Syringe Disaster

[LibraNurse27]

Hi all, I am having a mental health crisis and had to take a few weeks off work to stabilize, and feel I'm not able to accurately evaluate the seriousness of situations in my current state. I changed jobs 9 months ago and had trouble finding a psychiatrist with my new insurance, and ran out of my meds for bipolar 1. After a few days off meds I felt disoriented and experienced trouble focusing, even some visual hallucinations.

These symptoms became increasingly worse yesterday during a busy shift with short staffing. A pre-op nurse asked me to give 5000 units heparin SQ and show her how because she hadn't given a sub q since nursing school. I have given heparin hundreds of times. But I felt so out of it, I could barely figure out how to draw it up. I used a 1ml syringe that didn't have a leur lock instead of a 3ml leur lock syringe. When I gave the injection some of the heparin went in but then the syringe disconnected from the needle and the rest spilled onto the bed! The other nurse saw it but didn't say anything. The OR team was rushing her so they could bring the pt in. I told my charge nurse and she said I didn't need to tell the surgeon.

Apparently the pt had no history of blood clots but had once had a weird phlebitis of a vein in his hand that resolved on its own, all labs for a clotting disorder negative. She said anesthesia didn't think he needed heparin but surgeon did. I wanted to let the surgeon know but I was being called back to PACU because another patient was getting up unassisted and another coming out of OR with no nurse available. By the time those things were settled the heparin patient was in the OR. The rest of the shift I could barely function because I was sick with anxiety on top of my bipolar symptoms. I finished the shift but avoided giving any meds. Today I went to the ER and got my meds plus time off to find a psychiatrist. Do you think I am horrible for not telling the surgeon? I am seriously considering resigning even if I'm able to re-stabilize on medication. I don't want to be a danger to patients or become someone who doesn't own up to my mistakes. Thank you so much for reading this long post.

[SmilingBluEyes]

1 hour ago, LibraNurse27 said:

Thank you!! Yes I feel SO guilty about not reporting my error, and I still can’t really understand how I couldn’t figure out what to do. I also have anemia so I used that as an excuse and asked a nice coworker if all my patients from Friday are OK (we do post op calls). I just said I was out of it from anemia, and she said everyone is fine. I want to tell the full truth about why I was out of it, but my doctor advised me not to due to the stigma =( if I end up not being able to return I think I will be truthful about why though. Everyone I work with is so nice and it doesn’t feel good to be not all the way truthful. Thanks for your kind reply and your encouragement!

I feel for you. I have to ask, what, if anything, could you do to help yourself feel better now? (besides what you said at the beginning).

[LibraNurse27, BSN, RN]

1 hour ago, SmilingBluEyes said:

I have to ask, what, if anything, could you do to help yourself feel better now?

To be honest, the only thing that makes me feel better is thinking about not ever having to work as a hands on nurse again. I am meeting with a nurse friend who does medical writing to look into that. I want to do hands off nursing or just something else entirely. I never want to risk harming a patient again. Based on statistics I've been reading, up to 60% of people with bipolar disorder are unemployed (40-60% on average).

I'm trying to feel proud of ever having been able to work as a nurse, and give myself grace if I am not able to return to work in the same capacity. Recommendations say to look for a part time, low stress, routine job with day time hours and no long shifts... hard to find in nursing! Thank you so much for your concern and compassion.

[VivaLasViejas, ASN, RN]

Yes, sometimes mental illness gets in the way of accomplishing our goals. It’s sad, but the only way out of the accompanying guilt and disappointment is to accept what is and prepare to change course. You are at a crossroads: the choice is between the devil you know (bedside nursing) and the devil you don’t (medical writer or something else). Whatever you do, take your time and carefully evaluate the opportunities available to you…you don’t want to jump from the proverbial frying pan into the fire. 
 

Once again, I wish you all the very best. I feel a kinship with you because of our diagnosis and the damage it’s done to our careers. Viva

[anewsns]

I hear you friend. I have bipolar, adhd, and panic disorder. I think in this scenario, it is just a lesson learned. You don't want to replicate this mistake in the future but you can definitely forgive yourself and move on, no harm done. Bedside is so so hard even on meds with these mental health disorders as we can become so much more panickey about these types of small mistakes. The bigger problem is staying at work when in that state as you could have made a much bigger mistake, so if this ever happened again you will need to say you are sick and go home. Im not trying to shame you at all as it was probably difficult to make decisions that day, but definitely go home if this happens in the future. 

