What do we do with an "Imperfect" nurse?

[Norbert Holz]

Me, that is? I seem to make mistakes ! Nothing that has ever caused any injury, harm, or negative outcome for a patient.

I remember well the 10U of regular insulin that looked like 100 of regular. Yes, I made the mistake! I'll admit it. The patient was on an insulin drip that was covering at about that rate. The infusion was stopped and no negative outcome occoured to the patient.

This happened in an ER hold area on a weekend morning. I feel terrible about this mistake and am very glad that nothing happened to the patient! A fairly common and well researched mistake using an order that was poorly written. I was placed on the do not use for that facility.

Once I held an antibiotic. The ped had a central line that would not flush for me. I attempted to flush with a 10cc in hopes of having better luck with more pressure. The line still did not flush well. I told the student md during rounds that I was having difficulty with the line. "He said to just give it!" I held the med. On the next scheduled day of work I was fired. No harm came to the patient.

I failed to enact a heparin protocol at a facility. There were apparently some parameters somewhere that dictated that a bolus was to be given if the PT INR form a lab fell within a certian parameter. I was unaware of the protocol and bolus necessary. The patient was fine 2 days later when I cared for him again. I am now a do not use at that facility.

I am not perfect! I truly care about my patients! I try my best to assist them to achieve the highest level of wellness! I make the extra efforts to help the family. I feel terrible about making these mistakes!

Should I simply quit nursing? Having posted these admissions here for peer review I hope to recieve some feed back. I also hope that the BON does not see fit to take action against me. The only thing that the BON seems to do is prosecute when a mistake is made.

I need to know if I am just a "bad nurse" and should have never been allowed to or at least continue to pratice? Are there any other nurses in the world that have made mistakes? How did you overcome them? How did the facility handle them? Were you ever "forgiven?"

Please help me to gain the confidence to resume pratice or get out!

Thank you

[kaycee]

Norbert,

Only you know whether you are competent. There are no perfect nurses as has been stated. We all make mistakes at different times in our careers. We learn from our mistakes.

I agree with thisnurse. Agency is not for you. You need to work in a steady environment with a good orientation. Jumping around from place to place is not for nurses that are unsure of themselves.

Also why do you feel the do not use lists are unique to you? Sounds like you're down on yourself. Maybe this comes across to your co-workers. Somehow to be put on the do not use lists constantly without discussion means there needs to be discussion. Talk to the head of your agency. One med error doesn't usually get anyone fired or on the do not use list. There must be more Norbert.

[mom22]

Certainly, nobody is perfect, but maybe you should not be doing agency until you are more experienced.

Why not try to get a permanent placement and get comfortable with something?

[seven]

granted, there is some substantial issues that need to be looked at/resolved....but i do think it is intresting that i've only read one or two posts saying "good for you for admitting your mistakes and trying to become a better nurse"...i think that is sad...

norbert--good for you for bravely and publicly admitting your mistakes and making an attempt to figure out thier roots and resolve them

[RNforLongTime]

I think that it is safe to say that EVERY NURSe, at least once in thier career, has made a med error. I know I have and luckily no harm came to the patient. If one hasn't then they are lying or just "perfect". As Fiesty nurse said there is no such thing as a "perfect nurse". Don't be so hard on yourself. It is customary to have two RN"S check insulin and heparin drips. Always remember the five rights of medication administration:

1. The RIGHT DRUG

2. The RIGHT DOSE

3. The RIGHT Patient

4. The RIGHT ROUTE

5. THe RIGHT TIME

and the 6th .....the RIGHT DOCUMENTATION

It is imperative that each and every time a nurse gives a med that these "rights" are followed. I think that there are more med errors than actually reported because a nurse is afraid of being reprimanded.

Keep your head up! Good Luck!

Kelly:)

[Charles S. Smith, RN, MS]

Perhaps you need more structure than agency nursing allows you. Consider going back on staff somewhere to get a thorough orientation with a mentor. I sense you are feeling a bit underconfident. Agency nursing is not the place for underconfidence. No one is perfect, we all make mistakes, but agency nursing is not suitable for every RN.

good luck

chas

[mcl4]

Originally posted by kaycee

Norbert,

Only you know whether you are competent. There are no perfect nurses as has been stated. We all make mistakes at different times in our careers. We learn from our mistakes.

