Sloppiness results in write-up

Specialties Emergency

Published

Hell again,

If you have read my previous posts, I am a new grad in the ER since June of this year.

Yesterday I was called to my directors office, because one of the Docs had written me up.

Now that I look back on it I was being sloppy.

The patient was a chest pain, but not cardiac in nature.

Phlebo automatically went in drew labs and sent them, they were ordered by triage out front so they had been done.

I did not do an IV because in the past we give can give meds IM, and her EKG was fine and she had no cardiac hx.

Later Dr. gave me a verbal to give Toradol 30 mg, without asking the doctor the route I went to accu-dose drew up 30 mg Toradol and gave it IM, this is what we have done in the past.

He asked me if I gave the Toradol and I said yes I gave it IM, he said ,"Why does this patient not have an IV she is a chest pain?"

He said now the dose is now doubled due to it being IM it will be an

additional 30mg.

I told him it did not seem to be cardiac in nature.

He yelled and said it is either worked up as cardiac or non cardiac no exceptions! You need to know the difference.

Later I had done a triage for another nurse because she was busy.

I had failed to put in vitals, as well as spelled some of the meds wrong.

As a result the wrong route and incomplete triage was turned in to my supervisor and director and now I am on probation for 60 days. with weekly progress notes from my preceptor.

NOW,

I had asked for more time in the ER after my 12 weeks, because I was falling apart.

They have been putting me with seasoned nurses, to help me when I need it, but still have to carry a full load, but I do get help from the unit and the charge nurse.

The new plan is to have me precept with a 40+ year vet, and she is to help me with time managment, but because of being written up, I am to review all meds with her, and she is to check all my triage notes.

I am to do this for 60 days, it is a probationary period.

WHAT A LESSON!!!

I FEEL AWFUL...

I have worked with this nurse last leason and she is awsome, and is always there to help anyone in need.

They told me they are doing this to protect me.

Well I know I should have reviewed the medication route with the Dr.

That was a big mistake, and yes I will learn and never assume, and clarify with the Dr. 1st.

I do not blame the Dr. because he does not want his patients in danger, and he is also the ER director, so he has plenty of pull.

I know I can turn this into positive experience.

The Dr. has been super nice to me lately since my write up and he explains everything to me to help me with my learning experience.

Now there is no room for sloppyness, I am now under a microscope.

Any input from anyone??? :uhoh21:

You are a new grad. You made a mistake. Learn from it and move on. Stay in the ED if you want. But make sure you observe protocols.

I noticed some folks say you should quit. I don't necessarily agree. If you feel you've got good training, especially during your probation period, and you feel that you are up to making sure that you don't repeat your mistake, I say just dust yourself off and keep at it.

I have read both your threads and have several somewhat conflicting reactions. First, I commend you and your management for sticking with this challenging situation and not giving up. However , June to November is a long time and I am concerned that things should have gelled for you by now.

One issue that I haven't seen addressed is putting a new grad in Triage. Are you referring to bedside triage of ambulance patients, or initial treatments of the pts coming in the door? Our institution has a 10 week residency for new grads, and a modified progream for experienced nurses who have never worked ED. New grads do not triage until they have 2 years experience . Even experienced ER nurses do not triage until they have been in our facility 6 months. This gives them plenty of time to become familiar withour system and our protocols. At least half our staff, including our current CNS and some of our supervisors have gone through this program and we have been gratified by its's success. Many of the RNs were with us as techs while they were students, and every one tells us how amazed they were at the difference it is to be the RN, and how sometimes it was a very hard adjustment.

The beauty of nursing is that there is a place for everyone, no matter their style or preference. If the long term result is that ED nursing is not your niche, stick with it until you fine the place for you. My ED is a very hard place to work, and we have had many fine nurses who move on to something they are more comfortable with. TV sometimes galmorizes ED and Critical Care..after 39 years of both I can tell you it is not so !

Best wishes inyour career.

Specializes in tele, icu, homecare, long-term acute.

All i got to say is, if i were thrown on probation when I was a new nurse, for every time I forgot to chart something by accident or misspelled something, I would never have gotten off orientation! Those were honest, simple mistakes, and NO ONE HERE can claim they NEVER forgot to chart something or misspelled a medication!

Oh, and about the CP, if the doctor thought it was cardiac, he would not have ordered Toradol (unless he's a complete idiot, which he might be) and the fact that he yelled at you was completely unprofessional. There is no excuse for that kind of belittling, no matter what the mistake. If a mistake is made, it needs to be addressed professionally. That doctor should've been written up, not you.

Also, no nurse here can say they've never assumed a route when taking a verbal order, and while I'm not condoning this, we've all done it! Mistakes are much more easier to be made this way, which is why verbal orders should not be made, unless in an emergency...he should've written that order for you in the FIRST PLACE.

If I were you, I wouldn't put up with all the crap there, but if you really want to stick it out, good luck to you. I just think our jobs as nurses is hard enough without all this crap. You did not deserve probation for those simple mistakes...you sound like an awesome nurse. Good luck to you!

all i got to say is, if i were thrown on probation when i was a new nurse, for every time i forgot to chart something by accident or misspelled something, i would never have gotten off orientation! those were honest, simple mistakes, and no one here can claim they never forgot to chart something or misspelled a medication!

i have to respectfully disagree with this statement. in an er you never forget to do vitals, that is part of your role when you triage a patient. how can you possibly assess a person without doing baseline observations? it isn't a matter of a simple mistake, it had the potential to be very serious.

i work in er and we have new graduate rns rotating through our department for 6-8 weeks at a time. there are few new grads who can pick up and run with the ball and in general i don't think er is a good place to start your nursing career, but that's just my personal opinion.

to the op, good luck in your job, your er seems supportive and i'm sure you'll be fine once you start feeling confident in your skills.

