Over Nursing

[purple1985]

I’ve been a med-surg RN for 5 years now and started a new job about 6 months ago, still med-surg. I feel like here lately I am extremely anxious, always thinking about work, and worried about making mistakes.

I worked last Thursday and realized Sunday (on my off days) that I forgot to document I stopped an IV lasix drip on a patient I received as a downgrade around 1600 on Thursday. I know I put the order in and stopped it but do not remember documenting the fact I actually stopped it. I have been told I only have 24hours after shift ends to fix documentation so I cannot fix what happened last Thursday. I am worried I will get in trouble for this, as I am pretty positive I didn’t document I stopped it. 

Lately I feel like any error I make will cost me my license and I am constantly worried about it. I go over my shifts constantly on my off days and then cannot remember what I did and didn’t document and get worried about missing something (how I realized I may of forgot to document the lasix stop time). I know I do everything I should do, but worry about  missing the documentation for it. I have never had this issue before at any of the other facilities I have worked at.  I do use brain sheets but when I run in a patients room and then another’s, I forget to mark down everything I do. Here lately I noticed I may have forgot to document IV stop times on 2 of my patients. 

I feel like I am done with nursing. The stress and anxiety is killing me. 

I do have my MSN but have no interest in utilizing it at all either. When I realize I may of forgot to document something it makes me wonder what else I have forgot and that causes me to get very anxious. I want to quit but my husband thinks I am just being overly whiny about it all and should stick with it. I’m not sure what to do ?

[Daisy4RN]

I don’t think you are being “overly whiny”! It is difficult to try to explain the stress and anxiety of nursing to anyone who isn’t a nurse. I have said it here before that med-surg nursing was more difficult at the end of my career than Oncology was at the beginning of my career. Med-surg is hard, period! For now, I would try to find a system that works better for you to remember to document. One thing I started doing was to put little red boxes on my brain sheet to remind my of something and then put a check inside the box when completed. So for instance, when you stopped the Lasix I would write..Lasix stopped at 1600 and then draw a red box next to it, then next time you are at the Computer look at your sheet and see what documentation needs to be done (look for red boxes), document and put a check inside the box. I know it’s low tech but worked for me. You just need to find a system that works for you. I would also suggest that you look around and see what else is out there that you might like. Even if you think you don’t want to you just may surprise yourself and find something that interests you and is less stressful, you never know. I can’t speak for how your admin may react over the Lasix but hopefully nothing will come of it. Next time, If it is something you remember after you go home you can call and let the nurse who took over know and they can document what you said/did, happened all the time where I worked bc we were always running like crazy. Hope it all works out!

[SmilingBluEyes]

I think you should take advantage of your Employee Assistance Program (EAP) and get some counseling.

You are way overthinking and stressed out. Time to talk to someone who can help you sort this all out.

I wish you the best.

[Been there,done that, ASN, RN]

Agree with the counseling suggestion. Do NOT agree with the husband . Unless he is a nurse, he has no idea how stressed you are.

You worked hard for that MSN. Why NOT use it?   There are many less stressful positions available to you.

[JKL33]

Also remember to keep things in perspective. Documentation is very important. What's even more important is that the med was discontinued as ordered and the patient did not receive an intervention that was no longer necessary.

You are not going to lose your license over something of this caliber.

 Something about what you've written makes me think that some of the pressure/anxiety you are feeling is related to sort of buying into the idea that you can do everything and that even if extraneous factors make it harder and harder you should still be able to do it perfectly. That's not true. Also don't confuse laws and regulations for random/arbitrary policies, such as this 24* to correct an error thing. Who knows why they have that policy--probably related to other administrative functions like billing or HIPAA policing. Whatever the reason, this is the kind of thing that makes life more difficult than necessary. And definitely less pleasant.

You've bought into the idea that delivering on others' every desire is your professional role and practically part of your morality. Not true. And life goes on just fine if you do the very best you can do and then pretty much let the rest go. Inpatient nursing is a situation where others already made decisions that affect nurse functioning long before you got there. You're not there to make everything whole no matter what anyone else does.

[SarHat17, ASN, RN]

17 hours ago, Daisy4RN said:

"For now, I would try to find a system that works better for you to remember to document. One thing I started doing was to put little red boxes on my brain sheet to remind my of something and then put a check inside the box when completed. So for instance, when you stopped the Lasix I would write..Lasix stopped at 1600 and then draw a red box next to it, then next time you are at the Computer look at your sheet and see what documentation needs to be done (look for red boxes), document and put a check inside the box. I know it’s low tech but worked for me. You just need to find a system that works for you. I would also suggest that you look around and see what else is out there that you might like. Even if you think you don’t want to you just may surprise yourself and find something that interests you and is less stressful, you never know."

^^This! When I started, we had a "brain/SBAR" sheet for each patient. I used that for notes/etc on each patient, but made a sheet that had very basic boxes for each of the potential 6 patients I would have overnight. (Called it "My Brain Sheet" I think.) Each box had a box or line to be checked off for: (let's see if I remember it all!)

Assessment, Neuro Checks (2000, 0000, 0400) Education, Care Plan, Tele (2000, 0000, 0400), AM labs/Check Elytes, I&Os, and space for anything else that needed to generally be done each shift. ((I would keep specific med lists, what/where IV is, history, assessment information, etc, from report on the individual patient pages, and use the "My Brain Sheet" for general tracking of shift requirements. Then I could check tasks, etc, off as I go through the shift and use it to make sure I did it all.

I made a stash of copies of "My Brain Sheet" and pulled one out for each shift, stapled it to the top of my other patient pages. Multi-colored pens (don't need to get crazy, red and black are fine, or get the BIC multi-pen- it has 4 colors. Then write in a color or circle some stuff in a color to make it stand out. You may have to add/tweak/adjust as time goes on, but you WILL develop a rhythm that works. Hang in there!!

[purple1985]

Thanks everyone for the kind words and tips. 
 

I came into work today and checked my brain sheets from last week and I did leave the box to document stopping the lasix Unchecked. The patient is still here and I verified I didn’t document it being stopped, the system wouldn’t let me back chart a note so many days behind so I asked my manager and she told me just put a note for today in documented as late entry with the correct date and time the lasix was stopped,  so that’s what I did. 
A couple other nurses were saying they wouldn’t of even said anything as it hadn’t been documented a new bag had been started since 0600 the day before, and a bag only lasts about 10 hours. But I feel a moral obligation to make sure the chart is as accurate as I can make it. Perhaps I care too much? 
 

I'm trying to not stress so much about things at work. I have redone my brain sheets so I’m hoping that helps. 

[Daisy4RN]

I am glad that things turned out OK at work. For future charting I would advise to strive to be as accurate as possible. This is an area that you need to “care” about. Not only for moral reasons but also for ethical, professional reasons as well. Other staff use your documentation in deciding next steps etc. You should also document to CYA. So it is for the good of the pt and you as well. That said, none of us is perfect and things will happen but hopefully now you have a better understanding of how to deal with it when the situation arises. Again glad it all worked out and wishing you well!