beannie

Hi, I've been a nurse for 3 years. I made a med error -- I had 2 pts in the same room getting vanc, and I gave one pt vanc at the scheduled time for that pt, only prob is that the medication was labelled with the other pt's name. Another nurse caught the error. I am very concerned over this, basically, I did not follow the 5 rights --- RIGHT PT was apparently the one I neglected. I did not check the actual medication to the pt when I got into the room. We do have computerized charting, so I checked the med order to the correct pt, but still hung bed b's vanc to pt in bed A. I can not believe that after so many years I would do this. I am overwhelmed with fatigue when thinking about going back to work, as well as humiliated. Reminder to everyone - check your five rights every time.

thanks for the warning Suzanne! i just signed a contract (yikes!!) and there was a clause that I couldn't work at the facility or with another company at the facility for 1 year after completion of assignment. Of course when I saw the clause, I re-read this thread. I was uncomfortable with this and fortunately the company (nurse one staffing) changed the contract when I brought this to the table. good to hear such advice from other travelers! Thank you.

i liked my PPR recruiter, the pay quoted was better than medical express for the same assignment, but not the highest out there. But the quality of the company seems fantastic.

hmm. lol. i wanted a lot of experience also, I wanted to learn the most as quickly as I could. Not the best idea if you would like to keep your sanity as well. :) Well, good luck, you sound like you have a very positive attitude with loads of determination. Two very good qualities!

Why me? does anyone ask that? Well, it seems any pt that is going to have a problem I get! I don't know if I can take much more of this. It doesn't matter what it is, its going to happen. for example, get a post-decubitus debreidment pt, of the sacrum, what do you know, but her dressing is draining blood, soaking 3 abd's per hour. How is this possible!! And right next door is another post-op same docs, who is bleeding out abdomen. Grr. All I want is a few good days. I can see a few comps, but really this just keeps happening. How about getting an asymptomatic patient who develops bilat PE's after surgery? How about another Vag patient post-op bleed out. How about a post-op getting to the same room as the vag bleed (who BTW skipped ICU and went straight to OR) and within half hour to getting to floor needing Narcan - twice. How bout a stroke victim who mid-day assessment no radial pulse (gets transferred out)? how about coming in mid shift to relieve someone and their patient goes into SVT and hour after they leave, and on the sameday as the pulseless limb. How bout pt that's fine all day, calm, cooprerative, orientated, IV pump in failure, pt goes bannanas and busts the bolted to the wall mercury blood pressure fixtures? And then comes a root cause analysis for that one. Oh and they took him of Ativan the day before b/c of somnolence. Great. How about a ped of 12 months who goes into kidney failure, has a lets say major fluid shift and has to be flown out, from a M/S floor. How bout getting a post-op from ASU who is swollen like a chipmunk, voice unnaturally high pitched, and get report pt c/o cp just prior to transport. What?! I could go on. Plz, is this normal? Maybe this is what nursing is all about, however, the stories just keep racking up.

Hi all, I'm thinking about travelling soon, in fact I know I will. But I am also driving a car with 400,000+ miles and thus I am car shopping. So, this is the question ----- for all you travellers out there if I get a car like a honda or acura, will I be able to travel? carry my belongings? I want a car for better gas and price, but is it really possible to travel by car? Have you travelled by car and made out ok? please lend me your opinions, thank you!!! I've been struggling with this for a while and have finally decided I should seek some expert advice!

uhh, we have computerized charting. One of our nurses wanted to break down the time spent with patients and the amt of time paperwork takes up per patient, the results, approx 1.5 to 3 HOURS of paperwork per patient per shift. This translates to a lot of money!!! If you have 7 patients on a 12 hour shift, well i think you get the picture. And add to that three discharges, to admits, and one post-op, you are in pretty deep. This research that she completed was the cornerstone argument for adding a new position --- an admissions/discharge nurse (of course this is a trial position, but believe me we are charting our butts of to prove how much she is needed!). Thank goodness, it has made all the difference.

Wasn't too much to be done about it since the time had already elapsed. It is policy to start the antibiotic within four hours of admission. This did not happen, it was written to start the next day. I still feel bad, I don't feel I should have just changed the time of the antibiotic to be due at 1800 for the future and just be done with it. Thats what some of my co-workers think. It makes me nervous that this is the response to errors. I have made mistakes and learned from them, if I didn't know about them I would not know my weaknesses nor how to avoid repeating in the future. I remember one mistake I made and reported, after a review, turns out there was a pump failure and management made the appropriate changes and an inservice to boot. Just telling someone they made a mistake does not prevent the error from occuring again and may lead to oversight of a bigger problem. *shortened this post

