Of Med Errors and Brain Farts

 

Glasses ink 2019 by Julianna Paradisi

Giving an Unfamiliar Medication

I read the physician’s order carefully, looked up the medication in the nurses’ drug book, and consulted with a pharmacist before I gave it. Afterward, while signing the medication administration record (MAR), I read the order again, and I did not see the same dose I had read the first time.

Accountability for My Actions

Immediately the blood in my feet rushed up to my ears and I was lost in pounding waves of white noise. Fuck, fuck, fuck, I made a med error, and it’s a serious one! Of course, I didn’t say these words out loud. Instead, I carried the patient’s chart and the empty, pre-filled syringe to the nurses’ station. Putting them in front of the charge nurse I said, I think I just made a med error, a bad one. Look at the order and the syringe label. Tell me what I’ve done.

Relief: The Patient was Safe

She stopped what she was doing. She read the order and examined the syringe. You gave the right dose. You didn’t make a med error. Now breathe. The pounding breakers of white noise in my ears subsided into the gentle lapping of my breathing. Another nurse came to my side saying, I know exactly what you’re feeling.

I felt relief. My patient was safe. It was an unfamiliar medication. That’s why I read the order carefully, looked it up, and consulted with the pharmacist. The only explaination I have for my confusion after giving the dose is that I had a brain fart. Somehow my eyes and my brain disconnected after giving the medication, and the order unexplainably failed to make sense. That’s the best I can come up with: a brain fart.

Everyone Makes Mistakes

Later, my coworkers told me their stories of making med errors. We all make them. I didn’t know that when I was a new grad.

It is unbelievable to me as I type this, but it is true: in nursing school  I had an instructor who told our class that she had never in her thirty year career, ever made a medication error. Never. And I was young, and shiny, and idealistic enough to believe her. Seriously, I did. So when I made a medication error during the first couple months of my new-grad job, I was sure that I was not cut out for nursing. At that time, my coworkers didn’t gather around offering support like they did recently. No, I was written up, and had to call the pediatrician and tell him I had forgotten to hang a dose of ampicillin. He was more sympathetic than the day shift charge nurse back then. I made other medication errors too, nothing serious, but enough to consider quitting nursing during my first six months of practice.

Nurses Supporting Nurses

Then I met one of the best nurses I have had the pleasure to work with. For some reason, she decided to mentor me. I confided to her that I considered quitting nursing, because I made med errors, and that my instructor never had.  She laughed. If that instructor of yours never made a med error, then I’m thinking she’s too dumb to catch them. You are so crazy. Let me tell you about med errors… She was a great nurse, not a perfect one.

Eventually I gained the confidence needed to stay in nursing these past thirty-three years. I still make mistakes from time to time. I take responsibility for them. I learn from them. I am compassionate towards my coworkers when it happens to them. Nursing is not a risk-free profession.

And sometimes I have brain farts.

This post was originally published on January 30,  2011. I feel reposting it may be beneficial for nurses new to my blog. It has been updated. 

Book Review: Sky the Oar, Poems by Stacy R. Nigliazzo

Sky the Oar by Stacy R. Nigliazzo, Press 53, 2018

Sky The Oar

poems by Stacy R. Nigliazz

Publisher: Press 53, 2018

Stacy R. Nigliazzo is a poet living in Houston, Texas. She is also an emergency department nurse. Her second published collection of poetry, Sky the Oar, like its predecessor Scissored Moon is informed by her experiences as an ER nurse.

I once had a painting instructor who read a poem to his class before each lesson. He said, You need poetry to be a painter. I would add, You need poetry to be a nurse. Nigliazzo creates poetry from the struggles of the human condition nurses witness daily.

Unlike medical surgery or ICU nurses, ER nurses treat and care for their patients for short spans of time. The poems of Sky the Oar reflect these brief, intense encounters. They are fleeting thoughts and images occurring in the internal dialogue of a poet too busy caring for the person beneath her hands to attach judgement to their plight.

