I work on a busy cardiac stepdown unit. After a 3 month orientation, I've been on my own now for 3 1/2 months. I love my job, I love interacting with my patients and making them smile when they're going through a rough time. I try to keep a positive attitude, however, after several stupid stupid stupid mistakes, I'm wondering if I'm even cut out for this. I'm so scared that one day I'm going to make a mistake that is going to be fatal. Here's my list of mistakes thus far: Just got orders from a doc with notoriously horrible handwriting, thought the order said DC foley, which I did... only come to find out later on, the order said DC zosyn... Next mistake, had a patient with a wound vac for the first time, came in that morning and assessed, assessed the site where the wound vac was applied, and even thought I assessed the machine, WRONG, apparently the wound vac had died on night shift, was off my whole shift and it wasn't caught until the next nightshift... Ok, next mistake, had a CABG pt who was a walky talky, didn't need any assistance. Well apparently I forgot to lock his bed, and he fell on his butt while trying to get outta bed when I was not in the room.... All of these mistakes happened around the same time frame, and for a while I was starting to feel more confident since I was making less mistakes, wrong assumption. Had the day from hell yesterday, and don't even know if I want to be a nurse anymore. Had a pt who was in a fib with rvr, was running in the 110s, was on cardizem iv @ 10cc/hr, doc came in and ordered lopressor 25 po. Pt left the floor all day for tests, and the lopressor had not been administered, well the pt had converted to SB while gone, which I knew! but for some dumb reason, I gave the lopressor anyway!! His heart rate was in the 50s for goodness sake! So I got wrote up for that, of course. I leave the hospital bawling, because I have made mistakes, but never a med error like that, get home only to find that I had another pt's q 2 hr eye drops in my pocket. I call the floor to tell the pm nurse, only to find that I had forgotten to chart output on another pt who was strict I&O and the doc was up on the unit raising cane about it!!
Sorry so long, but after all this, I feel incompetent and am questioning why I ever went into nursing. I dread going to work, and bearly get any sleep before a shift (which could have something to do with all these mistakes) I just wonder now many more mistakes I can make before I just get fired...... Can anyone relate, or offer any advice, I'm desperate here!
Mahage, thanks for your advice and support. I am still emotionally overwhelmed by everything. For the past 2 weeks I have had the same stressful load of patients, I go to work on tomorrow and if I see them again, I will complain.
By far, this week was even worst than last:
-One patient w/psychotic daughter demands to see our manager b/c the attending has not been by in 2 days to write for a full PT eval/indicates that her mom is vegetarian (the woman had a plate of beef the day before); she also has chronic afiv/aflutter and an elevated INR; the daughter complained and ranted for the last 4-5 hours of my shift (i made calls to the doc, only cardio team came by)
-Bedridden patient who continues to eat despite having an NG tube and refuses Ct of the abdomen/NGT discontinued eventually (doctor came back from vacation); Patient is incontinent but has obstruction and foley can't be inserted
pee and poop all-over the bed, fortunately he had a good sitter
-Woman w/low K+; allergies to Heparin agents (totally missed this when doc wrote order for Lovenox BID) All physicians notified of BID but I am not sure they paid attendtion to the allergy--patient is given lovenox (hopefully she's fine)
-Diabetic patient w/insulin issues not given proper meals/shaving w/razor and on heparin 5000 units
-ETOH patient w/elevated Dias BP who needs a CT, I rushed to given Lopressor before patient leaves for TEE only to find the CT was pushed til the am
-Hospice patient on morphine that dies in the middle of my shift (2nd patient for me in 2 weeks) very emotional and frustrating to watch patients die
I have been crying, depressed, having diarrhea, nauseated, everything. I am just overwhelmed and pray to God that it gets better
Does anyone have a system that they use to keep track of these things until you get a chance to chart? I have a little notebook for reminders but sometimes forget to write it down in there. LOL
Always check your pockets before you go home.
Before you leave a pt's room, turn and do a quick visual scan from the doorway-Siderails up? Bed/w/c locked? Call light/water/phone/bed controls/urinal within reach?
Don't rely on your memory- a thousand things will come up and you will forget things. Write reminders down for yourself.
When you are new, it is really helpful if you can make a xerox of your pts' Kardexes, or print out a copy of the MAR. This way, you have your info with you and can write notes and reminders re: your pts on it.
You won't have to write down the name of the drug- it's already there in the MAR. Just write down the time you gave it and any other needed info, i.e BP- next to the med.
You can carry these papers in a small 3 ring binder, with dividers for each pt.
Get a binder in a bright color so that if you set it down somewhere, you can easily find it.
You can use super sticky post-it notes to mark pages in the notebook.
You can use various colors of highlighters to mark things.
