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Thread: Work anxiety strikes again in full force

  1. #1
    Platinum Member Annia's Avatar
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    Work anxiety strikes again in full force

    I don't know if I'm writing at the right category. I'm writing more to vent but I accept any advice anyone wants to give.

    Some days ago I was "alone" at work I did a very stupid and serious mistake. I gave a medicine to a patient that shouldn't get it for himself and should only some pills at once (probably an addict but I don't know). I gave him the full package because I didn't see that the doctor had written that he couldn't get it himself and all at once. I was basically "fooled" by the patient because I wasn't paying enough attention. I didn't have anyone with me to ask and the doctor office was closed and I shouldn't have delivered this medicine but I swear I didn't notice that there were these conditions to deliver the medicine.

    I noticed my mistake a while after when I came back go review the prescription to check something. Since the doctors office was closed and I was alone, I couldn't do anything. So next day first thing in the morning I told my boss my mistake and called the doctors office to report the situation and try to understand if there was something that I could do to make the situation better and of course apologize. And also try to understand the situation because I'm not even sure if I understand fully the conditions the doctor wrote. I was worried sick that the patient would harm himself by taking too much or something. I couldn't sleep all night.

    Of course that right that day the doctor wasn't at the office so I let the message with the Secretary and ask her to tell the doctor to contact me as soon as possible and explained to her what had happened. Then I told my other colleagues about the situation and left a message that everyone can see about the incident so that no one commits my mistake next time.

    When I wasn't at work the doctor called furious and told my colleague that he just hopes that the patient survives the weekend and that situations like this can't happen again. My colleague told me about this today.

    The next time I'm at work again at the same time the doctor office is opened is in the end of next week. My colleague says that since I'll take so long to be able to call the doctor and since he already knows about the situation that she doesn't see the need to call him myself. But at the same time my conscience is so heavy that I feel that I need to personally apologise to the doctor anyway myself like I intended to do when I called the doctor's office and he wasn't there.

    Both my boss and my colleagues are acting "relaxed" about this but I'm worried sick and feeling guilty of such stupid distraction mistake.

    I think I need to rest and sleep this weekend because I feel very tired and stressed and I got sick some days ago which makes me even more tired. Also being alone in this country and not having the full grasp yet of how things work in situations like this makes me even more anxious.

  2. #2
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    I can understand the guilt. I also can see you being too hard on yourself as you didnít know when you originally gave the medication to the patient that they would abuse it. Hopefully the patient doesnít take the full package for the patients sake but I donít see if the patient ends up seriously ill it being your fault as he fooled you into giving him it to abuse. Plus nowhere on his chart was it instructed by the doctor not to do that.

    I think thatís why your supervisor isnít mad.

    I would take good care of yourself and rest as much as you can. Sleep will bring more things into clear focus on if you should call the doctor or not also youíll see things not in such a stressful light.

    Lisa

  3. #3
    Platinum Member Annia's Avatar
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    Originally Posted by limichelle
    I can understand the guilt. I also can see you being too hard on yourself as you didnít know when you originally gave the medication to the patient that they would abuse it. Hopefully the patient doesnít take the full package for the patients sake but I donít see if the patient ends up seriously ill it being your fault as he fooled you into giving him it to abuse. Plus nowhere on his chart was it instructed by the doctor not to do that.

    I think thatís why your supervisor isnít mad.

    I would take good care of yourself and rest as much as you can. Sleep will bring more things into clear focus on if you should call the doctor or not also youíll see things not in such a stressful light.

    Lisa
    Thank you for your kind words. The doctor had written abreviated but I didn't notice it and even after noticing I wasn't fully aware of what that meant as he had gotten that medication before himself and full package. I should've have paid more attention, but I totally missed it. I've warned the doctor and wrote a warning to everybody at work that next time he can't get the medication himself and can't get full package and I told my boss and colleagues immediately. I don't think I can do much more at this point, but I'm still feeling anxious. I had a week from hell, it's like nothing has been going right this week. I hope I'm feeling better next week. I for sure will be paying much more attention to everything I do and pray that nothing tragic happens to the patient.