Specializes in tele, icu, homecare, long-term acute.

I believe she said she forgot to "put the vitals in" as in forgetting to put the vitals in the computer for charting, not forgot to take vitals altogether! Maybe the OP can shed some light on this?

Yeah I took it as she did the vitals but forgot to put them in the computer.

But the ER is rough, especially for a new grad. I have seen seasoned nurses cry when pulled to the ER.

Specializes in ER/ medical telemetry.
yeah i took it as she did the vitals but forgot to put them in the computer.

but the er is rough, especially for a new grad. i have seen seasoned nurses cry when pulled to the er.

hello all,

clarifications: triage meant bedside triage, as ems brings them in.

yes. i did hook them up for vitals just forgot to put them on the triage sheet.

meds that were spelled wrong were mis-spelled due to sloppiness, on my part, will not do again.

orientation was in the works before the write up, it just enforced commitment to help me.

i thank you for all your support and advise so far.

i went to work yesterday, and it was an eye opener.

i have so many supporters, i was amazed.

they are dedicating this 40+ year veteran to me,for 60 days.

we will work together, and we will be taking the hardest patients that come through the door.

this is what i wanted to begin with;more orientation, but i did not expect it to be like this.

they want me to be able to function through season, and they know, i can do it.

i am pleased with the support and encouragment so far.

i owe myself,as well as my co-workers/supporters.

i will stay...

the doctor that wrote me up has been very supportive to me as well.

cweeks, you sound like an amazing nurse, I wish you all the best for your future. It's just wonderful to see a new grad not buckle and give up in the face of pressure and difficulty. You've done so well:up:

Specializes in emergency/trauma.

CWEEKS,

DON'T WORRY, KEEP YOUR HEAD UP!!! THERE ARE ALWAYS GOOD AND BAD DAYS IN THE ER!! fROM PERSONAL EXPERIENCE, DON'T EVER ASSUME ANYTHING OR DOWNPLAY A PATIENT'S SYMPTOMS WITH ANY PATIENTS, I LEARNED THIS THE HARD WAY. iF YOU DON'T THINK ITS CARDIAC IN NATURE, ASK THE MD WHAT HE THINKS, THEY WILL RESPECT YOU FOR ASKING, EVEN IF IF THEY THINK ITS NOT CARDIAC EITHER. uSUALLY THE ER DOCS ARE HELPFUL IF YOU ASK QUESTIONS, ESPECIALLY IF YOU HAVEN'T WORKED WITH THEM BEFORE, THEY LIKE TO SEE YOU ASK MANY QUESTIONS ABOUT THEY WAY THEY TREAT PATIENTS, B/C EVERY DOC IS DIFFERENT.

ASK YOUR PRECEPTOR EVERYTHING, WHAT IS THE WORST SHE CAN SAY, SHE ASKS A LOT OF QUESTIONS??? NO!!!

GOOD LUCK LADY!

Specializes in ER, Occupational Health, Cardiology.

cweeks, like I said in my original response to your thread, the ER and MD obviously recognize some serious value in you to give you this opportunity. If you are with the most experienced nurse and are going to get the worst patients, you are going to see SOME stuff! I almost envy you. The "worst cases" in the ER covers a very broad spectrum of illnesses and injuries. Keep your eyes open and learn all you can. They obviously feel that you are the candidate for them or they would've greased the skids to get you out of there, not tried to make the transition easier and more thorough for you.

Just one addition to this interesting and very insightful thread-amazing the different opinions! Whether ER or anywhere, I believe it is your attitude 'cweeks' that has garnered you everyone's support in the ER.

I mean that entirely positive-as nurses, (not everyone, of course) there seems to be frequently many who takes things too personally, or are a bit oversensitive to any criticism. I think some learn through the years to not be defensive but to listen and see if there is validity and room for growth, learning while others decide to 'take a stand' and place the accountability elsewhere whenever criticized.

As a new nurse, your willingness to accept criticism, to learn from your mistakes (which we all have made at some point, none are perfect) and willingness to continue working hard, will take you far, whether you stay in the ER for 20 years or try ten different nursing arenas. You've 'survived' this and persevered-that also often gains respect amongst your peers.

Best of luck and keep giving your best wherever you are!

Specializes in ER/ medical telemetry.

Hello again.

It has been 60 days since the incident.

Well,

Progress has been made, and I have had training.

I feel more confident but I DO NOT FEEL SAFE...

I have decided to go up to the medical telemetry floor, which is slower paced, to learn more delegation,triage,and priority skills.

After 6 months to one year go back to ER or possibly go to critical care.

ER is fast paced, and I feel mistakes could be made, if my confidence level does not match the environment.

I feel due to the high volume of cardiac patients that we see in a high geriatric setting, that I need stronger cardiac assessment skills.

My goal now for the new year is:

1. Become a strong leader, and a safe nurse.

2. Be a strong team player when a code takes place.

3. Be strong in cardiac strip identifications.

4. Master my job.

I start the new floor January 7th, I AM EXCITED!!!!!

Happy New Year!!! ;)

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