Example, if the pt is a diabetic w/ fingersticks, I highlight this with a pink marker. I'll make a pink mark long enough so that I can write my glucometer results in it, too. If the pt has a foley, I highlight this w/ yellow.
Designate one color of highlighter to use to mark things out when they are completed and you don't have to worry about them anymore.
These papers are good to use for giving report, too. Keep the notebook w/ the papers locked in your locker. If you have the same pt again the next night, transfer updated info to a new xerox of the updated MAR/Kardex.
Use the skinny highlighters so they are not bulky in your notebook. You can use a zippered pencil bag in your notebook to keep your dressing scissors, hemostats, penlight, extra alcohol wipes, etc.
Mahage, thanks for your advice and support. I am still emotionally overwhelmed by everything. For the past 2 weeks I have had the same stressful load of patients, I go to work on tomorrow and if I see them again, I will complain.
This is about par for the course on our unit. This is what I would do and you may have already done these things or might not want to or be allowed to do what I would do..
By far, this week was even worst than last:
-One patient w/psychotic daughter demands to see our manager b/c the attending has not been by in 2 days to write for a full PT eval/indicates that her mom is vegetarian (the woman had a plate of beef the day before); she also has chronic afiv/aflutter and an elevated INR; the daughter complained and ranted for the last 4-5 hours of my shift (i made calls to the doc, only cardio team came by)
I would make sure the daughter got to see the manager. I would prep the manager by telling her about the daughters behavior and that it will help if she will see her and smooth things over. I would pet that daughter and listen to her for a few minutes everytimem I have to go in the room. I would tell her how sorry I am over the confusion about her mothers diet and ask her mother in front of her if she wants to be changed to vegetarian diet. I would apoligize to her for the docs not coming but would call the doc and emphasize that they really need to come because the daughter is very upset and is complaining.
-Bedridden patient who continues to eat despite having an NG tube and refuses Ct of the abdomen/NGT discontinued eventually (doctor came back from vacation); Patient is incontinent but has obstruction and foley can't be inserted
pee and poop all-over the bed, fortunately he had a good sitter I would tell the pt the consequences of his behavior, eating and make sure the doc in charge knows it. I would warn family or whoever brings food in that it is bad for the patient. I would try to get a bedpan under him/her and put loads of green pads under them. The sitter should be a great help in changing pt. and I would use her help and that of the tech instead of taking on the change myself.
-Woman w/low K+; allergies to Heparin agents (totally missed this when doc wrote order for Lovenox BID) All physicians notified of BID but I am not sure they paid attendtion to the allergy--patient is given lovenox (hopefully she's fine) I would specifically let the ordering doc know that she listed heparin allergy and ask if he is sure he wants to continue the Levenox. I might phrase it in a request for info...Like.....So do you use Lovenox when pt is allergic to heparin products?....Well you know since Mrs BlaBla is allergic to Heparin and she is getting Lovenox I wondered. (It way actually be just fine, but I would want to make sure they understood my concern.)
-Diabetic patient w/insulin issues not given proper meals/shaving w/razor and on heparin 5000 units. Do not allow pt to shave selfRemove razors. Snatch concentrated sugars off pt. tray and order new stuff to fill in for it if he doesn't have enough. You are the nurse, you get to be the boss here.
-ETOH patient w/elevated Dias BP who needs a CT, I rushed to given Lopressor before patient leaves for TEE only to find the CT was pushed til the am -par for course
-Hospice patient on morphine that dies in the middle of my shift (2nd patient for me in 2 weeks) very emotional and frustrating to watch patients die-A great honor to get to care for those who are ending this phase of their journey. Death is a part of living. I feel very special when I get to work with dying patients and their families.
I have been crying, depressed, having diarrhea, nauseated, everything. I am just overwhelmed and pray to God that it gets better
It will get better as you learn to take all this stuff in stride.:tinkbll: The same things used to freak me out, but now I just take it all in stride. It is unbelievable, but the other night I got called in and got three new patients. I just could not get caught up all night though my charge was the really good one and she did all the orders on all the patients, I was hanging iv's and getting blood sugar(delegated to tech) even as I finished report, but it was okay. I didn't have to get everything just right timewise, I just had to get it done. My patients all got taken care of, I gave a decent report and I was out of there, not even late. Plus I got call back pay!
Before you leave a pt's room, turn and do a quick visual scan from the doorway-Siderails up? Bed/w/c locked? Call light/water/phone/bed controls/urinal within reach?
Don't rely on your memory- a thousand things will come up and you will forget things. Write reminders down for yourself.
When you are new, it is really helpful if you can make a xerox of your pts' Kardexes, or print out a copy of the MAR. This way, you have your info with you and can write notes and reminders re: your pts on it.
You won't have to write down the name of the drug- it's already there in the MAR. Just write down the time you gave it and any other needed info, i.e BP- next to the med.
