Melissa Davis

Marie Ryan-- LOVE your post and you are absolutely right. I'm sorry you were traumatized by a hostile work environment and that you have found a place more fitting for your abilities and humanity. My heart goes out to you and to any other nurses, because we are all second victims of our errors. My research is focused on nursing medication errors and I can tell you this: 1. You were probably given the message in school that, if you are smart enough and care enough, you will not make errors. WRONG. 2. All humans make errors continuously-- I just made two typing errors while writing this post. It is not reasonable to believe that, as nurses, we will suddenly get perfect. 3. What really needs to happen is: nurses need to be taught how to spot the systems risks that make it easier to commit the all-too-human and inevitable error. We can then alter systems to reduce the risk of errors. I bet that, if we talked about your incidents, you would find that packaging is dangerous, you were in a hurry, patients had similar names, you had a migraine, etc. -- all things that affect humans' ability to be perfect. We are not robots, a good thing, but that also leaves us vulnerable to errors. 4. All errors should be treated as learning experiences, nothing more. It's not win or lose, it's win or learn. That's all you can do at this point-- and forgive yourself. You cannot be blamed for being human. Anyone who tells you they don't make errors is lying. I have 40 years behind me and have made plenty of them. People who name, blame, and shame nurses for making errors are unethical and destructive to the profession. It's high time we started to support one another instead of committing horizontal violence at every turn! Melissa Davis DNP RN

Hi, my heart goes out to you because you are in fact a second victim of your error, as we all are. My research is focused on nursing medication errors and I can tell you this: 1. You were probably given the message in school that, if you are smart enough and care enough, you will not make errors. WRONG. 2. All humans make errors continuously-- I just made two typing errors while writing this post. It is not reasonable to believe that, as nurses, we will suddenly get perfect. 3. What really needs to happen is: nurses need to be taught how to spot the systems risks that make it easier to commit the all-too-human and inevitable error. We can then alter systems to reduce the risk of errors. I bet that, if we talked about your incident, you would find that it's somehow very possible to assess a client without remembering to start a restraint check log. Imagine how different it would be if the signature area on your assessment reminded you to start the protocol, or even better, the EHR wouldn't allow you to finish documentation without starting the protocol. Remember that as humans, we are rushed, we are distractible, we have migraines, , etc. -- all things that affect humans' ability to be perfect. We are not robots, a good thing, but that also leaves us vulnerable to errors. 4. Use this as a learning experience-- it's not win or lose, it's win or learn. That's all you can do at this point-- and forgive yourself. You cannot be blamed for being human. Anyone who tells you they don't make errors is lying. I have 40 years behind me and have made plenty of them. I'm here if you need more support. It's OK. And I firmly believe you will NOT lose a license over this sort of thing-- if that were true, there wouldn't be any nurses left. Check your state BON listing for cases in which licenses were suspended or revoked-- very often it's about unrelated criminal activity, such as DWI charges or other felonies. Melissa Davis DNP RN

Hi, my heart goes out to you because you are in fact a second victim of your error, as we all are. My research is focused on nursing medication errors and I can tell you this: 1. You were probably given the message in school that, if you are smart enough and care enough, you will not make errors. WRONG. 2. All humans make errors continuously-- I just made two typing errors while writing this post. It is not reasonable to believe that, as nurses, we will suddenly get perfect. 3. What really needs to happen is: nurses need to be taught how to spot the systems risks that make it easier to commit the all-too-human and inevitable error. We can then alter systems to reduce the risk of errors. I bet that, if we talked about your incident, you would find that packaging is similar with the flushes, or you were in a hurry, or had a migraine, etc. -- all things that affect humans' ability to be perfect. We are not robots, a good thing, but that also leaves us vulnerable to our errors. 4. Use this as a learning experience-- it's not win or lose, it's win or learn. That's all you can do at this point-- and forgive yourself. You cannot be blamed for being human. Anyone who tells you they don't make errors is lying. I have 40 years behind me and have made plenty of them. I'm here if you need more support. It's OK. Melissa Davis DNP RN