I was working a night shift, which to this day I truly detest. When I got report, I found I had a patient in acute alcohol withdrawal (which in and of itself makes me furious, because there is no excuse for a hospitalized patient to suffer DT's if someone knows what they're doing, but I digress.)
Anyway, back to this unfortunate soul.
Because he was delusional and combative, he was restrained so he couldn't yank his IV out for the 10th time. They had also wrapped his IV site with kerlex as an added precaution...maybe if he couldn't find it he'd leave it alone. He was also being transfused with a couple of units of blood.
When I got there, he was nearly through the first unit, and I was to finish that and hang the next one. Well and good. Or so I thought. I started the second unit, but I had one hell of a time infusing it. I literally forced it in with the help of a pressure bag, and I am not kidding when I say it took a good 6 hours to get that blood in. Meanwhile, the patient was getting more and more agitated, which I attributed to his withdrawal.
Finally, mercifully, the blood was in so I opened up the saline to flush the line. But it wouldn't run. All of a sudden I realized, with absolute horror, what had happened.
I cut off the kerlex covering the IV site hoping against hope I was wrong, but alas, I wasn't. Yes indeed, I had infiltrated a unit of blood. I hadn't even bothered to check the site.
No wonder he was so agitated, it probably hurt like hell.
An hour later my manager showed up, and I told her what happened. She was probably the most easy going person I've ever known, and she told me not to worry about it.
I said "Listen to me, I infused an entire unit into his arm, go look at it." She did, and came out and told me to go home. I expected consequences, but never heard another word about it. But I am here to tell you I learned from that mistake.
#1: I gave a kid with a g-tube a med by mouth and was not supposed to. the order said po. the mom wasnt in the room, but she walked in after i gave the meds and the baby was coughing. she started yelling at me "didnt the other nurse tell you to put the meds in the tube!?" i traded patients with another nurse.
#2: I had a MRCP kid with a trach and a mist collar. When I was changing her diaper her trach fell out and she turned blue and desat to 50% i thought maybe she was having a lot of secretions in her trach because she had been all day but not to 50%. another nurse came in the room and put her trach back in in a rush thank god. we had to call rt to put another trach in and assess her. we had to put the % on the mc up to 35% instead of the 28% that it was on before. her sats went back up into the 90s eventually after multiple deep suctioning and trach replacement. i was supposed to wean her to room air that day. think i did it? nope. i felt horrible. the nurse asked me why i didnt call someone sooner and said that i seemed oblivious to what was going on.
i have been learning some hard lessons in these first 2 months of nursing =(
You poor thing!!! I've never worked in a hospital (LPN and they don't hire them in my area). How much of a preceptorship did you receive? Or did they just give you a week or so orientation before throwing you in? I would think that peds as a specialty would entail more than a brief orientation, esp. for new grads. If there is one thing I've learned (and yes, it was the hard way) it's that if you are new, there is nothing ever wrong with telling management that you need more time and/or training. Don't feel like you have to give in to coworkers and/or management who expect you to be Supernurse after a couple months experience. Question, question, question. You are well within your rights to expect and even demand good mentorship, and if you get a coworker who rolls her eyes or gets impatient, keep telling yourself that it's her problem, not yours. You'll get through it; everybody was a new grad once upon a time.
Just out of curiosity, I'd like to ask if there are any peds nurses who started out in this specialty as new grads, and if so, how much training did you receive?
thanks for the words... it has scared me away... but i dont want to give up after working so hard to become a nurse. i just hope it gets better in time. i've had my share of crying episodes at work, after work... and sleepless anxiety filled nights the night before work. i was never much of a cry baby until i became a nurse... eek.
just a word to everyone... especially those new nurses-- no matter how stupid you think a question is, if you don't understand something, ask for help. in the long run its better to look "stupid" to some doctor, nurse, or other person rather than having a patient harmed... im sure a dead/hurt patient will feel worse than you feeling stupid for asking a "dumb" questions =(
well... i graduated in december of 2006...i started orientation with an ip but a month or maybe more later, i took the nclex and failed. after that, i had to take it 2 more times. the total process was about 6 months.
orientation for peds is 6 months.
i had the problem that after i came back once i passed the nclex, i worked for umm i dunno maybe 2 more months? i then sprained my foot twice and couldnt walk-- had to wear various orthopedic devices... so i was off again...
i returned to work after that for almost 2 months-- and i had 2 more days left on orientation i remember... but THEN I got into a car accident because i had a seizure when i was driving... and i kept having seizure problems throughout the whole year.
by this time it was november and i decided that i needed to go stay somewhere where my family could help me instead of having no one to turn to when i have the chronic disease... so i moved to texas for 2 months...
i returned back to cali seizure free... and orientation maybe another month or so...
