What constitutes "a big deal"?

[LibraNurse27, BSN, RN]

I have been a nurse for 7 years and have made some minor errors along the way. I thought my acceptance that mistakes happen would get better over the years, but I don't think I've improved. A few examples would be a needle stick (has happened to me twice, once with a combative pt and no help to give an IM due to staffing issues but the other one just stupid), once giving an "underdose" of PO morphine, once giving 200mg IV thiamine instead of 100mg, and most recently giving 75mcg fentanyl instead of 25mcg at a time.

When I did community health I was thrown into giving vaccines with no training and gave an MMR IM and an adult Hep B vax to a (luckily large) Peds pt. Also some minor non med related mistakes that have faded away and caused no harm but at the time felt monumental. All of these mistakes have stuck in my mind for years, and I'm not sure if my reactions are over the top. For the IM MMR I called the CDC to see what to do and they said... do nothing, still counts as valid dose just might irritate muscle a bit. I reported all errors and did reports if advised to. The thiamine the MD said pt will just excrete it in the urine, the morphine pt ended up w/ pain controlled and didn't want rest of dose, the fentanyl pt was fine and said pain well controlled, neither of my needle sticks gave me any diseases. Do you think I've made an excessive amount of mistakes? Or that I blow things out of proportion by obsessing over them for years? Or both?! Sorry, just spiraling after the fentanyl thing.

People have been consoling me with stories of horrible/fatal errors and med errors but it makes me feel better a little but mostly more scared of worse potential errors.

[Jedrnurse, BSN, RN]

Speaking to two different angles of the main question, I would say one "big deal" is an error that results in harm and another big deal is a pattern of errors made by the same nurse.

[LibraNurse27, BSN, RN]

7 minutes ago, Jedrnurse said:

Speaking to two different angles of the main question, I would say one "big deal" is an error that results in harm and another big deal is a pattern of errors made by the same nurse.

Thanks Jedrnurse! I hope I don't fall into the "pattern of errors" nurse, but if I do I am constantly working on it! Most of the errors occurred in my first year as a nurse and then my first year in Stepdown. I want to blame it on always working places that are understaffed and poor resources, but I think that's unfair and I just need to take responsibility regardless of circumstances.

[Davey Do]

36 minutes ago, LibraNurse27 said:

Do you think I've made an excessive amount of mistakes? Or that I blow things out of proportion by obsessing over them for years? Or both?! Sorry, just spiraling after the fentanyl thing.

I did some quick research and you seem to be way below the amount of med errors considered excessive, generally calculating your number of nursing years and med administrations.

"Obsessing" can be interpreted as "reminding" ourselves so we don't repeat mistakes.

"Spiraling" is a response after an emotional trauma, adrenaline rush, realization, and coming to grips with the situation.

LibraNurse, I sense a certain quality about you of being a dang good nurse.

I have made my fair share of med errors in my career, that most likely outnumber yours. That's one reason why I worked psych. A med error is a med error is a med error. However, a med error on psych is not the same thing as a med error on medical, where it's more likely to have major adverse reactions.

As a psychiatrist told me after I reported a med error: "The patient probably just got a good night's sleep"!

 

[LibraNurse27, BSN, RN]

On 1/25/2021 at 1:23 PM, Davey Do said:

I did some quick research and you seem to be way below the amount of med errors considered excessive, generally calculating your number of nursing years and med administrations.

"Obsessing" can be interpreted as "reminding" ourselves so we don't repeat mistakes.

"Spiraling" is a response after an emotional trauma, adrenaline rush, realization, and coming to grips with the situation.

LibraNurse, I sense a certain quality about you of being a dang good nurse.

I have made my fair share of med errors in my career, that most likely outnumber yours. That's one reason why I worked psych. A med error is a med error is a med error. However, a med error on psych is not the same thing as a med error on medical, where it's more likely to have major adverse reactions.

As a psychiatrist told me after I reported a med error: "The patient probably just got a good night's sleep"!

Thank you so much!! I am surprised that all the managers/doctors I have reported to had similar responses as the doctor you reported to... saying the pt will just pee it out, thank God you didn't get HIV, no big deal and thanks for reporting... I think people appreciate honesty and owning up to errors. I sometimes wonder how often healthcare professionals hide/don't report errors that didn't cause harm.

