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!

Big fan of holistic health here :) Sometimes it is hard to imagine fitting a back rub in with all the other duties. The CNA's on my floor work hard and we all are so busy. But I have found it is possible to fit in personalized care. I have found the best way is to model that action. For example, I sometimes try to plan my care with the nursing assistants, be in the room for bathing, or in the room at night for PM care, checking up on if foley care was done, helping to turn patients. When I am in doing a nursing duty, I pay attention to what the NAs are doing. If it time to reposition a patient, I help and say where's the lotion and make a point of talking about how this is a necessity for skin care etc. It may be very brief, but effective. And by doing this it shows what the standard should be, not that giving a rub is an extra if you have the time. I think this has helped improve the care of my patients. I know time is limited, but I think it can be done and helps with teamwork and accountability.

Very very good thread. I have learned a lot already through this discussion, and have taken a step back to look at my spending patterns. My brother is very "green" as an architect and has preached to me for years. We can make a difference in this world if we all do our part. But I would like to talk more about nursing wages. I do believe we are underpaid. One poster stated that nursing is the most respected profession. I don't believe "the most respected" fits the description of nurses. I believe it is nursing is the most trusted profession. We are not the most respected, this is seen by the way administration views nurses, namely as replaceable, and the way the media denotes nurses. In many news stories shown on ABC, FOX, etc. stories about nursing shortages, ability for advanced practice nurses to prescibe, and about the roles of nurses in hospitals are covered with little respect towards the nursing profession. Intereviews are held with doctors, not nurses. Nurses are shown in the background hand holding and following orders, but this is not reality and a very limiting perception. but this is the media perception and this is the viewers perception. Stemming from lack of education, lack of representation. I would like to see conditions improved, better patient ratios, safer practice, less stress on the job, more job satisfaction. I think that part of the picture involves higher pay. Until the pay is increased, there is no vested interest by administration to listen to nursing staff. There is money in the hospital system, enough to increase nursing pay. The healthcare system is a big money maker, I know there are lots of arguments against this but I believe the money is out there. They are cost saving and cutting in the wrong places, spending in the wrong places. I think we can make a difference by looking at ways to save money within our facility. Nurses can have a big impact in cost saving. I think also that nurses need to be heard more often as experts within the healthcare field. Sorry, long post and a bit jumbled. But there are many different avenues of which nurses can be heard. We advocate for our patients and should advocate for our profession with passion as well. In doing so, we will be protecting our patients. It is hard to be so political when all I want to be able to care for my patients, but the field is changing and becoming more endangered as cost cutting increases.

Pt Senerio: Pt comes to floor from ASU. Within minutes the pt's face becomes severely edemetous, voice sounds like a chipmunk, and pt's pressure is 60/40. The question is, which would be most appropriate, epi or benedryl? I would think benedryl for the histamine release, but would epi be more appropriate b/c it appears to be anaphylactic? I had a similiar situation but BP was stable and we used Benedryl. I am a new nurse and would like some expert advice! :) Thank you.

Thank you :)

Hi, I am hoping someone will be able to hear what I am saying and offer some advice. I have been nursing for 1.8 years on a medical surgical unit. We see everything. Of late, I have found myself more and more stressed out. Could it be my honeymoon is over? My question, is can anyone relate to the following feelings : I think about my patients when I go home, I worry about any possible mistakes, the next AM I wake up and wonder about a patient status, is everything ok? I also find myself very reactive in the environment, I am able to have great relationships with my patients, but I find myself having a hard time regulating my mood at work. I'm afraid I'm becoming obsessive with my work and I am concerned that it shows. Can anyone relate to this? I would like to know that I am not the only one who worries about their patients or the day they had when it is time to sign off, but this is becoming very stressful and I am not sure how to deal. Thank you for reading this post.