You can carry these papers in a small 3 ring binder, with dividers for each pt.
Get a binder in a bright color so that if you set it down somewhere, you can easily find it.
You can use super sticky post-it notes to mark pages in the notebook.
You can use various colors of highlighters to mark things.
Example, if the pt is a diabetic w/ fingersticks, I highlight this with a pink marker. I'll make a pink mark long enough so that I can write my glucometer results in it, too. If the pt has a foley, I highlight this w/ yellow.
Designate one color of highlighter to use to mark things out when they are completed and you don't have to worry about them anymore.
These papers are good to use for giving report, too. Keep the notebook w/ the papers locked in your locker. If you have the same pt again the next night, transfer updated info to a new xerox of the updated MAR/Kardex.
Use the skinny highlighters so they are not bulky in your notebook. You can use a zippered pencil bag in your notebook to keep your dressing scissors, hemostats, penlight, extra alcohol wipes, etc.
Thanks Mahage! Those are some great tips. Actually, all the nurses use binders and keep the Kardex copies and MAR in them. They look just like the binders used for patient charts, though, so I put a bright sticky note on the front to differentiate mine. I did set it down one night and couldn't find it right away, so now I put that sticky note on it.
I will definitely get some highlighters, though. Most of my issue has to do with their method of charting. I went from doing clinicals at a hospital that used computer charting to one that uses flowsheets, so it is an adjustment. Just trying to keep track of when I did things so that when I chart later (if I don't have time to do it that second) I won't have to trust my memory as much.
I think the biggest mistake we make is blaming ourselves before we realize that hey... we are rushed and thrown in there without proper training or the benefit of modern tools like computerized documentation or checklists to help us since, hey! - we are only human, and then we get blamed and made to feel stupid and as if we are failures. To hell with preceptors who are irresponsible or just plain evil and to hell with facliities who do not support us or train us well. Putting pressure on you to be an experienced nurse in 3 months - or in my case when you start on day 1 is just plain stupid and irresponsible. It is NOT your fault. The best way to fight back is to stick together and participate in forums and share tips and tricks. And remember - the facility and your preceptors will blame you rather than take responsibility or be understanding. That's their game so we should have our game ready - they have experience, they are responsible for you - do not let them lay the blame on you - stand up for yourself and above all - be prepared at all times to slow down and think in small steps. If they rush you - tell them to back off and that any mistakes resulting from rushing you as a new nurse will be considered their error - don't let them push you around! You are not alone. Thousands of nurses have been in your shoes and the ones who say they never made a mistake ...I don't believe them. The current health care system is a big mistake waiting to happen and the "perfect people" make the system worse for us honest human people. - Durable
P.S. at my facility is is strictly forbidden to make copies of anything - chart pages, MARs, Kardex pages. Also, I made a schedule table and posted it at the nurses station of which patients on the floor are scheduled for finger sticks and when because they are all stacked on different days and times and it takes a 1/2 hour to go through the Medexes every day and rewrite down the schedule for myself. But the manager ripped it up and said I am not allowed to do that because it violates HIPPA - which is ridiculous. It is also ridiculous they haven't switched to computerized documentation yet.
Thanks Mahage! Those are some great tips. Actually, all the nurses use binders and keep the Kardex copies and MAR in them. They look just like the binders used for patient charts, though, so I put a bright sticky note on the front to differentiate mine. I did set it down one night and couldn't find it right away, so now I put that sticky note on it.
I will definitely get some highlighters, though. Most of my issue has to do with their method of charting. I went from doing clinicals at a hospital that used computer charting to one that uses flowsheets, so it is an adjustment. Just trying to keep track of when I did things so that when I chart later (if I don't have time to do it that second) I won't have to trust my memory as much.
Dazlious- you are welcome, but those good practical pointers were from another poster. I use some of those ideas when I remember, I am ultimately scatterbrained. I loose my notes and my highlighters. Oh well. I make it through somehow, some way. ONe thing that helps me to remember is actually writting stuff down that I get in report. It stays with me better.
I am lucky that we do computer charting. Makes lots of stuff easier in my opinion, but some of the nurses that have been around a long time hate it.
P.S. at my facility is is strictly forbidden to make copies of anything - chart pages, MARs, Kardex pages. Also, I made a schedule table and posted it at the nurses station of which patients on the floor are scheduled for finger sticks and when because they are all stacked on different days and times and it takes a 1/2 hour to go through the Medexes every day and rewrite down the schedule for myself. But the manager ripped it up and said I am not allowed to do that because it violates HIPPA - which is ridiculous. It is also ridiculous they haven't switched to computerized documentation yet.