Nigliazzo’s words are crisp and precise, things of beauty without sentimentalism or euphemism. The words are like shards of glass glittering in our hands, their edges sharp enough to pierce the skin. Her poems elevate these crystalline splinters of humanity for our understanding and compassion. In I Am and Nocturne, I found myself at the bedside with her. In the poem Frequently Asked Questions By My Patients, Nigliazzo captures a patient’s experience in a mere nine words.

Sky The Oar is poetry for all readers. For nurses, the slim volume is salve for the soul.

 

 

 

 

 

 

 

Nursing School is Just The Beginning of a Career of Learning

One aspect of changing nursing specialties, or being a new nurse for that matter, is the agreement to do homework to get up to speed. Being a certified oncology infusion nurse, while helpful, does not make me an expert in my new oncology nurse navigator position. Though working with preceptors who generously share learning, the responsibility of identifying my knowledge gaps, and seeking resources to fill them is mine.

Newly graduated nurse, I hate to break this news to you: graduating from nursing school doesn’t mean you’re done with homework. It’s the opposite. Nursing school provides the tools for finding information you need to succeed in any nursing job throughout your career. I’m serious. When early in my career a pediatric intensive care nurse befriended me, and agreed to be my mentor, the first thing she did was hand me a hardcover, 1,000+ page copy of Mary Fran Hazinski’s then gold standard text, Nursing Care of The Critically Ill Child, saying, “Read it. You can keep it too, because I just bought the newest edition,” cluing me in that expert level nurses continue learning.

I read the tome twice: the first time by looking up the diagnoses of every patient I was assigned to learn their assessment, and then understand the medical care plan. The second time, a few years later, I read it cover to cover preparing for pediatric CCRN certification.

In similar fashion, these days my evenings and days off are occupied with an hour or more of reading about nurse navigation. Yes, I’m a bit of a nerd, but the fact is I haven’t been this excited about nursing in years. Nursing school is just the beginning of a career of learning.

Nurses & Doctors: Make Appreciation Reciprocal

artist: jparadisi

artist: jparadisi

Few life-threatening or terminal diseases present themselves in otherwise healthy, alert, and charming hosts the way cancer does.

From the get-go, oncologists are not only captain of the ship; they hoist life preservers in the form of treatment to patients drowning in waves of shock after a cancer diagnosis.

In my opinion, oncologists’ hearts closely resemble those of nurses. This is attributed to the fact that although oncologists do not spend the same quantity of time with patients as nurses do, the quality of the time they spend is intense. They often form relationships with patients over years. It’s common for an oncologist to know close members of their patient’s family, also like nurses.

During my last episode of possible (it wasn’t) recurrence, I experienced this truth.

My oncologist and I share a professional relationship. One of the reasons he’s my oncologist is because I know he’s good at what he does. My husband likes him, too. They share an easy communication, which is another reason for my choice. If/when cancer recurs, I know they will cooperate on my care, freeing me to be the patient, not the nurse. This arrangement brings me peace of mind.

Anyway, I had suspicious symptoms, which landed me face down in an MRI. My appointment to receive the MRI results was scheduled at end of a workday for my oncologist.

David accompanied me. Dr. My Choice entered the exam room holding the films, clipping them to the light box.

“I haven’t looked at these yet,” he explained. “I thought we could see them at the same time.”

It hit me in a flash: Dr. My Choice likes us too. He is about to find out if he will tell a nurse he enjoys working with, and her husband, whether or not her cancer has recurred.

Snap! What have I done to him?

Fortunately, the films revealed I am still cancer free. The look of relief on Dr. My Choice’s face nearly equaled David’s.

Oncologists, (doctors) have feelings, too. This knowledge affects the professional relationships of nursing practice in the following ways:

  • When questioning an order, assume the doctor has good intentions toward his or her patient, same as you.
  • Avoid framing questions to a doctor with your personal inferences, such as opinions of whether or not the physician is “good” or “bad.”
  • Consider that doctors suffer from work overload, and burn out, as do nurses.
  • Remember: Being part of a team is catching one another when we fall. No one is on top of his or her game every time.
  • Protect the Rock Star Doctor (every unit has one) by double-checking their orders the same as you do for any other physician. Don’t let them fall to earth because you were not diligent in providing a safety net for their patients.

Education is the tool of our trade. It is our demeanor, which makes us professionals.