Suddenly making errors?

[SookeyRN]

I don't know if this is even a problem, or if I am making more of this than it really is.

I have worked on my unit for a year and a half now, working 60% (24 hours a week), and attending graduate school full-time to obtain my NP in adult/gero with emphasis in oncology and palliative care. I had a short orientation to my unit, because I did my last-semester internship of 245 clinical hours on that unit. My six-month evaluation came and went and I was doing very well, and I got an excellent evaluation at my one-year evaluation in July. Of course there were a couple of errors I'd made over time - forgetting to unclamp a med (NOT unusual - I can't tell you how many times I've followed the previous shift and found meds still clamped), not signing out a medication (but I had given the med), or once I missed an order when I red-lined. I also recently obtained my OCN certification from the Oncology Nursing Society (only two other RNs on my unit have their certification).

So a couple of weeks ago I had one day, a Saturday, (which was only an 8-hour day) where I had to give platelets to one patient, two units of blood to another, and Mag and K to even another patient. When I received report, I thought it was pretty busy, but I could handle it, no problem. Well, in the meantime, labs came back for my platelet patient, and he needed two units of PRBCs. The physician decided that the first patient who needed two units also needed 75 gm of albumin and lasix in between units, and my platelet/2 units PRBC patient ended up having an ENT consult/ct with contrast/possible move to MICU due to risk of airway loss.

I knew that in this 8-hour day, and with my level of experience, I could not complete all this, and that perhaps I should trade out a patient with one of the other nurses who only had 2 patients and was mostly sitting around. I was told by one of the more experienced nurses that nobody could, and to not worry, that we're open 24/7, and to take it easy.

I come in on Monday and my NM wants to speak with me. My patient with possible airway compromise did not get an abx and steroid that had been ordered. I had transcribed the order, and had even called the pharmacy twice wondering where the drugs were. As it turns out, the order never got sent to pharmacy as it didn't get torn out and sent. During the week, our unit pharmacist checks the orders, tears them out and sends them. This was a weekend day and I didn't realize the order hadn't been torn out and sent. So I got written up for this error (she said I should have traded out one of those patients - DOH!!) and now she wants me to have a "resource person" to go to when I work.

I follow people all the time who haven't taken off orders from day shift and left it for the night shift, or meds haven't been run, things aren't signed out, etc. I fix them and go on. When I started this job, I was told to pick my battles, and most of the time it wasn't worth it. I told my NM that I felt like I have a target on my back all of a sudden - that I did not suddenly, in the last couple of months, become incompetent and need remedial training. I just can't figure out what is happening here. Any thoughts?

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Every man is guilty of all the good he didn't do.

--Voltaire

[starcandy]

I

I follow people all the time who haven't taken off orders from day shift and left it for the night shift, or meds haven't been run, things aren't signed out, etc. I fix them and go on.

I feel the same way, but there are some who do not and will complain for hours where I work:roll Did you pass this info in report of the outstanding meds to the next shift?? I find sometimes that the follow up from the next shift can be less than genuine. I would chart what was left outstanding and reported to the next shift.

[AtlantaRN, RN]

you just do what you can and go on...

that is why a hospital is open 24h/day with 2-3 shifts/day...

linda

[Billy5949]

Unbelievable. The same stuff has happened to me. I find med errors EVERYWHERE. I say nothing. Yet what I do is magnified. I don't know how to get around it. Kiss the right ***?