Student nurse here. Am i going to be a bad nurse??

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TLDR; 4th semester student, want to work in ER, make stupid mistakes constantly that may eventually kill someone, not sure if this is normal or if im just not meant for it

I am in my fourth semester of nursing school. I had a really bad day at clinical and it is making me question whether i will be a safe nurse or not. Basically i am starting to get more independence now and starting to have less supervision and i guess my flaws are beginning to show. Here are my negatives.

1) I made a medication error because i gave the medicine first and and then scanned. I rushed and just did not follow the systematic approach because i dont know, my brain just blanked. The patient was completely okay but i think this shows how i am as a person. I am prone to rushing things and i lose focus quite easily. Its like my brain just stops working when i need it to work the most. No matter how hard I try to focus i just simply cant. Imagine that i was your nurse and i was giving you heparin. Now imagine that i was that nurse and i was tired and it was the end of a long day and maybe i hadn't ate for a while. Would you really trust me to set up a heparin drip??? Personally I would be scared for my life.

2) I was unable to start an IV without help from the instructor, although the instructor also agreed that this patient has bad veins. The thing is that I have been missing IVs constantly for the past couple of weeks. I started out very well, I would get them in one after another but now i cannot figure out what i am doing wrong. I never get good blood return even though i am doing everything i should be doing (letting the arm hang, putting on a tourniquet, checking for bounce). Even if I get blood return its like i can never fully advance the catheter.

3) I straight cathed a wrong patient. Basically the nurse told me to go straight cath a patient, room whatever bed 2, but by the time i got my supplies my brain blanked or something and i thought it was room 1. So i straight cathed him. It was no big deal to the patient because he always straight caths himself anyways but this shows the way i am.

After that day I just felt burned out and like i dont care anymore, which is even more dangerous.

Things i do well:

1) Im the least lazy person out there. I take on all the hard and dirty work and never try to get out of it. Patient needs to be cleaned 7 times a day? Fine with me, its part of the job. I am overloaded with patients that all need help going to the bathroom? Thats ok. Basically im fine with working my *** off, and i enjoy it.

2) I straight cathed the wrong guy but i did the procedure perfectly and it was sterile. I am good at hanging fluids and giving shots and pushes. Good at math (although there is definitely potential there to make stupid mistakes there that could kill someone).

3) I know a lot of medications; what they are for and what i need to check before administering them (but i forget to check).

It was basically my dream to work in the ER because i thought it was the perfect environment for me but now I think i may not even be a safe nurse on the floor. Maybe i should work as a telephone operator nurse or work in a clinic where i have less potential to be unsafe. I know it was a long read so thank you.

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Specializes in Psych ICU, addictions.

Making mistakes in itself doesn't mean you will be a bad nurse.

What WILL make you a bad nurse is not learning from your mistakes. In this case, it's clear that you need to slow down and pay more attention to what you are doing. Unless you are in a code situation--and trust me, you will know when you are in a code situation--there's no reason for you not to double-check your meds, your MAR, the patient's room, who your patient is, scan their wristband, etc. Simple little steps that at most take a sliver of time...and those simple little steps are what will help to keep your patient safe.

As far as IVs...don't sweat that at all right now. Your making mistakes due to rushing and inattention is a far more critical deficit that needs to be addressed than you being unable to place an IV. Not being able to place an IV won't necessarily kill a patient...but a medication mistake could. The wrong procedure on the wrong patient could cause lasting damage. Plus, many new grads aren't IV masters when they graduate--a lot pick up their IV skills once they start working as RNs/LVNs (depending on your state).

You're not beyond hope. You know where you're going wrong. You need to work on fixing that.

Learn from your mistakes. You can do it.

Best of luck.

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You are definitely correct that i need to slow down a little. I think i need to develop a sort of fool proof system for myself for every procedure i could think of. So far i have started checking for an order everytime before i place a catheter or an IV and doing my 7 medication rights with every med. With my math i use dimensional analysis and that seems to be working pretty well for me so far. From now on I dont think i will ever give a med without thinking about my med error i made. Will scan first everytime.

Thanks for the reply.

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Specializes in Psych ICU, addictions.

Remember, you're a student and you're still learning. And once you graduate, you are going to still be learning. The first year of nursing as a new grad (Nursing 101) is where the real learning begins because you are out nursing in the real world but lose the safety net of your clinical instructor. So it's best to start tackling those bad habits now.

And yeah, we all feel horrible after our first medication error, that we're going to be the world's worst nurse. My first mistake was in nursing school--IV medication incompatibility. I hadn't thought to check if it was compatible with the solution. Imagine my surprise when precipitate started forming in the line...

Sometimes we need to learn these lessons the hard way. As long as we learn from them.