I agree with thisnurse. Agency is not for you. You need to work in a steady environment with a good orientation. Jumping around from place to place is not for nurses that are unsure of themselves.

Also why do you feel the do not use lists are unique to you? Sounds like you're down on yourself. Maybe this comes across to your co-workers. Somehow to be put on the do not use lists constantly without discussion means there needs to be discussion. Talk to the head of your agency. One med error doesn't usually get anyone fired or on the do not use list. There must be more Norbert.

After reading this message, I did question this nurse's ability to give safe care. We all do make mistakes, but serious mistakes such as these are different. Med errors that were listed above with an agency nurse would certainly give the facility reason not to request this person back. A nurse who would give a 100 units of R insulin without question would send up red flags to me.

Nurses, who make consistent errors or do not change their pattern of making mistakes with giving meds are not giving safe care to patients. We must adhere to policies that ensure meds are given safely with the six rules of safe medication administration and knowing all the information of the medication which includes dosages.

Nothing was written in the orginal message that question were ask of other staff members or that this nurse looked up the medicaton prior to giving or not giving it to their patient? I once had a nursing instructor who stated we don't need to know everything, but we must know where to look it up.

[mcl4]

Originally posted by thisnurse

we all make mistakes. i made the same insulin mistake when i was in school. i misread 2U as 20 units. after i pushed the insulin i realized that was an awful big dose so i questioned it. i should have done that BEFORE i gave it. no harm came to the patient, thank god, but i learned a lot from that. i always write out units now. ]

Where was your nursing instructors and most hospitals and nursing homes, you will be required to have insulin dosages drawn up checked by a second nurses.

[mcl4]

Originally posted by leia

I don't think tthat there is a perfect nurse and we all do make mistakes-you just get caught doing them.

So nurses are out there making these same mistakes, they just haven't been caught?

[radnurse2001]

I agree with what everyone is saying. I think your first oversight is not having a solid base of nursing to go by. I would advise you to go to a med-surg floor. LEARN THE NORMALS!!!! Be straight up with them and let them know that even though you have been a nurse for 7 years, you want an orientation--a good one(seeing as you may have never worked in one consistant place before) as far as the ped's patient with the central line I wouldn't have given the med either, however, I would have notified the attending physician. The he11 with the med student. And most importantly....DOCUMENT. The insulin issue---I was trained to always have a nurse double check the insulin with the original written order. Fresh eyes are always good. At our facility, heparin protocol orders are always on the chart...always check your charts. The charge nurse may not always be able to get to them in a timely manner. If all this seems overwhelming...it is. Take a time management course, get out of agency nursing and find a home. It sounds to me like you need constants to gain back your confidence and your skills. Good luck and don't give up. Sharpen yourself up a little and be the best nurse you can be. We need you.

Anne

[nightingale, RN]

Norbert:

I too applaud you for bearing yourself so openly; That in itself is proof that you worthy of caring for patients because you are so willing to learn from your mistakes. I fear the nurse who is never wrong for "we" all learn something everyday.

Your confidence needs help. The other posts were right on when they mentioned a class or other sort of brusch up for your medication knowledge. I recently purchased a new Drug Book by Loeb; This book is very user friendly with large print, stays open in one hand while you use your other (wouldn't it be great to have three hands?), and colored print for alerts. I picked it up from Amazon.com for less then $ 20.00.

Find what works for you. Nursing needs commited individuals, like yourself, who are willing to go the extra mile and continually reassess themselves and get the training/education they need.

When in doubt: ask, check the policy and procedure manual, look it up, follow your gut... move forward...

Recently, I listened to a wonderful tape about Mother Teresa's book "Passages"; I learned a very helpful prayer for forgiveness. It helps me to realize that we are all forgiven the moment we ask Him for forgiveness.

You have learned from each of your mistakes. It is now time to move on and do what you need to do. Only you know what that is... follow your instincts.....

In peace,

B.

[fiestynurse]

Yes, mcl4, I believe that many errors go unreported because of the punitive nature of our system. And I also want to compliment Norbert on the admission of his errors and the seeking out of help.

[mcl4]

Originally posted by fiestynurse

Yes, mcl4, I believe that many errors go unreported because of the punitive nature of our system. And I also want to compliment Norbert on the admission of his errors and the seeking out of help.

On this board, errors have been admitted by the person, but my reading of the orginal post is that other staff nurses he was working with found these three errors. It didn't appear he had the knowledge necessary to realize he made an error?