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

[Pete495]

Dear Worrier,

I've made my share of mistakes in nursing, but the biggest thing that you can worry about is Medications. It should always be custom to you to double and triple check your MAR for medication dosage. I know nurses in a unit I worked in that are Great nurses with copious years of experience who always check their medications 2 to 3 times. It's almost a must because it is easy to make errors when you give out so many medications per day.

Nurses are Health care Professionals. Everyone expects us to be perfect, but it's just not the case. Many managers and supervisors come down hard because of the perceived cost of mistakes against patients. It's understandable, yet hard to believe since no one on earth is expected to be so perfect. Our managers give the perception that nurses are perfect and this is why they come down hard.

Even agency nurses should be given orientations if that is what you are doing. Don't settle for anything less. Also, you need to become more aware of each hospital's protocols if you are going to continue doing nursing. This is a difficult job esp. if you jump from hospital to hospital. it's easy to confuse them. But don't worry too much, and enjoy your patients. Maybe seek out a place you are comfortable with for a permanent position, and still do some agency work on the side. It's a good way to get experience. Good Luck!

Pete

[EXOTIC NURSE, RN]

I agree with most of the posters on the board that he was brave and also he recognizes his mistakes but the thought I am mainly supporting is I feel the poster should get out of agency nursing and work in a hospital on a specific unit first and get some good experience then progress to agency nursing. It does not have to be a med surg floor it could be any unit that you feel comfortable in the nursing atmosphere. I personally do not like the med surg units I work on a tele unit, but I feel comfortable there and I am going to try and explore the ICU or even ER units at one point but I just did not feel comfortable in those areas as yet.

[Cubby]

Thank God you admit your mistakes. The big problem comes from nurses who don't or won't admit their mistakes. As long as you know you need to learn more there isn't a problem in my eyes.

God be with you. Things will get better for you.

[Agnus]

When I have to do something or give a med that I haven't given for a while. I ask questions. If I have not see a protochol for something that should have one I ask for it. We all have and will make mistakes. Use them for stepping off points for learning. I frequently ask another nurse to check me on dosing and drips even when I'm very sure of what I'm doing. I figure if I'm too sure that will be the time I'm wrong. Errors especially med errors are hard on us; we try to to be everything to every one. I once has a sympathetic pharmasist tell me. "You are expected to be absolutely perfect in everything you do. That is Impossible for any human being and is not expected in other professions. Don't beat yourself up. Learn from it and move on."

[egmillard]

Yes, we all do make mistakes, but it is what we learn from them that matters. I check all my drip rates, except NS with another nurse when I start an infusion, and I check all my insulin doses with another RN, if they are of a large amount. I work on a tel unit and we use Heparin, Flolan, Dopamine, Dobutamine, Lidocaine, Amiodarone etc etc etc, I always double check with another RN when it comes to infusions, believe me I know how easy it is too make mistakes.

My most interesting mistake, was interpreting SP CT, as to mean Spiral CT, instead it was status post CT removal, as I know now. However I double checked with two nurses and they aggreed with me. The patient had the spiral ct, and the MD was most annoyed, and quite right. Fortunately, there was no harm done, but I look twice now.......