* have made that mistake!" Of course, one wants to avoid mistakes, but we WILL make mistakes The concept of *shouldn't've* or "should've* suggests that the mistake *could've* been avoided... and if each individual mistake could've been avoided, then couldn't ALL mistakes have been avoided? But of course, ALL mistakes can't be avoided... so how it is ever accurate to say that one "should've" or "shouldn't've" done something that they clearly did or didn't do?

I work nights so things are a little less distracting, but I wouldn't care about what other nurses think of you regarding your sociability. As long as you are pleasant, proffesional and willing to help others out when you can, a good nurse is going to respect you.

New grads that act like they know everything and don't focus on what they don't know, or don't know enough about.... scare me. I would NOT want them as my nurse.

You focus on you, and then your patient, working as an evidenced based nurse. Social cliques, gossip and judgement of other coworkers personality (not their work or safety) is BS and you need to stay as far away from those people as possible. That is such old school high school bull that us new nurses need to ignore or confront depending on the situation. We are not going to eat our young and there should be nurse mentors that you trust to go to either for advice or just a pep talk, if not... definitely think about switching jobs.

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