Week from Hell

Specialties NICU

Published

Okay -

I am a recent grad and have been on the job in a Level 3 NICU for 6 months. Most of that time was spent in our Level 2 nursery. I functioned independently for about 3 months handling 4 feeder/growers. I am now beginning my orientation on the level 3 side of the nursery. Well --- I screwed up big time on Monday. I hung an IV med without checking it with my preceptor (long story short I had checked it earlier in the day with my preceptor - but the pharmacy sent up half of the needed volume - my preceptor clarified the order with the Neos - finally several hours later I hung the med). Well I forgot to change the rate since the new order was twice the concentration I should have 1/2d the rate. It hung for 45 minutes before my preceptor noticed.

No ill effects - but I have been beating myself up all week -- I know better. My professors taught me better, how could I screw up so badly?

Well I filled out an incident report and the Unit Educator sat down with me today. She asked me what happened. Of course I broke down in tears as I explained the day. She said my preceptor has said that even before this incident I seem to have poor time management and am easily distracted.

Wow! Am I that bad of a nurse? Is this typical new grad behavior? I am a second career adult and these two statements seem very atypical of my past performance in corporate America.

Any advice at all is appreciated --

:-)

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Specializes in NICU, Telephone Triage.

Don't beat yourself up too much. We all make mistakes. I am curious if you don't mind telling what med it was. The longest I've hung an IV med is usually an hour, maybe 2 at the most. You said it was running for 45 min., how long was it supposed to run over?

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Specializes in NICU.

I'm curious as to what the med was too, just because I've never heard of something like that .... the pharmacy sending the wrong thing, and then you having to adjust it based on their mistake? Our pharmacy would have sent up a whole new med and we would have written it up as an error from pharmacy.

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[quote=Kattabba;2422337 She said my preceptor has said that even before this incident I seem to have poor time management and am easily distracted.

:-)

Sure sounds like a CYA statement from your 'preceptor'. I dont get these management types who pile on someone who obviously is distraught over an error. 'Time management' usually is a 'buzz word' for a unit that piles on with very heavy assignments that leave a new nurse treading water. I have been there... and moved on. Hang in there and don't beat yourself up.

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Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.

Learn from this but please don't be so hard on yourself. :icon_hug:

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Specializes in Nephrology, Cardiology, ER, ICU.

I agree with Sabby - learn from this mistake. Also, when they say you have "poor time management skills", get specifics and then ask what the corrective action would be.

Good luck - hang in there - it does get easier.

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Hang in there!

Time management is something that takes time and your educator should know that.

I think your preceptor is just trying to cover her butt over that IV bag being run at the wrong rate. She is responsible too, she should have been there with you when you hung it since it wasn't right and she was aware it wasn't right and it was your first day in the level 3 nursery.

I'm surprised the pharmacy didn't send a new bag, that is a huge issue to try and figure out and it would have been safer and easier to just send up a new bag. Also, some meds are caustic and to send a double concentration freaks me out. I am a pain in the butt when it comes to stuff like that, I insist that things are the way they are prescribed, pharmacy has never gotten upset when I ask nicely. We are the baby's advocate and it is our butt on the line. Just think about this, the pharmacist is pretty sure that something is ok and tells you it should be ok on the phone. If an untoward result occurs and it wasn't ok do you think the pharmacist is going to say, oh yeah, I told her on the phone it was fine. It would be more like, oh, I don't recall talking to her, I don't think I would have said it was ok to give that med if I wasn't 100% sure it was safe. I don't look at the world in a cynical way, but when people are up against a wall and their livelihood is at stake they are going to go into self preservation mode. I think that your error was the culmination of many errors starting at the pharmacy and ending when you hung the bag.

We have a policy in my unit that 2 nurses have to check all IV bags and lipid syringes against the order, then 2 nurses have to sign off when you do a tubing change, bag change, or rate change. It takes a few extra seconds of time, but the peace of mind is worth it. This change came about because of an incident that happened a few years ago. This is what incident reports are supposed to be for, when something untoward happens, the powers that be can investigate and if there is a pattern of incidents then they can come up with new ways to do things so that the errors don't happen. Incident reports aren't supposed to be punitive and I am sorry that it appears this way.

I am a new grad, I am a couple of months away from completing my first year of nursing. I am just now starting to internalize time management and prioritizing. Handling a 4 feeder assignment is very time consuming and shows that you can manage your time. I run more when I have a feeder assignment then when I have sick kids.

Keep on keeping on, learn from all mistakes, yours and others. I think it is awesome that you have such a long, phased orientation.

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Sure sounds like a CYA statement from your 'preceptor'. I dont get these management types who pile on someone who obviously is distraught over an error. 'Time management' usually is a 'buzz word' for a unit that piles on with very heavy assignments that leave a new nurse treading water. I have been there... and moved on. Hang in there and don't beat yourself up.

bingo!!!!

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Specializes in NICU.

I have been a preceptor in a university hospital level III. I've dealt with similar issues. As far as I'm concerned, it was your preceptor's fault. She is the one there to teach you and catch the potential mistakes before they happen. This is precisely why you have someone there to work with you. There is a reason we double check meds, I.V.'s, etc., in NICU. She didn't catch your error to me = her fault. Also, all new nurses have "time management issues." Working in a level II, even for 3 months, really isn't preparation for a level III. IMHO, the orientation should start with level III and us older folks should retire to level II. There are very different issues between the two types of units.

Last night I sat and had a talk with someone new. She had "time management issues." I explained to her that this is normal. It will take a very long time before you feel you have things organized, know what you are doing and have things under control. Knowing it's normal I think helps. It's not bad nursing, being a moron, etc., but time management and not being distracted is something that is built with time and experience. Please do something kind for yourself. It sounds like you need it.

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I know exactly how you feel. We just finished our internship, and of course, they want us to train with the sick babies. But then they throw us out on our own to handle 3-4 feeder/growers after weeks of having 1-2 kids.... Any way, learn from your mistakes, thats all we can do. Good luck.

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Specializes in NICU.
But then they throw us out on our own to handle 3-4 feeder/growers after weeks of having 1-2 kids.

I think what Sketeerbug says here is key - irrespective of the fact that I just *prefer* taking care of ECMO or otherwise really acute kids, having a 1:1 or 1:2 is much easier on the time-management. Having to feed 3 or 4 pokey preemies within an hour or so makes me want to tear my hair out, and has more than once brought me to tears of frustration.

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Specializes in NICU.
I think what Sketeerbug says here is key - irrespective of the fact that I just *prefer* taking care of ECMO or otherwise really acute kids, having a 1:1 or 1:2 is much easier on the time-management. Having to feed 3 or 4 pokey preemies within an hour or so makes me want to tear my hair out, and has more than once brought me to tears of frustration.

I totally agree. I think that's where I learned how to manage my time rather well, working in the well-baby nursery with 6-8 kids. So now when I get 3 (we never have more than 3) in our level II, it's not too bad.

Do you guys have a lot of unstable ECMO kids? I've only ever helped out with a few ECMO kids, that were rather stable and it was a looooooooong night.

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