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. 

JParadisiRN Guests on RNFMRadio Tonight Oct 14 9pmEST/6pm PST

Great news!  I’m being interviewed on “RN.FM Radio: Nursing Unleashed!”, the newest internet radio station for nurses:

JParadisiRN’s interview is on Monday, 10/14/13  at 9pm EST / 6pm PST. You can listen in here: http://www.blogtalkradio.com/rnfmradio

In my LIVE interview, I plan on discussing The Adventures of Nurse Niki, authentic nurse characters, and writing a fictional nursing blog.



In preparation for the interview, I wrote a guest post for RNFM Radio:

The Adventures of Nurse Niki: Nurse Characters Doing Nurses’ Work.

If you can’t listen in, bear in mind that the show will be immediately archived and available for listening on Blog Talk Radio (http://blogtalkradio.com/rnfmradio), and will also be quickly available as a free downloadable podcast on iTunes.

Call-in # is: (347) 308-8064.

The link to listen in on Monday, 10/14/13   at 9pm EST / 6pm PST again is: http://www.blogtalkradio.com/rnfmradio

I look forward to connecting with you then!

The Adventures of Nurse Niki Chapter 15: Two Separate Worlds is posted. If you’re a new reader, the chapters are short, so it’s easy to catch up. New chapters are posted weekly on Thursdays.

 Please Like Nurse Niki on Facebook, and follow her on Twitter @NurseNikiAdven

The Adventures of Nurse Niki Chapter 9 is Posted: No Good Deed Goes Unpunished

The Adventures of Nurse Niki
The Adventures of Nurse Niki

The Adventures of Nurse Niki Chapter 9 is posted!

In this week’s post, Niki unintentionally stands ER nurse Corey up for breakfast after her patient’s early morning code. As if that wasn’t enough, Niki meets a traffic cop on her way home from the hospital.

Off the Charts has this to say about The Adventures of Nurse Niki:

This blog is made up entirely of first-person episodes told by a fictional nurse named Niki. Each episode is short, detailed, and engaging, and it’s easy to keep up with it on a regular basis, or quickly catch up if you haven’t yet read any episodes.

                      Jacob Molyneux, AJN senior editor/blog editor

You can interact with Nurse Niki on her Facebook page, and don’t forget to “Like” it. Show Niki some love!

Thank YOU!! to the readers following The Adventures of Nurse Niki, the retweets of  @NurseNikiAdven, and those who not only Like Nurse Niki’s Facebook Fan Page, but post comments too. The support is very much appreciated!

I NEED HELP! The Adventures of Nurse Niki Chapter 8 is Posted

The Adventures of Nurse Niki
The Adventures of Nurse Niki

The Adventures of Nurse Niki Chapter 8 is posted.

In this episode, Niki’ makes breakfast plans with her friend from ER, Corey, and her PICU patient suffers an unexpected, early morning code.

Off the Charts has this to say about The Adventures of Nurse Niki:

This blog is made up entirely of first-person episodes told by a fictional nurse named Niki. Each episode is short, detailed, and engaging, and it’s easy to keep up with it on a regular basis, or quickly catch up if you haven’t yet read any episodes.

                      Jacob Molyneux, AJN senior editor/blog editor

You can interact with Nurse Niki on her Facebook page, and don’t forget to “Like” it. Show Niki some love!

Many thanks to the readers following The Adventures of Nurse Niki, the retweets of  @NurseNikiAdven, and those who not only Like Nurse Niki’s Facebook Fan Page, but post comments too. The support is very much appreciated!

The Adventures of Nurse Niki Chapter 2 is Posted!