I code lots of things, if I need to keep a list. Just use the room number and time and date and keep it on your person. No HIPPA violation there and it is for your own personal use. If you have more than one pt to room, use first two letters of last name along with room number. I did this a lot when I was working as a social worker at a dialysis clinic for repeditive tasks that had to be done on most all patients but at different times. This is how I would set it up for Blood sugars
Example
Monday
6116 La 7_____11______1600_______
Th 7_____ 2200______
6120 Ro 7______
Wi 12_______
etc., etc.
No HIppa conflict there. Recopy and destroy when it is used up or changed. You can handwrite it or type it.
Mahage - Kudos to you! You sound like a wonderful person and a very good nurse - I wish there were more Mahages where I work. And I love this "...put on your big girl panties.".. :) Thank you Mahage for your wisdom, humanity, and sense of humor! to Caribqueen12 and to us all. You are very much needed in the field of nursing and you did my soul good today! - Durable
Dazlious- you are welcome, but those good practical pointers were from another poster. I use some of those ideas when I remember, I am ultimately scatterbrained. I loose my notes and my highlighters. Oh well. I make it through somehow, some way. ONe thing that helps me to remember is actually writting stuff down that I get in report. It stays with me better.
I am lucky that we do computer charting. Makes lots of stuff easier in my opinion, but some of the nurses that have been around a long time hate it.
Mahage
Oops! I looked at the wrong name. Thanks Valerie!
Mahage, you are so lucky to have computer charting. I'm sure I will eventually get used to the paper charting. It really seems like it just makes things more confusing for the nurses.
I've been a nurse for nearly 9 months now (time flies when you're having fun)... I dare you to find a nurse that's been working as one for more than a few months and hasn't made a mistake of some sort. I sure haven't found Perfection, RN yet!
My biggest fear starting out (and still is) was to hurt one of my patients. This fear caused me to pick up on a few habits that make my life a little more managable when I'm at work.
1. I keep a to-do list for each patient. This list consists of the pt's last name, diagnosis, any meds (and times) that need to be given, any tests/treatments the pt is scheduled for, etc. I'm the type of person who would lose her head if it weren't attached, so this system helps tremendously!
2. Ask questions! I saw this mentioned in the earlier posts. I was always praised during my orientation for constantly asking questions. My nursing instructor said it best: Would you rather risk sounding like an idiot or risk your patient's life by assuming something?
3. Perhaps you can sit down with your floor's educator and hash out your feelings/concerns. The educators deal with us newbie RNs all the time, so I'm sure they might have some tips to keep you focused and functioning (with confidence of course).
With that, I'll just say that you should have some confidence in yourself and your abilities as an RN. There's a reason why you made it through school and passed the NCLEX! Breathe, and give yourself some credit for the things you have been doing right!
Thanks Mahage! Those are some great tips. Actually, all the nurses use binders and keep the Kardex copies and MAR in them. They look just like the binders used for patient charts, though, so I put a bright sticky note on the front to differentiate mine. I did set it down one night and couldn't find it right away, so now I put that sticky note on it.
I will definitely get some highlighters, though. Most of my issue has to do with their method of charting. I went from doing clinicals at a hospital that used computer charting to one that uses flowsheets, so it is an adjustment. Just trying to keep track of when I did things so that when I chart later (if I don't have time to do it that second) I won't have to trust my memory as much.
caribqueen12
19 Posts
Mahage, thanks for your advice and support. I am still emotionally overwhelmed by everything. For the past 2 weeks I have had the same stressful load of patients, I go to work on tomorrow and if I see them again, I will complain.
By far, this week was even worst than last:
-One patient w/psychotic daughter demands to see our manager b/c the attending has not been by in 2 days to write for a full PT eval/indicates that her mom is vegetarian (the woman had a plate of beef the day before); she also has chronic afiv/aflutter and an elevated INR; the daughter complained and ranted for the last 4-5 hours of my shift (i made calls to the doc, only cardio team came by)
-Bedridden patient who continues to eat despite having an NG tube and refuses Ct of the abdomen/NGT discontinued eventually (doctor came back from vacation); Patient is incontinent but has obstruction and foley can't be inserted
pee and poop all-over the bed, fortunately he had a good sitter
-Woman w/low K+; allergies to Heparin agents (totally missed this when doc wrote order for Lovenox BID) All physicians notified of BID but I am not sure they paid attendtion to the allergy--patient is given lovenox (hopefully she's fine)
-Diabetic patient w/insulin issues not given proper meals/shaving w/razor and on heparin 5000 units
-ETOH patient w/elevated Dias BP who needs a CT, I rushed to given Lopressor before patient leaves for TEE only to find the CT was pushed til the am
-Hospice patient on morphine that dies in the middle of my shift (2nd patient for me in 2 weeks) very emotional and frustrating to watch patients die
I have been crying, depressed, having diarrhea, nauseated, everything. I am just overwhelmed and pray to God that it gets better