    PS: I think that stress is creating a chain of events in which I also broke some medicines because I accidently let them fall to the ground today and I also made other sloppy mistakes (but not relevant ones). I also had 2 patients screaming at me yesterday. I'm really scared that I can't trust myself at this point, I'm a mess.

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    Platinum Member indea08's Avatar
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    You feel the same remorse any nurse feels after a mistake. And a medication error of this gravity is a huge mistake (Iím basing this of the physicians reaction). You could have killed someone. So no, youíre not being too hard on yourself. You need to feel this way to make sure that you never, ever allow yourself to do this again. Next time, you really might kill someone!!

    Going forward, if you ever donít understand a physician order 100% then you call and get clarification. If an order is ever abbreviated, throw it away and call for a new order. If an order seems unusual, maybe a weird med, unusual dose, anything, you call the physician to clarify. If the physicianís handwriting is too sloppy and youíre not sure what it says, you call the physician and clarify. If thereís an order for a medication you donít know anything about, you research that med before giving it. If you donít know what youíre doing 100% then you call for another nurse to help you.

    As nurses, we catch mistakes all the time that could have been life threatening. You are the last person to catch a mistake before it reaches the patient. Thatís why you must be a patient advocate and speak up about anything that doesnít seem right!! This is how nurses save lives everyday! So be honest with yourself, is this career for you? If it is, then commit to being a patient advocate and doing the right thing every single time.

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  6. #5
    Platinum Member Annia's Avatar
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    Originally Posted by indea08
    You feel the same remorse any nurse feels after a mistake. And a medication error of this gravity is a huge mistake (Iím basing this of the physicians reaction). You could have killed someone. So no, youíre not being too hard on yourself. You need to feel this way to make sure that you never, ever allow yourself to do this again. Next time, you really might kill someone!!

    Going forward, if you ever donít understand a physician order 100% then you call and get clarification. If an order is ever abbreviated, throw it away and call for a new order. If an order seems unusual, maybe a weird med, unusual dose, anything, you call the physician to clarify. If the physicianís handwriting is too sloppy and youíre not sure what it says, you call the physician and clarify. If thereís an order for a medication you donít know anything about, you research that med before giving it. If you donít know what youíre doing 100% then you call for another nurse to help you.

    As nurses, we catch things all the time that could have been life threatening. You are the last person to catch a mistake before it reaches the patient. Thatís why you must be a patient advocate and speak up about anything that doesnít seem right!! This is how nurses save lives everyday! So be honest with yourself, is this career for you? If it is, then commit to being a patient advocate and doing the right thing every single time.
    I know that, which is why I took action after finding out I've made a mistake. I've never done such type of mistake in my life and I often pay lots of attention to what I do and I'm even known for calling doctors constantly to ask for clarification and I often catch lots of mistakes from doctors and refuse to give medication if something is not right. I take full responsibility for my mistake and feel awful about it, to the point that I can't sleep and have barely eaten since it happened. If I thought that I was a liability to the patients I wouldn't be doing my job and would've changed career long ago, but after this incident I'm not even sure if I'm a good professional and have been reconsidering my professional choices.

  7. #6
    Platinum Member indea08's Avatar
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    Originally Posted by Annia
    after this incident I'm not even sure if I'm a good professional and have been reconsidering my professional choices.
    This is normal after an incident like this. Itís terrifying when you realize exactly how badly things can go if you forget or misunderstand one little thing. Iím sorry youíre in this situation, I really am. Youíre not alone. Do you have any friends who are nurses that you could turn to for support? Maybe look for a support group specific to healthcare? There are forums on allnurses.com where you could just get some support or share stories with others whoíve been through this.

    I would say give yourself some time. If youíre going to leave nursing, donít leave on a bad day. Wait until youíve healed a bit, and had some really good days, and then decide.