[LibraNurse27, BSN, RN]

9 hours ago, VivaLasViejas said:

Whatever you do, take your time and carefully evaluate the opportunities available to you…you don’t want to jump from the proverbial frying pan into the fire. 
 

Definitely! One problem with bipolar is making impulse decisions! Thank you for the reminder.

 

30 minutes ago, anewsns said:

The bigger problem is staying at work when in that state as you could have made a much bigger mistake, so if this ever happened again you will need to say you are sick and go home.

Yes!! I know the pt is fine and it was kind of a weird order, but we also give a lot of IV narcotics, and I was in no shape to do that. Luckily I was recovering GI pts, but I am scared to think if someone asked me for help medicating an OR pt. I'm going to figure out with the doctor if it's safe to ever work with these types of meds again in terms of risk to patients if I have symptoms at work, and in terms of suicide risk due to access. Sounds dark but it's a real concern with this disorder so better to think ahead. Thanks for the advice.

[FolksBtrippin, BSN, RN]

On 8/22/2021 at 12:29 AM, LibraNurse27 said:

Hi all, I am having a mental health crisis and had to take a few weeks off work to stabilize, and feel I'm not able to accurately evaluate the seriousness of situations in my current state. I changed jobs 9 months ago and had trouble finding a psychiatrist with my new insurance, and ran out of my meds for bipolar 1. After a few days off meds I felt disoriented and experienced trouble focusing, even some visual hallucinations.

These symptoms became increasingly worse yesterday during a busy shift with short staffing. A pre-op nurse asked me to give 5000 units heparin SQ and show her how because she hadn't given a sub q since nursing school. I have given heparin hundreds of times. But I felt so out of it, I could barely figure out how to draw it up. I used a 1ml syringe that didn't have a leur lock instead of a 3ml leur lock syringe. When I gave the injection some of the heparin went in but then the syringe disconnected from the needle and the rest spilled onto the bed! The other nurse saw it but didn't say anything. The OR team was rushing her so they could bring the pt in. I told my charge nurse and she said I didn't need to tell the surgeon.

Apparently the pt had no history of blood clots but had once had a weird phlebitis of a vein in his hand that resolved on its own, all labs for a clotting disorder negative. She said anesthesia didn't think he needed heparin but surgeon did. I wanted to let the surgeon know but I was being called back to PACU because another patient was getting up unassisted and another coming out of OR with no nurse available. By the time those things were settled the heparin patient was in the OR. The rest of the shift I could barely function because I was sick with anxiety on top of my bipolar symptoms. I finished the shift but avoided giving any meds. Today I went to the ER and got my meds plus time off to find a psychiatrist. Do you think I am horrible for not telling the surgeon? I am seriously considering resigning even if I'm able to re-stabilize on medication. I don't want to be a danger to patients or become someone who doesn't own up to my mistakes. Thank you so much for reading this long post.

This is why we need psych urgent care. Im so sorry you’re going through this. 
 

There’s no reason to decide that you can’t go back to work right now. Right now, just get stable. You can’t make a good decision when you’re not.

 

[anewsns]

1 hour ago, LibraNurse27 said:

Definitely! One problem with bipolar is making impulse decisions! Thank you for the reminder.

 

Yes!! I know the pt is fine and it was kind of a weird order, but we also give a lot of IV narcotics, and I was in no shape to do that. Luckily I was recovering GI pts, but I am scared to think if someone asked me for help medicating an OR pt. I'm going to figure out with the doctor if it's safe to ever work with these types of meds again in terms of risk to patients if I have symptoms at work, and in terms of suicide risk due to access. Sounds dark but it's a real concern with this disorder so better to think ahead. Thanks for the advice.

