Paranoia and panic! How can I be safe?

Dranger · May 21, 2015

It's called the practice of medicine, there will be mistakes or oversights. As long as you were doing your due diligence there shoudn't be an issue.

Mistakes are more common in a office setting because of the lack of diagnostics.

Jules A, MSN · May 21, 2015

In the beginning I relied very heavily on my experience with assessments and medications I knew from floor nursing. It was nerve wracking but also exciting. Congratulations and best of luck to you.

guest538567 · May 21, 2015

What you are feeling is normal. I recommend asking questions and trying to find someone that can mentor you (even in an unofficial capacity). If in doubt, look it up. Buy a good resource program like uptodate. Refer a patient to a specialist if you are in doubt and until you have better experience. Egregiously missing something or misdiagnosing is likely rarer than the statistics indicate (ie. 15% of patients are not harmed each office visit). Clinical medicine is often practiced in a trial capacity, ie., lets see if this rash is steroid responsive.

I would much rather a new NP have a healthy dose of fear than overconfidence. The former will protect you, while the latter may cause harm.

PG2018 · May 21, 2015

Like the sage advice given with Miley's sub-boob tattoo, "just breathe."

You're going to be fine - really. Document prudently. Diagnose reasonably. Know this: you will make diagnostic and treatment errors. It happens. Everyone involved will be fine.

FNPSafety · May 21, 2015

I can accept that there will inevitably be oversights and mistakes, everyone is human, but I do want to try to minimize them as much as possible. I am interested in what experienced NP's found the most helpful when they were starting out to keep their care as safe as possible. I feel like there are not a lot of quality control measures in primary care. (i.e. Double checking high-alert medications and the like)

FNPSafety · May 22, 2015

I have never really framed clinical medicine like that--practice in a trial capacity. I like that! It's so true, we don't have superhuman magnifying lenses into every single problem someone might have. We just have to make a decision, see if it works, and re-evaluate our action plan if it didn't work. Uptodate is awesome, plus I'll have to always be on the look out for friends and mentors to help me along. Are there any formal oversights or double-checks in your job setting? Is there any form of error prevention program other than you being vigilant? It certainly is a position with a lot more responsibility and autonomy than bedside nursing.

carachel2 · May 22, 2015

The number one thing you can do is to not work at an office that is giving you ten minute slots for your patients or pushing you to exceed a safe number of visits per day. Also...when you have a visit that doesn't end up in a nicely wrapped diagnosis take the time to sit and explain this to the patient i.e. "I have a number of different possible diagnoses in my head. There is a possibility this is X because of this, this and this but I want you to know I am also considering X and X. We will be in touch as soon as your labs/scan, etc results come back. Let's follow up in X amount of days/weeks. In the meantime, if you have new or worsening symptoms, PLEASE let me know so we can change our plan accordingly and see you again." Patients appreciate the explanation, they appreciate that you are listening and putting thought into them and they will NOT be mad that there is no precise diagnoses. What makes patients mad is not being listened to, not explaining and not knowing what the next step in the process will be.

bullfrogicubeach · May 24, 2015

Great post Arwen, I think the answer to your question can be found in how we approach our practice, how we handle our inner fears, and above all how you live with your choices. Staying up to date on Evidence based practice while providing care is essential. Forming a systematic approach to a good review of systems and correlating that with a well taken exam is the key to providing safe care. Learning how to gain the self confidence to proceed will be gained in life experiences not only in the office but correlates with, how we deal with fears in our personal life as well, My recommendation to you is go rent the movie, "What about Bob?". It is a great 80s movie on knowing ones self on the inside as well as on the outside. Confidence is always the product of letting go of the illusion that you have control.

Jeremy.

meganmaz · May 25, 2015

These are my very sentiments when I think about practicing sometimes! I like the advice given to not start in a clinic where the appt times are 10 minute slots. I think it's important to not just take the first job that comes along, but to find a place that has a culture of safety and doctors that will support you and be patient with you. I had a NP friend who took a job in a family practice clinic that was just slammed, and she almost wanted to go back to regular nursing because she felt so stressed about hurting someone/practicing unsafely. She's a smart girl and now has a NP job she loves, but I think it just goes to show that not all jobs are created equally. And Jeremy, I like your advice on "What About Bob?" I have 4 copies of it if anyone needs to borrow it. :)

sgalgiani · May 30, 2015

Yes Arwen, I am nervous about this as well. I think the main thing is remaining confident yet humble. It makes me think about a top-dog surgeon who does excellent work, but lets say he is cocky and does not provide a good rapport with patients and staff. Complications could develop if there is poor follow up and communication. No body is perfect, and no test is 100% perfect. I feel like we need to perform a thorough ROS and PE, and make decisions based on the best evidence. Even after doing so I think errors still occur, but we can prevent some of those errors by being humble and asking questions when we truly aren't sure of ourselves.

TammyG · Jun 5, 2015

I agree with SGalgani on this. I think it is the individuals who think they know everything that make the mistakes. Those of us who know we don't have a clue, and will do a thorough assessment and note, and review and look things up, we do the better job much of the time. I truly believe this and have found it to be true in my practice. So keep on feeling scared and clueless! You will be the better provided for it.