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

[psnurse]

I have some concerns. By stating them I am not implying perfection. But the words that echo in my head from nursing school a lot of years ago are these "You are the patient's last line of defense". Perhaps unfair, but I have found this to be true. It is worthy to note, this is part of our job that our patients are unaware of.

The mistake with insulin must be common. At least common enough for recommendations that the word units be written out in the order. To not question an IV infusion of 100 units per hour isn't orientation related. It is a little scary.

Holding antibiotics because an IV doesn't work? You can't do that unless the antibiotics are changed to another drug, dose, or route. It is the nurses responsibility to follow up on this. Don't force a central line to flush either. And if the medical student tries to, then stop him/her. Can cause embolus. It may be necessary to replace the central line, they are only good for so long, or obtain peripheral access. But we can't just decide what meds to give and not give based on if our IV access is working. Follow up, follow up, follow up!!!

Is IV Heparin ever given without a titration schedule?? You indicated that the heparin was to be titrated by PT/INR. This is a red flag to me that you may not be all that familiar with heparin, since it is titrated based on PTT, not PT or INR.

I guess my question would be are you working agency in care areas where you are familiar with the patient population, common diagnoses, and usual treatments? I have worked agency and you don't get a lengthy orientation. You are expected to hit the ground running. If you are unfamiliar with the care required for a particular patient group, then it is your responsibilty to say, "Sorry, I can't take that shift".

I am not perfect, but my background would not permit me to take a shift in labor and delivery.

[fiestynurse]

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[psnurse]

I agree, Norbert needs to become intimately familiar with the patient group he will work with as agency staff. This will probably require a staff position with a good orientation.

I would not suggest that he quit, but a regrouping seems in order.

[thisnurse]

fiesty, double checking insulin and heparin used to be required at our hospitals here but is no longer. was a good system too. i guess it was too time consuming.

[kaycee]

I also applaud Nobert for asking for help and advice. He sounds like a very caring and compassionate nurse, that as psnurse said may need some redirection. I only suggest as I said before that maybe a consistent job in a facility would be helpful. Agency nursing isn't for everyone. I know it is not for me.

I hope your doing ok Norbert and know that our suggestions are meant to help. Please let us know how you are doing.

[thisnurse]

mc,

my instructor was with another student. you cant lay blame on her. i was second year...it was MY mistake, i knew enough to know it was a high dose but didnt question it until AFTER administering it. that was my fault not hers.

it is no longer required we get a double check on insulin and heparin. it hasnt been for years.

i always get a double check on heparin now. ALWAYS.. ive not made any mistakes and im going to keep it that way.

i now work with so many diabetics i dont think i need the double check on insulin. i know the usual doses and when something seems strange i question it. i do the five rights and i check and double check.

you cant be niave enough to think that nurses arent making med errors out there and not reporting them.

[funnynurse]

Perhaps you would be more comfortable in another setting where you don't have to worry about making med errors.....preadmission testing, casemanagement...... also the preop holding may be a good placement for you(yes, you will still administer meds but very few) I would look into other areas fast before you lose your liscence! (I am sure you busted your but to obtain it and don't wish to lose it) Also I know we have time constraints put on us, but remember the 5 rights and your policy and procedure manuals. No nurse out there is perfect and we all have probably made some mistake(be it med error or order error)

Be glad noone was hurt and move on, try not to beat yourself up about it, just find ways to fix the problem so they don't continue. Please don't leave nursing, we need you!:)

[LilgirlRN, ADN, RN]

Sounds like you are traveling nurse, agency nurse ( I only read a few of the posts, you may explain yourself better later). I think it would be hard to know what to do in each facility and I myself would rely heavily on the regular staff. Remember there are no stupid question, only stupid answers and we learn by making mistakes or by watching others make mistakes Maybe you need glasses?

[mcl4]

Originally posted by thisnurse

mc,

my instructor was with another student. you cant lay blame on her. i was second year...it was MY mistake, i knew enough to know it was a high dose but didnt question it until AFTER administering it. that was my fault not hers.

it is no longer required we get a double check on insulin and heparin. it hasnt been for years.

i always get a double check on heparin now. ALWAYS.. ive not made any mistakes and im going to keep it that way.

i now work with so many diabetics i dont think i need the double check on insulin. i know the usual doses and when something seems strange i question it. i do the five rights and i check and double check.

you cant be niave enough to think that nurses arent making med errors out there and not reporting them.

As a student nurses, instructors are responsible for their student's actions no matter what level of clinincal rotation they are in. The fact is a two year nursing student nurse still needs supervision. I would not be happy with a student that took it upon themself to work this independently and subsequently make an error.

I would say most medication errors are found by other shifts and they report them. This nurse was written up by other staff after they found his errors since he appears unaware he made them.

[mcl4]

Originally posted by thisnurse

fiesty, double checking insulin and heparin used to be required at our hospitals here but is no longer. was a good system too. i guess it was too time consuming.

Policy or no policy, it takes a small amount of time to have a nurse double check your insulin or heparin. We double check medication math calculation also.

[mcl4]

Originally posted by LilgirlRN

Sounds like you are traveling nurse, agency nurse ( I only read a few of the posts, you may explain yourself better later). I think it would be hard to know what to do in each facility and I myself would rely heavily on the regular staff. Remember there are no stupid question, only stupid answers and we learn by making mistakes or by watching others make mistakes Maybe you need glasses?

My experience has been that agency nurses are expected to come into a hospital or long term care facility with experience and be flexible enough to handle many situations without a lot of supervision. Not everyone can do this.

[RNKitty]

The other bonus to getting out of agency and finding a "home" where you can orient is that you can establish a trust with your coworkers. Then you can find mentors. Mentors and a consistant work environment definitely improve experience level and self-esteem and confidence! Good luck!