Yes. Also, regardless of the risks at work, (which you are clearly well aware of) your mental well being will always come first before hanging onto any job, and you do need to always be a step ahead with this illness. It's not to say that people with mental illness shouldnt  do this job. Along with meds and other treatments, doing a fulfilling job can be stabilizing and you can be successful. If you don't like it though it is a constant possible trigger for an episode. It will depend on what is right for you.  I understand that horrible dark feeling all too well. It's scary! I am very well and very high functioning, but due to my past, my psych care will always remain my number one priority. I cant do anything if my illness overtakes me, so its better for me to drop everything Im doing and nip it in the bud when I start to slip. Im very off topic since the problem is that you ran out of meds, but hopefully I helped in some other ways as well. 

[LibraNurse27, BSN, RN]

1 hour ago, FolksBtrippin said:

This is why we need psych urgent care. Im so sorry you’re going through this. 

That would be awesome! I think there are some psych urgent cares out there, but definitely few and far between.

[LibraNurse27, BSN, RN]

1 hour ago, anewsns said:

Yes. Also, regardless of the risks at work, (which you are clearly well aware of) your mental well being will always come first before hanging onto any job, and you do need to always be a step ahead with this illness. It's not to say that people with mental illness shouldnt  do this job. Along with meds and other treatments, doing a fulfilling job can be stabilizing and you can be successful. If you don't like it though it is a constant possible trigger for an episode. It will depend on what is right for you.  I understand that horrible dark feeling all too well. It's scary! I am very well and very high functioning, but due to my past, my psych care will always remain my number one priority. I cant do anything if my illness overtakes me, so its better for me to drop everything Im doing and nip it in the bud when I start to slip. Im very off topic since the problem is that you ran out of meds, but hopefully I helped in some other ways as well. 

Thank you for the validation that mental health comes first. Even while on the meds I felt my memory and concentration were off, which I read can happen over time on the meds. So I hate to admit that when I ran out I didn't seek a way to get it refilled right away. I thought I was doing better off the meds, but obviously that was totally wrong and a terrible idea. I will never do it again. I talked to a friend who has HIV and once went off his meds due to side effects, only to have his T cells plummet after being normal for years. He said this should be a wake up call and while it was wrong he understands why I did it.

I feel guilty that everyone has been so compassionate and understanding, because I have to take accountability for not re-starting my meds, for staying at work while mentally impaired, and for only reporting my error to the charge nurse. I know there is some gray area due to some of the actions happening while experiencing symptoms of psychosis, but I still need to be accountable. I once met a pt with schizophrenia who went off meds, became psychotic, and killed both of her parents. The next day she had no recollection of it but had blood all over her. She went to jail and when I met her she was awaiting trial to see if she needed to stay in jail or go to a mental facility. She told me her parents were her lifelong best friends and caregivers, and that she never would have harmed them if not psychotic. I can't imagine having to live with something like that, and I hope she ended up in the right setting to recover.

[FolksBtrippin, BSN, RN]

7 hours ago, LibraNurse27 said:

That would be awesome! I think there are some psych urgent cares out there, but definitely few and far between.

We have it where I live. 

[LibraNurse27, BSN, RN]

Update: I am feeling much better even on the low loading dose of medication. I spent hours researching the pathophysiology of bipolar disorder, and it is fascinating what they have found with MRIs, CSF samples, etc. With a clear head I now realize the big deal was not the heparin, the big deal is that I went to work unmedicated and stayed there while disoriented and hallucinating. The patient is fine and based on my (also obsessive) research on pre-op anticoagulation criteria, likely didn't need heparin anyway. But the fact that I was giving a med I didn't know the indication for and then not even able to remember how to do basic nursing skills is scary. 

My psychiatrist will not recommend me to go back to work until stable on the full dose, which will take months, so I will have to resign. My partner and I are moving in with her mom so we don't have the financial pressure. We were planning to anyway to save for a house. I think losing this job (paid very well with free benefits!) is a necessary consequence. I'm not fired but I know they can't hold the job for me for months, so my only option other than resigning is going back "AMA" LOL and I promise not to do that. Thank you to everyone who posted those kind and thoughtful responses ❤️

[VivaLasViejas, ASN, RN]

Please don’t think of your leaving your job as a “consequence”. That word implies you’ve done something wrong, and you haven’t. You’ve been ill, that’s all, and now you’re on the road to recovery. It’s a win-win, if you ask me. Congratulations!