The Adventures of Nurse Niki Chapter 2 is posted. This week, Niki begins discussing her workplace. On Facebook, Niki explains some of the differences between Pediatric Intensive Care Nursing, and Neonatal Intensive Care Nursing. These two nursing specialties are often misunderstood by lay people. I let Niki post one of my drawings to her Facebook page too. Please be sure to Like Nurse Niki’s Facebook Page, and you can Follow Nurse Niki on Twitter @NurseNikiAdven

Commitment Makes You an Artist or A Nurse

That I am an artist was never questioned by anyone other than myself. It took time for me to believe in myself as an artist, because I felt I would know when I became one. Some artists laugh at such thoughts:

In artistic work one needs nothing so much as conscience; it is the sole standard. — Ranier Marie Rilke

Self-Portrait. Pencil on paper by jparadisi

Self-Portrait. Pencil on paper by jparadisi

How do I know I’m an artist?
The same way I know I am a nurse: Not because I am paid for my work, but because of my commitment to nursing. Commitment manifests itself as time set aside for continuing education, and time to practice skills. It’s not enough to want to do something. You need time to practice skills, whether it be starting IVs, or developing a series of paintings for exhibition. You commit to nursing through education, taking boards, and continuing education. You have to commit to creativity, too.

Begin with one hour a week, every week. It needn’t be the same day or time each week, although a set schedule may make it easier, childcare and weird nursing work schedules may necessitate flexibility. Protect this hour as if it were a difficult-to-reschedule dental appointment.

What will you do with this hour each week? You will have a creative date with yourself. For now, don’t invite a friend. Free yourself completely of taking care of other people. You need to hear your voice to find your creativity. You may already know what you’ll do with the time: write a poem or short story or resume piano, dancing, or voice lessons. If you’re drawing a blank about what to do, here are a few suggestions:

  • Wander the aisles of an art supply or craft store. Give yourself $10-$20 to spend on pens, paper, stamps, inkpads, dried flowers — whatever. Need ideas? Check out MarthaStewart.com, or Pinterest.
  • Wander the aisles of an office supply or dollar store with $10-$20. Buy felt pens, stickers, glitter, glue sticks, and an inexpensive scrapbook. Tear pictures from old magazines of everything catching your eye. Paste them into the scrapbook using a glue stick. Decorate the pages with your glitter, stickers, and felt pens.
  • Buy a cheap rectangular or square flower vase made of clear glass. Fill it three-quarters full with small glass beads. You can use small, polished stones instead, but they tend to scratch the implements. Use it to hold pens on your home or work desk.
  • Go for a walk with your camera. Take snapshots of anything that attracts your attention. Take lots of pictures without over-thinking the process. You’re practicing how to “see.”

The important thing is to make a habit of allowing yourself at least an hour a week to explore and develop your creativity. What ideas can you add to this list?

Not All Nurses Are The Same

by jparadisi 2012

Not all nurses are the same. At work, I entered the staff lounge just in time to overhear one nurse say to another:

“I’m mean really, nurses don’t care about clothes. We have our work clothes, and jeans for home. Who cares about clothes?”

Grabbing my lunch sack, I headed outdoors to eat, inaudibly mumbling:

“I do. I care about clothes.” 

I recently bought a pair of platform wedges. I’ve written before that I envy my neighbor her 7-inch stiletto platforms, and the ability to walk in them as gracefully as a bamboo reed. Just once before I die, I want to own a pair of big girl shoes, and wear them like a grown up.

No one knows I bought them yet, but David, who accompanied me. In fact, he encouraged me to buy them. He thinks the shoes are sexy. I love him.

Even though my new peep toe wedges are only the equivalent of a 3 1/2-inch heel, walking gracefully as a bamboo reed is as difficult as it looks. I’ve been practicing walking in them around the house. Did I mention they’re beige, and make my legs look very long?

This day, the sun shone magnificently, without the slightest threat of rain. I decided to try a test spin outdoors in the new shoes, and walk a few blocks to the bank, though I have a way to go towards developing the skill to walk in them gracefully, like a bamboo reed.

Taking cautious steps, balancing 31/2 inches taller than usual, I pass a man on crutches navigating a sidewalk café table and chair. He intends to enjoy a latte in the brilliant sunlight. I’m unable to offer help, because I don’t have any better control of my legs in these platform wedges. He successfully maneuvers the table and chair, while I slink away with a gait reminiscent of Frankenstein, acknowledging the irony of the scene.