    I once had a patient who was complaining of chest pain and shortness of breath, but troponins and chest X-ray were normal. I continued to call the doc to come see him, but she kept blowing me off. I finally demanded that she come see him, and she did. She gave me an order for IV pain medication, a normal dose, a med the patient had no allergy to, should have been no big deal. I gave him the med she ordered, and he finally relaxed...and continued relaxing further...until he coded. Minutes later he was gone. Despite the fact that Iíd called the doc all day, got the necessary lab work done, did everything right...I still felt responsible because I gave him that pain medication. I know that medication couldnít have caused his death, but the chain of events left me feeling responsible regardless. I still remember his name, his face, his daughters, everything. It took me awhile to deal with it, and years later I still carry this memory. I know how you feel, and I know how scary it is. Eventually, after making positive impacts on many, many other patients, I gained my confidence back and have still had a successful career.

    Give yourself time. If you ultimately feel this may not be for you, thatís okay. But donít count yourself out yet.

  8. #7
    Platinum Member Annia's Avatar
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    Originally Posted by indea08
    This is normal after an incident like this. Itís terrifying when you realize exactly how badly things can go if you forget or misunderstand one little thing. Iím sorry youíre in this situation, I really am. Youíre not alone. Do you have any friends who are nurses that you could turn to for support? Maybe look for a support group specific to healthcare? There are forums on allnurses.com where you could just get some support or share stories with others whoíve been through this.

    I would say give yourself some time. If youíre going to leave nursing, donít leave on a bad day. Wait until youíve healed a bit, and had some really good days, and then decide.

    I once had a patient who was complaining of chest pain and shortness of breath, but troponins and chest X-ray were normal. I continued to call the doc to come see him, but she kept blowing me off. I finally demanded that she come see him, and she did. She gave me an order for IV pain medication, a normal dose, a med the patient had no allergy to, should have been no big deal. I gave him the med she ordered, and he finally relaxed...and continued relaxing further...until he coded. Minutes later he was gone. Despite the fact that Iíd called the doc all day, got the necessary lab work done, did everything right...I still felt responsible because I gave him that pain medication. I know that medication couldnít have caused his death, but the chain of events left me feeling responsible regardless. I still remember his name, his face, his daughters, everything. It took me awhile to deal with it, and years later I still carry this memory. I know how you feel, and I know how scary it is. Eventually, after making positive impacts on many, many other patients, I gained my confidence back and have still had a successful career.

    Give yourself time. If you ultimately feel this may not be for you, thatís okay. But donít count yourself out yet.
    I'm not a nurse, sorry if I didn't make myself clear. I'm a pharmacist. I admire nurses a lot, you are at the forefront of the "battle" and literally save lives, but unfortunately are undervalued and underpaid (at least from what I observe). I also admire you a lot because I don't think I'd be strong enough to endure a "nursing" day, and I've seen lots of awful things in life due to volunteering and some experience in an hospital.

    I can totally see why you felt like that and I'd probably feel the same if someone died after me administring a medicine, even if it wasn't caused by me. It shows you really care for the patients. I'm really sorry you went through it and I hope you've healed and overcame it. I can't imagine going through something like that.

    Thanks a lot for your words, it helped a lot.

    As to people in healthcare who can listen to me, the only people I feel closer and more comfortable to talk about how I'm feeling are people in my country. I feel that I have no one to talk here, though I think that if I tried to talk openly with someone they'd listen. I can't stop thinking that the guy will take all the sleeping pills at once and OD and will die because of me. I think I've never felt such guilty conscience in my life. I think not knowing the actual consequences of my mistake is what's making me more stressed, I feel physical sick to the point that I have trouble breathing and I'm not thinking straight. I just feel like giving up and returning to my country, but I know I need to be strong and think straight.

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    Platinum Member catfeeder's Avatar
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    My heart goes out to you, Annia. I find it most helpful when dealing with an important mistake to get clear about which attitudes and behaviors will actually address a correction going forward versus which will only amplify my own upset and potentially make the problem worse.

    I agree with your colleagues that immediate attempts to contact he physician after he or she is already aware of the mistake would only demonstrate that you are emotionally distraught about the mistake--NOT that you are committed to competence going forward. So it's better to allow for your own recovery before addressing this with the physician, because your goal should be to convey that you not only understand the gravity of the error, but also that you possess the ability to recover your composure and your focus on competence going forward.