my time lines might be a bit off but im sure its clear that i had a very broken up orientation.
well... i graduated in december of 2006...i started orientation with an ip but a month or maybe more later, i took the nclex and failed. after that, i had to take it 2 more times. the total process was about 6 months.
orientation for peds is 6 months.
i had the problem that after i came back once i passed the nclex, i worked for umm i dunno maybe 2 more months? i then sprained my foot twice and couldnt walk-- had to wear various orthopedic devices... so i was off again...
i returned to work after that for almost 2 months-- and i had 2 more days left on orientation i remember... but THEN I got into a car accident because i had a seizure when i was driving... and i kept having seizure problems throughout the whole year.
by this time it was november and i decided that i needed to go stay somewhere where my family could help me instead of having no one to turn to when i have the chronic disease... so i moved to texas for 2 months...
i returned back to cali seizure free... and orientation maybe another month or so...
my time lines might be a bit off but im sure its clear that i had a very broken up orientation.
Wow, hun, that is so much to deal with. Be proud that you re-entered the workforce at all after that. Lots of people would have given up and gone on disability.
Have you considered getting a year or so of med-surg before specializing? Lots of experienced RNs suggest that. Hugs go out to you.
I don't have a "worst" mistake, mine are all just stupid, but I *will* tell on a friend who made a bad (somewhat hilarious looking back) mistake...
We were working med/surg and of all times, at like 3am she got an order to change the foley on a nursing home pt who came in. The guy was probably in his 90's, unresponsive, and the foley looked like it had mussels or barnacles on it -- crusted, the tubing in the member was disgusting, it was just... BAD.
So she goes to remove it and I was bored, keeping her company, and for who knows WHAT reason when she took her little 10CC syringe in to deflate the balloon, she pulled back the plunger, hooked it up to the foley, and proceeded to shove 10CC more INTO the balloon.
Why, I have no idea, but I was in such shock that I busted out laughing HYSTERICALLY. I think mostly because I was relieved that it was her that did it and not I. Either way, obviously it was a rather large mistake especially since the balloon popped and the foley slid right out... LUCKILY the balloon was VERY much intact with the exception of where it had broken. In her defense, the cath really looked like it was rotten, and probably didn't take much to burst that balloon.
So yeah... to this day I remind her of that. LOL. I know, I know, it's terrible to laugh at something so stupid and such a simple thing that should not be mistaken... but, people make mistakes. Learn to forgive yourself now so when you have that "Oh Sh!t" moment later, you don't beat yourself up so much.
I wish I could cry. I have had hot flashes, heart palpitations, anxiety through the roof over errors I have made. I know I am in the wrong profession because my OCD is killing me. I am a male nurse and that doesn't keep me from crying, but I would love to just break down once and get this off my chest.
I lost a job over med errors.
I worked the evening shift and every other weekend I would have to work days. Can you see where this is going? I was passing am meds and on one pt got it in my head that it was evening and pulled the wrong tray of meds. I even checked them against the medex as if it were evening. I didn't hear about it till the evening nurse called me and told me I passed the wrong meds. There was no harm done and we both survived it.
About 6 months later I did the exact same thing. Got put on probation and could have 0 med errors in 6 months. I made it 3 months before I forgot a pill on one lady. Once again, on day shift.
My next job I was so focused on the med cart that my DON told me that I spent too much time on it. She was right, I was never going to do that again yet she criticized me for it. I never volunteered to work a different shift than my own so I would not be able to make the same mistake.
I did make another mistake with an eye drop later though. It was atropine for a Hospice pt and was to be given orally. I guess it didn't make sense why you would give an eye drop in some one's mouth, and looking back, it was labeled po. I guess I thought it was an error and didn't check.
It is sooooooo easy to make a mistake as a nurse when you have 35 pts. and no med aid and 2 CNA's. The sinking feelings I have read about on this post is so common, the fear, the dread, the over compensation to make sure you make no mistakes.
It is sad that we all work so hard just to get that license, and then are almost set up to fail in some circumstances. I would like to get out of nursing so I can live a normal life and not worry about the feeling of dread I get when I make a mistake.
It is sad that we all work so hard just to get that license, and then are almost set up to fail in some circumstances. I would like to get out of nursing so I can live a normal life and not worry about the feeling of dread I get when I make a mistake.
I make mistakes. The world needs to get over it.
I really felt for you reading that. It's very difficult to do your job well, particularly a task like administering medications, when you're anxious or stressed out with too high a workload. Anxiety is crippling. Even with day to day activities, much less work tasks.
Nursing isn't for everybody. Hell, nursing is probably not for most people - most of us muddle through the day, doing our best, hoping we don't make an error - that didn't stop me going home at night, lying awake worrying I'd given the wrong dose, had forgotten something or had offended a patient somehow.