Hi all. I am in the middle of an internal/external what you want to call it conflict. The other day I wrote a QCC on a nurse who is new but has 8 yrs experience. The problem was that there was an antibiotic that got missed on her shift, the even bigger problem was that the patient was admitted the day before and antibiotic therapy was not initiated on that date, so for 24 hours the patient did not start her antibiotic therapy. If we were trying to beat sepsis it was a pretty poor attempt. So I told that I wrote the QCC b/c I would want to know if it were me. I felt awful telling her this. Her reaction - she started crying and said that did not enjoy working here and that she felt it was an unsafe environment. Again, I had a very guilty feeling. The problem is that there is some merit to her statement. Nurses are constantly being called away to help with toileting, turning, etc... What do you do, risk a fall to prevent a med error? I have been on this unit for a while and have learned the ropes, but the risk of error is still present. So, my external plight is what to do about this. I hate writing QCC's!!! So here is what I would like to hear about, 1) QCCs are the only way to track and report errors. If there is no documentation stating errors are or have occured there is no one who acknowledge such, i.e administration. If changes are to occur, then there has to be documentation that a problem exists. Most errors stem from a systamatic fault/root cause. Most of the nurses on my unit say they have never written a QCC, they instead go to the person to let them of the mistake. If these errors go undocumented, how will patient safety improve? Are we not putting patients at risk by not documenting? Errors are under-reported because it makes individuals feel vulnerable. When staffing is poor, supplies low, etc.. there will ultimately be consequences. Are we not responsible as a whole if we don't take accountability not only on a personal basis but should that not fall on the heels of our supervisors and administrators as well? 2) Md's don't "tattletale" on each other, and why in nursing is it seen as a "tattletale" scenerio? 3) If morale is low then patient safety will be compromised. Should we then not report errors? Is there not another way other than to blame individuals? Our hospital has anonymous reporting, but ultimately the individual is approached and it becomes the individual who is at fault. I believe in accountability, but if errors are under-reported then there will not be improvement for all nurses. Does anyone have a system that works in their hospital?. I feel like I never want to write another QCC again!!!!!. But what will happen if Quality Improvement has no reports of errors, will they not have evidence that shows nursing is need of quality improvement?? I am at my wits end on this. In my opinion, errors should be reported, not under-reported. I feel nurses should not feel it reflects upon them, but rather upon the system or environment. Sure some nurses are not competent, but the majority are. If the majority feel they are unable to provide a safe environment and have poor job satisfaction, then there has to be accountability within the system. Not just a continuation of grumbling that goes un documented. How can this be done without compromising the integrity of nurses or the morale of the unit?

Eric, lol your first explanation was clearer to me. Thank you, for both bits of good clinical information.

Just the other day a family member came to me and said she gave the pt a back rub and forget the pain medication I was going to get b/c the pt was relaxed and pain free. It only takes a minute or two to get in a "rub". I can attest the benefits of massage for the orientated pt, but I wonder how it affects agitated/confused pts, is there really enough benefit to try massage for them instead of sedatives which leaves them asleep all day and then awake during night? I just know that on med/surge, time is a limited commodity, but I also know I spend so much time running for pain meds for backaches, headaches, etc., so much time answering call bells, I wonder if incorporating more hands on care would reduce the amt of time spent running from pt to pt. I guess most would argue not, but anyone have any personal stories for this question?

the staffing scenerio you mentioned is a point of concern, though common in LTC. But with that point aside, and getting back to your original post, I think you have several qualities that are needed in the trenches of patiet care - attention to detail, advocate for patient needs/safety, accountability, and a determination to stick to high standards of care. In a new CNA, these qualities are admirable but can be viewed negatively by other staffers. I just hope that through your career you will stay true and dedicated to what your own high standards/good pt care and not wane with time or more exposure of the healthcare system. I think you have the potential to make a positive difference in that facility. You can make changes and the residents will benefit. Be a role model, careful not to correct people on a daily basis, follow the heirarchy, go the nurse first, NM next, and on up. You may discover many things by going to the nurse first and the nurse will appreciate your feedback. Also, I would try to look at the root of the problem, are supplies lacking or poorly organized? understaffed? do they feel unsupported? lacking knowledge?, just plain lazy? too long with the same residents/need a change? There are no excuses for behavior, but you may find that looking at root of problem will help you to approach the problem in a "tactful manner" Good luck!

re: caroladybelle What you stated is what I am talking about. The advice is very good. I too support staying with the job, and support the nurse who posted. The responses have been about looking what can be done to remedy the situation, not the person. B/c as it was said, yes human error but there is also the system to look at. I have seen where nurses are not so supportive on the job. It does look a bit confusing when I look at the post, I really was just meaning that I think it is great to see such analytic and supportive responses.

oh man, how supportive everyone is. what an incredible group of nurses that reply, i am impressed with the supportive words, air of restraint practiced in order to propel young minds to achieve the stately job of nursing. :) hmm, my first reaction brings me to wonder if the five rights of administration were considered, the basic cornerstone of patient safety. i would not be concerned with calling the md to clarify an order. and would not be concerned with calling the pharmacist (great pharmacist) prior just to get grounded when calling the md. but don't beat yourself up, accept the knowledge you will gain,true a lot was learned in school etc., but who knows, this charge nurse may end up to be a great mentor and resource for the future. 1. right patient 2. right time and frequency of administration 3. right dose 4. right route of administration 5. right drug

thank you all! Very clear now!