At the bank, the teller asks if I have plans for the rest of this beautiful afternoon. I tell her no, too embarrassed to admit that practicing walking gracefully in my platform wedges is my plan for the afternoon.

As I walk home, my gait becomes smoother. I gain a little confidence. I feel like a grown up. I can’t help it; I like fashion.

Not all nurses are the same.

What sets you apart from your nurse colleagues? Do you have a funny story about it?

A Social License Part II

Occupy Portland Encampment (first week of November 2011) image: jparadisi 2011

“Oh, that’s too funny! Well, thanks for letting us know. See you in a few days.”

Those were the words of the charge nurse at the infusion clinic, when I called to let her know that, because of jury duty, I would miss the next day’s shift too.

The jury was selected. The judge outlined the case and instructed us in our responsibilities as jurors. Then we were dismissed for lunch.

The trial began when we returned. It was expected to last through the late afternoon of the next day. If the jury reached a decision quickly after the closing arguments, our job would be done. If not, a third day would be required to complete deliberation.

When court resumed, thirteen jurors took their seats. The thirteenth juror, an alternate, would hear the entire case, and then be identified before deliberation. The alternate would only participate in deliberation if another juror became ill or had an emergency preventing him or her from serving. Looking at each face in our group, I wondered which one of us would be kicked off the island (Survivor reference). Was it me?

The only other potential juror, beside me, who had been called out, had not been selected for duty. It was her opinion that cases seeking medical damages resulting from a car accident, such as this one, are always based on greed. She was rejected as a juror because she could not set aside her opinion to hear the case.

The plaintiff suffered neck and shoulder pain since her car was rear ended three years ago at a stop light by the defendant. She was suing for pain and suffering. The defendant was driving his sister’s car at the time of the accident, because an intoxicated driver totaled the defendant’s car two days before he rear-ended the plaintiff.  The defendant had been on his way to school when the accident occurred. He was not intoxicated nor using his cell phone. His foot slipped off the brake. It was a low impact collision. The sister was not in the car at the time of the accident, but was included in the suit because the car belonged to her.

That first day, I wanted to side with the plaintiff. I have seen serious injuries occur from seemingly insignificant impacts. I imagined the plaintiff sitting at her desk job in pain everyday. I listened carefully to her lawyer’s lengthy circumlocutions about her suffering, and the testimonies of her primary health care provider and chiropractor on her behalf.

I left the courthouse at the end of that first day believing the case was motivated by fear: fear of disability and loss of income, fear of a healthcare system that will likely fail the plaintiff when she needs treatment in the future. I felt disheartened.

At the end of that first day I left the courthouse. The defendants‘ lawyer would present their case the following day. Across the street, the people of Occupy Portland gathered among their tents and makeshift shelters.

I felt the onset of a melancholy I cannot identify in the chill of the autumn air.

Next: A Social License Part III

The Meaning of Success Is In The Squiggles

What Success Looks Like, After via, via, via, via ...Facebook 2011 by jparadisi

Recently one of my friends on Facebook posted a drawing about success. I took the liberty of drawing a copy of it. In art school, copying the drawing of another artist, particularly a dead one, is acceptable if you write “After and insert name of the artist whose work you copied following the title of the drawing. In nursing, copying a written policy of another institution or department by using it as a template is legitimized by the phrase, “Don’t reinvent the wheel.” My point, is this: I copied the above drawing from an unidentified artist on Facebook, because it illustrates the path of success. Maybe not the path of your success, but certainly mine, and that of many artists, writers, and nurses.

The definition of success has plagued creative and ambitious people since, well, the invention of the wheel. Is success defined by external validation from society in the form of wealth, fame, and Klout score? Or is it generated within the individual, an internal sense of satisfaction derived from knowing that what one contributes holds merit, whether society recognizes it or not? This brings to mind the contrast between the fictional character Ebenezer Scrooge, who’s myopic vision of success impoverished his soul, and the nonfictional, archetypical starving artist Vincent van Gogh, living in poverty for the sake of his art. Both had destructive relationships with success. A similar disparity exists in nursing, which demands intellect, critical thinking, and expensive educations as avenues of success, but offers limited career paths and varying financial incentives in return. Nevertheless, nursing’s contributions to society, and those of artists, are not diminished, though some find it difficult reconciling commercial success with creativity, or caregivers.