I agree it's an occupation which sets people up for failure - if you're not 100% on the ball, confident, knowledgeable and skilled all the time, you run the risk of making errors - and really, who can say they're all that and a bag of chips every single day?
You have learned many skills from nursing - use that to move into another area and be happy. In my current field, I see many unhappy people who hate their jobs, everyone has the right to like what they do most of the time.
I'm a new grad have been working for a few months now, but I made a really idiotic mistake. I was giving an SVN treatment, and the o2 was running at 6L. I stayed with thr patient throughout the treatment, and after it finished I started talking to her and turning the nob down on the o2. Or so I thought. I start hearing this hissing noise, then all of a sudden I hear a huge POP! as the oxygen tubing pops off the mouthpiece. It nearly gave me a heart attack. Luckily the patient did not get hurt, and we had a good laugh after I told her what happened. But man oh man I still kick myself at not looking at the o2 gauge first. ugh.
Specializes in Med Surg, Telemetry, Long Term Care.
I want to share another story that happened to me a while ago.My supervisor called me and told me that the patient that I handled last week died and she told me that she is gonna write me up.I worked day shift and the patient died that night.The patient's bp during my shift was kinda low.It was 90s/40s.There was an order to give lasix q 3 days.I hold the lasix because of the bp.I forgot to tell to my supervisor that the bp was kind of low.But I called the cardio consult of the pt and told him about my concerns.The dr told me that the bp is ok and to hold the lasix if the systolic is less than 100.During endorsement,I told the night nurse that the bp was kinda low so I need to hold the lasix.He told me that the pts bp was okay.The patient died that night.The primary doctor got upset because if she's the 1st one to be informed,she'll order a bolus of ns right away.I was really frustrated because that day,the family was thanking me for the care that I did to the patient.Anyways,my supervisor asked me why I didnt call the primary?Why do I need to call the cardio consult.I was speechless that time.
I have made a few med errors in the course of 16 yrs of nursing...but one of the things I did that bothered me most was one morning, on a busy med-surg floor, rushing trying to stay 'on top of things'....had 6 or 7 pts and was primary care, no nurse aides to help with pts needing feeding, etc. Dietary had brought in the tray for this particular pt and set it on the bedside table, but that was all they do. I had gone in and opened the milk, put the straw in, etc, silverware, etc. Spoke to the pt, then rushed on to the next. When I stepped in again to the room OT or PT or some tech was there, and I learned the pt was in restraints and with the tray right there, smelling the food, but unable to get to it. The pt, best I remember, was confused, anyway, the tech was saying 'I really should write this up'....They were not very nice about it, but I can understand why. But, the thing is, it was very early in my nsg career, and I felt like I was sinking anyway. This just made me feel so bad. As bad as any med error. I never heard anything more about it. But, I sure beat myself up on it so much. I don't remember if I had gotten in report that the pt was confused and was a total feed. It's been too long, but I would think I probably did, and just got in such a rush that I forgot and with the pt being covered, I just assumed she wasn't ready to eat yet, and went right on to the next thing.....But, in the end, it wasn't a life threatening problem and no long term effects...
My first mistake: 2 kids come into the pediatrics office for allergy injections. Same first name, last name with the first 2 letters the same. Yep....I gave the wrong serum to the wrong patient. I was in tears. Stomach drops...I go to the Dr. crying. He calms me down, reassures me that it is fine and it was...turns out they were on almost exactly the same serum....you can believe i double, quadruple check now!
second mistake: working in a LTC facility. All the Coumadins were given at 4 p.m. there was a change in this order for Only one patient (my patient) got his Coumadin at 12 noon. So I give it at noon. Well the nurse that re-ordered the new order and re-ordered it at 1600. So what do I do? Didnt check the MAR and gave it at 1600 also. You can bet I check the MAR now!
Simba&NalasMom, LPN
633 Posts
You poor thing!!! I've never worked in a hospital (LPN and they don't hire them in my area). How much of a preceptorship did you receive? Or did they just give you a week or so orientation before throwing you in? I would think that peds as a specialty would entail more than a brief orientation, esp. for new grads. If there is one thing I've learned (and yes, it was the hard way) it's that if you are new, there is nothing ever wrong with telling management that you need more time and/or training. Don't feel like you have to give in to coworkers and/or management who expect you to be Supernurse after a couple months experience. Question, question, question. You are well within your rights to expect and even demand good mentorship, and if you get a coworker who rolls her eyes or gets impatient, keep telling yourself that it's her problem, not yours. You'll get through it; everybody was a new grad once upon a time.
Just out of curiosity, I'd like to ask if there are any peds nurses who started out in this specialty as new grads, and if so, how much training did you receive?