Making a mistake is an inevitable part of learning in healthcare, especially nursing. It doesn’t matter how high your GPA was in nursing school, whether you had 75 questions on the NCLEX or all 265. If you’re a nurse, you will make mistakes. The goal is to learn from your mistakes and, if you’re brave, share your mistakes so others can learn from them as well.
For many years as a nurse I participated in peer reviews for medical errors. Time and time again I realized that no nurse drives into his or her shift thinking, “Today I am going to make a mistake!” What I did realize is there are 3 practices that lead to mistakes. Some nurses use these practices in an effort to save time. Avoiding these bad practices doesn’t guarantee you won’t make a mistake, but chances are you’ll make fewer. Here are the top 3 mistakes I’ve seen other nurses make (and, ehem, perhaps even made myself) and tips on how to avoid them.
Rushing Through an Assessment
We all do it, even though we say we never will. We try to convince ourselves that we can listen to breath sounds and heart sounds simultaneously. When you feel that urge to omit portions of your assessment due to your superhuman abilities, ignore it! You will miss something. It may not happen immediately, but it will one day. And in the end, it’s your patient that will suffer. Take the time every shift to perform a thorough assessment. Take your patients’ socks off and look at their feet. Pay attention to their urine output. Remember to check all their pulses. And please review their vital signs. These simple steps take seconds and can literally save your patient’s life.
Trusting Without Verifying During Shift Report
It’s happened to all of us. The off-going nurse tells you she gave a med, or maybe that she didn’t give a med, and that the labs ran during the previous shift were all normal. You’re hours into your shift and the rounding physician angrily approaches you because he or she was not called regarding that elevated serum lactate, or they ask why the last dose of vancomycin wasn’t given. You try and explain that the previous nurse assured you all those things were taken care of. You frantically review the chart, and then BOOM! There it is. The red font in the EMR indicating a medication is overdue. Or maybe it’s the red font in the lab screaming that a value is outside of the normal range.
The previous nurse made a mistake during the report, and now you’ve made a mistake in practice. While we should trust our co-workers and what they tell us in report, you always have to go back to the source of truth: the patient record. Trust your co-workers, but please verify what they are telling you. Remember: 12 hours is a long time. You have likely reviewed multiple charts and assessed multiple patients. At the end of your shift, patient information runs together when you’re giving report. Don’t rely on your memory when giving report, and don’t rely on your co-worker’s memory when receiving report. Best practice is to always verify.
Not Preparing Your SBAR
Let’s face it – calling doctors is no one’s favorite activity. In fact, if I had to choose between calling a doctor and giving an enema, I would chose enema, hands down, everytime. In the early days, most of the calls were humiliating and usually ended with me wanting to cry in the clean utility closet. Then, I realized my mistake. I wasn’t preparing my SBAR. When I embraced the simplicity of SBAR, my life changed! Well not my entire life, but I became way more confident when I called doctors.
Take a few minutes before you call the doctor and get your thoughts in order. Summarize why you’re calling in 8-10 seconds (this is the “Situation”). Have all the necessary background information in front of you: lab results, vital signs, output, etc (this is the “Background”). Then quickly summarize your assessment findings and tell the doctor what you need (“Assessment” and “Recommendations”). Another thing I noticed when I started using SBAR is my patients received better care. A systematic review published in 2018 found improved patient outcomes when SBAR was used, specifically in nurse-to-physician communication (Muller M, Jurgens J, Redaelli M, et al, 2018). The doctors trusted my assessments and agreed with my recommendations. And even if they didn’t, they would still order the extra lab I requested. In the end, my patients received better care and that’s really what matters. If you need more help with your SBAR, click here.
Remember nurses, we all make mistakes. You can graduate in the top of your class and procure decades of experience. But when you’re neck deep in 5 patients, one discharge, one admission, and a patient on frequent monitoring, you’re going to be tempted to cut corners. You probably won’t make a mistake the first 10 times you do this, which gives a false assurance that the corners you’re cutting were not necessary in the first place. But eventually you will make a mistake, and hopefully it’s not one that will haunt you for the rest of your life.
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