Poor Judgement / Mistakes

[adam123]

I've been a nurse for 1 year now. I still feel so inadequate in my decision to help patients. I lack judgement and common sense. Is there any helping me....i really don't know at this point. For example, recently a patient came in w chronic back pain from cancer. He has orders for pain management. However, when I went to his room, I saw an empty bottle or Percocet on his bed. I asked through a translator if he had taken any of these medications. He denied it and eventually I took his word for it and moved on. I explained it was imperative for me to know if he had taken any but he assured me he did not take any extra medication. He wasn't acting strange and there wasn't anything alarming in his demeanor that caused me to think he did take it but I should have at least call the doctor.....and I didn't. 

My issue with this situation is that I should have at least called the doctor or inform the charge nurse but I did not....why....i have no idea. I honestly forgot. I know it's so stupid on my end. To think I actually want to be an ICU nurse and I lack common sense. I have no idea if I will ever improve because i know the number one role as a nurse is patient safety.  

As i was giving report, it clicked and i told the other rn about the situation. She said she would inform the doctor but i knew she wondered why i didn't. It was a very quiet ride home because I felt horrible about how i forgot to mention this to the md and at least charge nurse.

Any advice would be sooooo appreciated no matter how hard it is to hear. Thank you.

[Sour Lemon]

I don't see any issue or problem here? I would not have called anyone to inform them of anything ...assuming no pertinent details have been left out of this scenario.

[brownbook]

I would not have called the doctor...what was the doctor going to do?

When you assessed him, was he alert and oriented, O2 level okay on room air, vitals WNL, responded appropriately to questions, etc. no signs of someone with a drug overdose?

I bet the patient brought his medications to the hospital to show the staff what medication he was on.

Unless you reply here that the patient was later found unresponsive due to a drug overdose...you did nothing wrong.

[Daisy4RN]

Yeah, I agree with above posters that this is not a big issue. The only thing I would have done is monitor the pt just in case, and wait to give any meds if requested. Pts bring there meds/bottles to the hospital all the time, you may need to tell them to take them home, or take them per your policy. If you are worried they are lying about taking them, or just want to CYA, then yeah notif MD/charge and document. You will gain experience as you go and learn what is important and what is not, you are not going to have every experience in 1 year and some situations will be new even after 20yrs. When in doubt just ask and then you dont have to go home and worry!

[adam123]

Vital signs were normal, he was AxO 3-4 and he was answering questions appropriately; however, there was a language barrier so we had to use a phone to translate. I know if he was acting out of the norm, i would of asked another nurse and definitely called the doc. I guess it's because every time I interested with this particular nurse, i feel so anxious because i have made other mistakes around her and i know she thinks i lack judgement compare to our other co workers.

The day shift nurse also mentioned that the family was concerned about the patient lying in general because the Pt had lied about his medical condition but he was also oblivious about his condition until the docs spoke to him about his ct scan and possible Mets from his previous CA. He was told he was in remission for years and finally came to the hospital for back pain. That's what led to a ct scan, which subsequently led him becoming hospitalized.

[adam123]

And he wasn't asking for any pain meds or anything at all. He slept majority of the night and i gave him one pain pill towards the end of shift. This whole thing happened at the beginning of the shift and he went to sleep right after. He was easily woken from sleep and was compliant with everything.

[Daisy4RN]

I still don't see a problem. I just would have documented in a nursing note and been done with it. Maybe not necessary but I always side with better safe than sorry (ie CYA). Something like this: Pt found with empty percocet bottle in room, denies taking any home meds including pain meds, pt ed done re: the need to not take home meds in the hospital, pt states understanding/agreement. VS WNL, pt remains A&OX4. Conversation completed via use of translator telephone.

And I would not worry about what you think others are thinking about you, that is their problem. Dont even think about it unless you hear something officially from charge, mgmt etc.

You got this!

[Sour Lemon]

3 hours ago, adam123 said:

Vital signs were normal, he was AxO 3-4 and he was answering questions appropriately; however, there was a language barrier so we had to use a phone to translate. I know if he was acting out of the norm, i would of asked another nurse and definitely called the doc. I guess it's because every time I interested with this particular nurse, i feel so anxious because i have made other mistakes around her and i know she thinks i lack judgement compare to our other co workers.

The day shift nurse also mentioned that the family was concerned about the patient lying in general because the Pt had lied about his medical condition but he was also oblivious about his condition until the docs spoke to him about his ct scan and possible Mets from his previous CA. He was told he was in remission for years and finally came to the hospital for back pain. That's what led to a ct scan, which subsequently led him becoming hospitalized.

The patient lying to his family has nothing to do with anything. Maybe he just doesn't want them knowing every detail about his medical issue(s). Someone who's being sneaky about ingesting narcotics doesn't typically bring them in a marked bottle and leave the bottle sitting around their hospital room.

No worries ?

[brownbook]

5 hours ago, adam123 said:

Vital signs were normal, he was AxO 3-4 and he was answering questions appropriately; however, there was a language barrier so we had to use a phone to translate. I know if he was acting out of the norm, i would of asked another nurse and definitely called the doc. I guess it's because every time I interested with this particular nurse, i feel so anxious because i have made other mistakes around her and i know she thinks i lack judgement compare to our other co workers.

The day shift nurse also mentioned that the family was concerned about the patient lying in general because the Pt had lied about his medical condition but he was also oblivious about his condition until the docs spoke to him about his ct scan and possible Mets from his previous CA. He was told he was in remission for years and finally came to the hospital for back pain. That's what led to a ct scan, which subsequently led him becoming hospitalized.