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Specializes in Critical Care; Cardiac; Professional Development.
29 minutes ago, mrnurse543210 said:

You are definitely correct that i need to slow down a little. I think i need to develop a sort of fool proof system for myself for every procedure i could think of. So far i have started checking for an order everytime before i place a catheter or an IV and doing my 7 medication rights with every med. With my math i use dimensional analysis and that seems to be working pretty well for me so far. From now on I dont think i will ever give a med without thinking about my med error i made. Will scan first everytime.

Thanks for the reply.

This is good. Don't forget also to check your patient identifiers for procedures, not just meds. Cath, IV starts, dressing changes and the like can all be done on the wrong patient, especially in the ER. Take that moment to check. Make it part of your standard of care.

You are doing very well at your self assessment and this is the first step that will lead to changing your practices to be safer.

I don't know how old you are, but you sound rather young. If you are in your early 20s, your frontal lobe is still finishing up its development. That is going to help a great deal with your decision making ability. You can help shape it now by taking the time to give yourself a safety net for your known challenges.

Best of luck. Its good to be aware of what you need to improve. Its bad to whip yourself. Your intentions are excellent. At the end of the day we are human beings taking care of human beings. Grow from this and you will be fine.

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10 minutes ago, not.done.yet said:

Don't forget also to check your patient identifiers for procedures, not just meds. Cath, IV starts, dressing changes and the like can all be done on the wrong patient, especially in the ER.

That is a really, really good point. It never really hit me how easy it would be in the ER to misidentify a patient. Thank you for bringing that up.

8 minutes ago, not.done.yet said:

I don't know how old you are, but you sound rather young. If you are in your early 20s, your frontal lobe is still finishing up its development.

You are spot on. I am 22 :).

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Specializes in Critical Care; Cardiac; Professional Development.

Dude, you are going to be okay. You made mistakes. Slow down. A lot. You will get better with the kind of reflection you are doing as long as you follow it up with action. Its going to be okay. This rattled your confidence. Nothing like a dose of humble pie and abject fear to make you reassess how you are doing things. Hang in there.

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1 hour ago, not.done.yet said:

Dude, you are going to be okay. You made mistakes. Slow down. A lot. You will get better with the kind of reflection you are doing as long as you follow it up with action. Its going to be okay. This rattled your confidence. Nothing like a dose of humble pie and abject fear to make you reassess how you are doing things. Hang in there.

My confidence definitely took a hit but I think it was about time. It’s good to be reminded that what you’re doing is not a game and though I definitely wasn’t treating it as a game, I feel I was getting a little too comfortable.

Thank you for the encouragement it really helps.

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Specializes in Psych (25 years), Medical (15 years).

Well, mrnurse, I would encourage you to add this to your things I do well list: "I own my mistakes, do some self-examination & appraisal, and seek advice from others on how to improve my skills".

I doff my proverbial hat to you, mrnurse!

And, hey, if it turns out that you really are going to be a bad nurse, you can always work psych.

It's kept me employed!

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Specializes in Neuro.

Omg, as I am now learning as a new grad just on the floor...I can now confidently say you are NOT even going to be close to being floor ready right out the gate when you graduate. That's why we have our preceptors to back us with their guidance when we start. Breathe, slow down, ask questions, clarify, ask to be critiqued or for guidance. Learn from mistakes (which sounds like you have) & when you make a mistake, learn and do not keep dwelling on it. To sum it up, you will be far from perfect & that's expected & you'll learn as you go and are trained.

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Specializes in LTC, assisted living, med-surg, psych.

You have been given excellent advice here. I can't really add a lot, but I'll say that I'm proud of you for taking constructive criticism with a humble heart. The worst kind of nurse is the one who doesn't know what they don't know but proceed anyway. You're clearly learning from your mistakes. Keep up the good work!

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.
On 9/5/2019 at 9:13 AM, mrnurse543210 said:

You are definitely correct that i need to slow down a little. I think i need to develop a sort of fool proof system for myself for every procedure i could think of. So far i have started checking for an order everytime before i place a catheter or an IV and doing my 7 medication rights with every med. With my math i use dimensional analysis and that seems to be working pretty well for me so far. From now on I dont think i will ever give a med without thinking about my med error i made. Will scan first everytime.

Thanks for the reply.

That's it. You've got it. Every procedure: check the order; check the patient. ALWAYS use 2 identifiers: the patient's name and either the birthdate or the medical record number. Never go by the room number.

EVERY medication: check the 5 or 7 or 20 rights. EVERY TIME. When you're rushed and tempted to cut corners: Don't. That's when you make a point to slow down and do all of the checks. Always scan first because the whole point of it is to eliminate errors. In fact, the whole current system of medication administration is developed to reduce errors. Do not defeat the safety system by doing work-arounds.

Every single thing you do is a mistake waiting to happen. Be meticulous about following the correct procedure. Conscientiousness is not an innate talent. It's a chosen behaviour. I think you have it in you to be a safe and prudent nurse. Good luck.

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