I admit I was considering doing it with the fentanyl since I'm brand new to the job and pt was fine, but my conscience didn't allow it. Luckily my new manager was so nice, didn't think it warranted making a report and just said be careful and don't do it again, you're new to giving meds this way, no way to scan, etc but step it up and get used to it. He even told me he's made serious errors... I wanted to know more but didn't ask! The nurse training me said she made 3 med errors in first month in a SNF... but she was giving meds to 40 pts with paper charting!!

[JBMmom, MSN, NP]

I think that as a whole, our profession attracts people with a tendency towards perfectionists, and we are acutely concerned about the possibility of harming others. Sounds like you have made a very reasonable number of mistakes in your time as a nurse. Sometimes whether a mistake causes harm to a patient is just a matter or luck, sometimes it's true negligence, but you haven't caused any major harm in any of your small mistakes.

Some people have a tendency to focus on negative events/remarks/situations more than positive. I know that I can replay in my head the most negative conversation I have had with most people, but probably wouldn't be nearly as likely to remember the positive. I can also tell you every med mistake I've made. I've also been fortunate that none caused any harm, but I know the feeling you've had.

Try to give yourself a break. You're a good nurse. EVERYONE makes mistakes, don't let it consume you. 

 

[Sour Lemon]

1 hour ago, LibraNurse27 said:

People have been consoling me with stories of horrible/fatal errors and med errors but it makes me feel better a little but mostly more scared of worse potential errors.

Same here. I've made several errors over the past ten years, each under unique circumstances. None of my errors have caused harm, thank goodness ...but they were all "stupid" and could have been avoided if I'd been just a little bit more careful than I was.

I am definitely very aware that "the perfect storm" occurs on rare occasions. I hope it never happens to me or my patients, or you or your patients, or anybody else. It know it will, though. There's no way for any of us to to get around being a fallible human being.

[Jedrnurse, BSN, RN]

4 hours ago, LibraNurse27 said:

Thanks Jedrnurse! I hope I don't fall into the "pattern of errors" nurse, but if I do I am constantly working on it! Most of the errors occurred in my first year as a nurse and then my first year in Stepdown. I want to blame it on always working places that are understaffed and poor resources, but I think that's unfair and I just need to take responsibility regardless of circumstances.

Just to clarify, my "pattern" comment was meant in a general sense as an answer to your question, not a personal criticism. (If it came off as such...)

[LibraNurse27, BSN, RN]

2 hours ago, Jedrnurse said:

Just to clarify, my "pattern" comment was meant in a general sense as an answer to your question, not a personal criticism. (If it came off as such...)

Oh no it didn't feel personal! Even if it was, I always appreciate advice ?

[TheMoonisMyLantern, ADN, LPN, RN]

I've made many stupid mistakes over the years, the important thing is to learn from each of them. I think it's good that you're doing self reflection after a mistake, but try not to drown in it. A mentor once told me one time in reference to mistakes, "It's amazing what patients survive in the hosptial." and this tends to be true in many cases. While obviously medical errors cause a disturbingly significant amount of deaths each year, it's still amazing that there aren't more!

A lot of healthcare organizations are moving away from punitive measures towards errors in order to increase self reporting and identifying potential system failures contributing to errors.

[Nunya, BSN]

As a psychiatrist told me after I reported a med error: "The patientprobably just got a good night's sleep"! 

This comment by Davey Do reminds me of what a neonatologist said when a friend of mine gave a preemie baby too  much lasix, "well, it's not the way I would have done it but his lungs really cleared up!" Sometimes mistakes have an unintended good side effect.  

[LibraNurse27, BSN, RN]

On 1/25/2021 at 11:20 PM, Nunya said:

As a psychiatrist told me after I reported a med error: "The patientprobably just got a good night's sleep"! 

This comment by Davey Do reminds me of what a neonatologist said when a friend of mine gave a preemie baby too  much lasix, "well, it's not the way I would have done it but his lungs really cleared up!" Sometimes mistakes have an unintended good side effect.  

And that is the best outcome you could ever have for a med error... an unintended positive effect! Then you feel relieved, terrified, happy, stressed, ashamed, all at the same time LOL