The day shift nurse is an idiot. There is a thread under General Nursing titled Useless Shift Report Information, what the day shift nurse told you is a perfect example of useless information. Heaven knows if any of what the family says is true and why does it matter!

I hate Nurses Eat Their Young stories but I think this nurse is doing it to you.

You come across as an intelligent nurse with great critical thinking skills. She comes across as an idiot. Ignore her little digs about your nursing skills, patient assessments etc. You're doing a great job.

[CharleeFoxtrot, BSN, RN]

12 hours ago, brownbook said:

...I bet the patient brought his medications to the hospital to show the staff what medication he was on.

Given the bottle was empty and there was a concern about a language barrier this could have been the case. However, don't discount the fact many people bring home medications into the hospital and take them. Can't tell you how often that happens, and how badly double dosing (home and inpatient meds) can turn out.

But since the patient was I/O, in my mind this wasn't a "call the doc right now" situation. I'd have mentioned it to the charge, reported it at shift change and charted it to cover my bases but I don't think the OP showed "poor judgement" at all!

[Megan Betts]

I have been an RN for 25 years. The first few years are for learning. School does not prepare you for being an experienced nurse. That’s why some nursing jobs should never hire new nurses. Don’t be so hard on yourself. We are so overwhelmed by the amount of patient care we are expected to do with such little help of course your going to feel inadequate. Everyone thinks we are so “highly” paid!. That’s a joke!!. Considering the hours, the stress, the abuse I think the pay is pitiful. It makes me so angry that we are so under appreciated. It’s no surprise to me that there is a nursing shortage. Who would take on this kind of job?. Missing weekends and holidays with your family, forced overtime, abusive doctors, patients, and patient families. Other nurses, especially managers who are bullies. With all you need to do and remember while still being cheerful and caring can take its toll. You will get better and better with time. Give yourself a break, you have to because nobody else will.

[adventure_rn, MSN, NP]

So many thoughts...

Although it sounds like you didn't actually make a mistake, your post does bring up some interesting points about feedback and opportunities for improvement....

First, I can assure you, every single nurse on the planet has had the experience of driving home and second-guessing a choice that they made during their shift. It sucks to feel as though you've made a mistake (even though it sounds like you actually haven't). When you're just starting out and still finding your footing as a nurse, it's normal to go home and ruminate over the things you could have done differently.

Second, report is a great learning opportunity, even though it can be a somewhat unpleasant one. It is one of the few times in nursing that you have someone coming behind you and 'checking your work,' so to speak. For the most part, nurses work fairly independently; if you're making a mistake, there often isn't anyone around to recognize it and correct you. During report, you may realize a mistake that you've made; once you become more experienced, you may realize mistakes that newer nurses are inadvertently making when they're giving you report.

It is completely normal as a newer nurse (or, as an experienced nurse in a new unit/specialty) to realize minor mistakes/oversights that you've made while giving report. They generally aren't true 'errors,' but rather opportunities for improvement. Sometimes, by virtue of talking through the patient, you recognize your own mistake. Other times, the person you're giving report to may point your mistake out to you. As awkward as it is to get feedback from your peers, I'd try to think of it as an opportunity for growth. If I'm ever getting report from a new grad nurse and recognize a mistake or oversight they might have made, I try to gently, non-judgmentally bring it to their attention as a learning opportunity. If I were making a mistake without realizing it, I'd rather have somebody tell me than continue to make it; I figure my coworkers would probably appreciate that feedback as well.

Third, while I personally try to be tactful and gentle when providing such feedback, some nurses are total a**-holes about it. There will be a handful of experienced nurses who treat you like a moron when they point out your errors. You coworker sounds like one of them. If it's any consolation, if she's treating you like that, I can almost guarantee that you're not the only one. It's probably more of a reflection on her character than on your competence.

Fourth, I'm hearing a lot of undertones of anxiety; it's important that you find a way to keep it in check so that it doesn't become a hindrance. This is a common theme among new nurses: You say that this nurse has seen you make mistakes and questions your judgment; the more focused on that you become, the more you feel as though you're under a microscope, and the more likely you become to get lost in your own head and make even more mistakes. I know it's easier said than done, but the healthiest thing you can do is to explore ways to keep that anxiety in check (which may mean talking with your educator or a trusted mentor, seeing a counselor through your Employee Assistance Program, practicing self care, etc.) Addressing your anxiety will help you function more effectively, and it will make you feel a heck of a lot better.

Lastly, you mention that you're interested in doing ICU. I will tell you what I tell everybody who tries a new specialty (especially a high-acuity specialty like ICU): When you first start out, you will feel dumb. All. The. Time. You'll finally have started to feel confident and competent in your old specialty, and then all of the sudden, you'll feel like a new grad again. This is completely, entirely 100% normal. You will walk away from plenty of reports wondering if there's something you could have done better. It will have nothing to do with whether or not you're competent or have good judgment; it just means that you're learning a better way to do things. Confronting these feelings requires a huge change in your frame of mind. Instead of walking away from an experience saying, "Gosh, am I dumb," try to think of it more like, "Look at how much I learned."

I guess what I mean to say is that you didn't make a mistake, but you can still think of your encounter with your coworker as a learning opportunity. It doesn't mean that you have poor judgment. However, this experience will give you a new way of thinking about similar patients in the future. Each time you encounter an unfamiliar situation like this, you'll learn something from it; that cumulative knowledge is what will make you a better nurse over time.

Thank you for attending my TED Talk on self-esteem, anxiety, and learning from your mistakes as a new nurse (lol) ?