    It's more helpful to disabuse yourself of the idea that demonstrating emotional wreckage is the way to demonstrate sincerity. Sincerity comes from your commitment to recovery, and that cannot be achieved by beating yourself up and compounding the emotional wreckage.

    Once you can clarify for yourself that a capacity to recover from a mistake ALSO demonstrates your commitment to competence, you can let go of the self condemnation. It's not useful--it's a barrier to recovery, which is also a barrier to competence.

    As for the patient, learn whether your supervisors are allowed to contact that patient to inquire about his condition and caution the patient about potential consequences of overusing the medication, or whether that is being handled by the physician's office. Learn the chain of response to such an error along with any possible role you can play in facilitating such a response. Then if you speak with he physician you can demonstrate this knowledge and report on your inquiries to ensure that these steps have been taken.

    Head high, and adopt a view of yourself as a competent person who can learn from error rather than someone who self destructively compounds the problem. Write more if it helps.

    ((((HUG)))),
    Cat

  10. #9
    Platinum Member Annia's Avatar
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    Originally Posted by catfeeder
    My heart goes out to you, Annia. I find it most helpful when dealing with an important mistake to get clear about which attitudes and behaviors will actually address a correction going forward versus which will only amplify my own upset and potentially make the problem worse.

    I agree with your colleagues that immediate attempts to contact he physician after he or she is already aware of the mistake would only demonstrate that you are emotionally distraught about the mistake--NOT that you are committed to competence going forward. So it's better to allow for your own recovery before addressing this with the physician, because your goal should be to convey that you not only understand the gravity of the error, but also that you possess the ability to recover your composure and your focus on competence going forward.

    It's more helpful to disabuse yourself of the idea that demonstrating emotional wreckage is the way to demonstrate sincerity. Sincerity comes from your commitment to recovery, and that cannot be achieved by beating yourself up and compounding the emotional wreckage.

    Once you can clarify for yourself that a capacity to recover from a mistake ALSO demonstrates your commitment to competence, you can let go of the self condemnation. It's not useful--it's a barrier to recovery, which is also a barrier to competence.

    As for the patient, learn whether your supervisors are allowed to contact that patient to inquire about his condition and caution the patient about potential consequences of overusing the medication, or whether that is being handled by the physician's office. Learn the chain of response to such an error along with any possible role you can play in facilitating such a response. Then if you speak with he physician you can demonstrate this knowledge and report on your inquiries to ensure that these steps have been taken.

    Head high, and adopt a view of yourself as a competent person who can learn from error rather than someone who self destructively compounds the problem. Write more if it helps.

    ((((HUG)))),
    Cat
    Thank you for your suggestions. I reported the situation to the doctor's office right away and left the message and the doctor already called my workplce (when I already wasn't there) and he talked to my colleague and expressed his concerns. I don't think there's much more I can do given that everyone is aware of what happened. I told my boss and colleagues as soon as possible about the situation too. And I left notes regarding that specific patient so that everyone is aware of the situation and how not to repeat it.

    I feel that there's not much more that I can do, and I think that's what's distressing me, because it's out of my hands.

    I have a tendency of auto-destructive thoughts yes, as I've thought that I'm going to be fired and feel that I deserve it and I'm also thinking that I "killed" the patient. I need to get off my tragedy thinking mode and wait, but I'm feeling so anxious that it's hard.

  11. #10
    Platinum Member Annia's Avatar
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    I think it's not just this work situation, I'm just reaching a point of emotional distress that I've hardly felt before. I've spent hours last night crying without being able to stop and I've been feeling emotionally unstable. My mother tried to call me yesterday and I knowingly didn't answer the phone because I wasn't feeling in condition to talk to anyone. I'm scared with some of the self destructive thoughts I've been having lately. I don't want to harm myself nor anyone by consequence, so tomorrow I'll schedule a GP appointment to see if I can get a referral to a therapist.

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