While writing posts for this blog, I ponder the meaning of success. Success as a blogger, writer and artist is often hidden in the squiggles, but it is not lost in them. The blog bears fruit. It has attracted opportunities for the sale of my stories and artwork. Moreover, within the squiggles I have discovered an Internet community of artist, writer, nurse companions, and like-minded readers through blogging. With such camaraderie, getting lost in the squiggles becomes a camping trip instead of The Exodus.

If you are a passionate blogger, artist, or nurse currently lost in the squiggles on the Road to Success, keep going. You are not alone.

If Lousia May Alcott Were a Nurse: Oh Wait, She Was.

Peds Ward by JParadisi Acrylic,charcoal, flash & pencil on vellum 2008

     Nurses’ Week is over, but we left out one of my favorite nurses. She did not advance nursing science. Instead, she gave the profession a human face. I love Louisa May Alcott.

     She wrote Little Women. Do girls still read Little Women? I am grateful my mother considered reading the classic a rite of passage into womanhood (along with Gift from the Sea, and The Good Earth). She gave me a hardbound, illustrated copy of the novel for Christmas when I was in the fifth or sixth grade. To this day I do not know if I love Jo or Amy more. Beth scares me. Meg…she never really materialized for me.

     Okay, Little Women, blah, blah blah, yeah, you read it. You like Jo too. Amy was a bimbo. Too bad for Elizabeth. Meg went on to play the sister on Family Guy, who cares? Well, darling, do you know that Alcott borrowed books from Ralph Waldo Emerson’s private library? That neighbor Henry David Thoreau was her mentor. That she was an Abolitionist and Women’s Rights activist.  Do you know that before she became famous for penning Little Women in 1869, she was a nurse in the Civil War? The experience changed the course of her life, and likely shortened it. In 1863, she published her nursing experiences in the slender volume Hospital Sketches. The book has the tagline:  “An Army Nurse’s True Account of her Experiences during the Civil War.”  

     An aspiring actor and playwright, Alcott grew up in poverty.  Her father, Amos Bronson Alcott was a respected educator and philosopher lacking both business sense and money management skills. Louisa took jobs teaching and in domestic service to support her family. When war broke out among the United States, she wrote, “I want something to do.” Encouraged to write, young Alcott felt she lacked necessary life experiences. At a neighbor’s suggestion, she decided to “go nurse soldiers. So far, very good.”

     I won’t post a synopsis of the book, other than to say it contains a disturbing account of the death of a soldier whom Alcott befriended.  Her description illustrates that in the days before anesthesia, a soldier’s death was the male counterpart of a woman’s sufferings in childbirth.  

     Alcott was dedicated to the men in her charge. Her brief nursing career ended when she contracted typhoid fever. She survived, but suffered life-long chronic pain; a side effect of the mercury-based medication used to treat her. She obsessively turned to writing, becoming the main financial support of her entire family.  Little Women made her rich, but it was her nursing experiences that made her a writer. I will close this post with Alcott’s own words about Hospital Sketches:

These sketches, taken from letters hastily written in the few leisure moments of a very busy life, make no pretension to literary merit, but are simply a brief record of one person’s hospital experience. As such, they are republished, with their many faults but partially amended, lest in retouching they should lose whatever force or freshness the inspiration of the time may have given them.

To those who have objected to a “tone of levity” in some portions of the sketches, I desire to say that the wish to make the best of every thing, and send home cheerful reports even from that saddest of scenes, an army hospital, probably produced the impression of levity upon those who have never known the sharp contrasts of the tragic and comic in such a life.

The unexpected favor with which the little book was greeted, and the desire for a new edition, increase the author’s regret that is not more worthy such a kind reception.

Louisa May Alcott

Concord, March 1869

Hospital Sketches by Louisa May Alcott is available from Applewood Books.