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.
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.
I love this. That moment when you feel like you need to get done faster is always the moment where you need to slow down, despite what your brain is screaming at you to do. It’s an exercise in self control. Beautiful advice.
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!
I always say that if a piece of criticism bothers you it means you yourself believe it to some degree. This means that if you ignore it you are stopping yourself from growing because of pride. And that is the last thing I want.
As an instructor, and a staff nurse, I do find these mistakes concerning.
You will never be as cautious in administering medications as you are in nursing school, so this is a red flag. If the error was simply an error because you're not familiar with clinical facility policy, like their scanning software, that's not ideal, but meh. If the error is that you gave a wrong medication, dose, route, or something 6 rights related, that is unacceptable from a 4th semester nursing student. 6 rights are preached from day 1, and failing to verify the 6 rights at the bedside is simply sloppy care... and would have resulted in clinical failure for the semester in 2 programs I've taught in. (I hold your instructor or assigned preceptor equally accountable for this. Nursing students should not be independently administering meds, so they dropped the ball.)
Inserting a catheter on the wrong patient is inexcusable. This would have resulted in clinical failure for the semester in two programs I've taught in as well. Why would you take a verbal order from an RN who isn't authorized to order catheters instead of verifying that a provider's order existed? Why in the world would you accept a patient's room/bed number as identifiers for ANY procedure? You completed an invasive sterile procedure of a sensitive nature on someone without having any idea who they were. It most certainly does NOT make it "no big deal" just because it's someone who self caths. What if the unknown cath recipient had an iodine allergy? What if you caused a UTI on someone who had no need for the cath? Did you appropriately report this error to the patient's physician and assist the nurse in completing an incident report? Did you document the procedure in this patient's chart or just pretend it didn't happen? Again, I partially fault your instructor or preceptor for lack of supervision. A student shouldn't be performing sterile procedures unsupervised.
Slow down. Use your critical thinking. Ask yourself why something is ordered for a particular patient, and make sure the order makes sense before blindly carrying it out. Take time to be safe.
I do agree with the previous posters that it's no big deal if you aren't great at IVs yet. Many students never successfully start an IV during nursing school. It's a skill that is mastered with practice.
I know my response may seem harsh, but I really find your post startling.
As an instructor, and a staff nurse, I do find these mistakes concerning.
You will never be as cautious in administering medications as you are in nursing school, so this is a red flag. If the error was simply an error because you're not familiar with clinical facility policy, like their scanning software, that's not ideal, but meh. If the error is that you gave a wrong medication, dose, route, or something 6 rights related, that is unacceptable from a 4th semester nursing student. 6 rights are preached from day 1, and failing to verify the 6 rights at the bedside is simply sloppy care... and would have resulted in clinical failure for the semester in 2 programs I've taught in. (I hold your instructor or assigned preceptor equally accountable for this. Nursing students should not be independently administering meds, so they dropped the ball.)
Inserting a catheter on the wrong patient is inexcusable. This would have resulted in clinical failure for the semester in two programs I've taught in as well. Why would you take a verbal order from an RN who isn't authorized to order catheters instead of verifying that a provider's order existed? Why in the world would you accept a patient's room/bed number as identifiers for ANY procedure? You completed an invasive sterile procedure of a sensitive nature on someone without having any idea who they were. It most certainly does NOT make it "no big deal" just because it's someone who self caths. What if the unknown cath recipient had an iodine allergy? What if you caused a UTI on someone who had no need for the cath? Did you appropriately report this error to the patient's physician and assist the nurse in completing an incident report? Did you document the procedure in this patient's chart or just pretend it didn't happen? Again, I partially fault your instructor or preceptor for lack of supervision. A student shouldn't be performing sterile procedures unsupervised.
Slow down. Use your critical thinking. Ask yourself why something is ordered for a particular patient, and make sure the order makes sense before blindly carrying it out. Take time to be safe.
I do agree with the previous posters that it's no big deal if you aren't great at IVs yet. Many students never successfully start an IV during nursing school. It's a skill that is mastered with practice.
I know my response may seem harsh, but I really find your post startling.
Thank you - I’ve seen people dismissed for way less.
Why would you take a verbal order from an RN who isn't authorized to order catheters instead of verifying that a provider's order existed? Why in the world would you accept a patient's room/bed number as identifiers for ANY procedure? You completed an invasive sterile procedure of a sensitive nature on someone without having any idea who they were.
I am not sure why it never occurred to me that I should never just trust another nurse on their word. Possibly because as a student nurse I am not taught to check for a physicians order but instead just do as my instructor tells me to. Not saying its excusable or that it wasnt a dumb mistake just providing a possible reason.
On 9/8/2019 at 7:22 PM, FacultyRN said:
What if you caused a UTI on someone who had no need for the cath? Did you appropriately report this error to the patient's physician and assist the nurse in completing an incident report? Did you document the procedure in this patient's chart or just pretend it didn't happen?
I self reported and everyone knew about my mistake immediately. I completed an incident report with my instructor for the cath and charted the med error.
On 9/8/2019 at 7:22 PM, FacultyRN said:
You will never be as cautious in administering medications as you are in nursing school, so this is a red flag.
This was my whole reason for this post. I was not sure how to go on because i know this to be true. I have received a lot of good advice I think but i am really still unsure how to proceed besides what ive already implemented (rights, slowing down, verifying identity).
This was the harshest reply i've had so far and it stings but i believe it is also one of the more constructive ones so I am very grateful that you took the time to write this.
mrnurse543210
12 Posts
This is a beautiful thought because it means that I have control over how successful I am. Thank you for the feedback.