I had a horrible situation yesterday on shift.
I was doing drug round. Patients were in the dining room eating their breakfast. The nurse watched me calculate the doses and okayed me to give the drugs to the patient. I gave him the drugs. Lorazepam 1mg tablet and Epilim 7.5mg in a solution. The patient (A) said he wasn’t on lorazepam in the morning which threw me. I turned to the nurse and said the patient (A) had queried this. The nurse checked the notes and the patient was right. In the meantime, the patient (A) had put the epilim on the table while I was looking away and another patient (B) had drunk about two thirds of it. Patient B is acutely psychotic and very confused about everything. He’s in a manic phase and everything he does is superfast! I told the nurse who said some colourful words. We both went to the ward manager and the nurse explained what had happened. He explained the initial drug error – reading 1800hrs as 800hrs. And then explained that I turned to tell him and the patient B drank it. Nobody was particularly surprised as there have been a few issues with this patient. She kind of rolled her eyes in a “it would have been that patient” kind of way but was very non-judgemental about both errors. She basically told us to give patient A his epilim, withhold Patient B’s medication (which he hadn’t yet had) and she would do an incident form and bleep the SHO. But at the dose he’d taken she was sure he would be absolutely fine and joked that it may even be just what he needs to bring him down a bit.
We continued with the drug round, the nurse thanked me for helping and sent me on my morning break. Obviously, I didn’t enjoy my break. I was surprised nobody had pulled me up about leaving patient A with a cupful of epilim while I queried the other drug. I presumed this was because the nurses accept responsibility for the actions of students in this particular placement, particularly first years. Or because the initial error was made by the nurse so they let mine go. Or they would talk to me about it constructively at some point.
I thought about what I should’ve done in the situation, watched patient A take the epilim and then queried the other drug or taken both back to the trolley and queried the lorazepam. I decided to bring it up at the earliest opportunity, to get some advice and also to demonstrate that I’d thought about and learned from the situation.
After morning breaks, I approached the nurse I’d done the drug round with and asked if I could have five minutes at some point to discuss what had happened earlier. He said he’d give me a shout when he had a bit of time. Patient B was given the all clear. He was a bit tired and sat for an hour or so then reverted to pacing the ward and setting off the panic alarms on the wall and wandering in and out of everybody’s rooms. His morning medication was given during the midday drug round which I participated in, administering the drugs without incident.
Following the midday drug round, we had the conversation. I said I knew I’d made an error and was surprised nobody had said anything about it. I explained what I thought I should’ve done and would do in future. It was a very uncomfortable conversation. He said yes, I shouldn’t have taken my eyes of the medication and explained how bad the situation could’ve been. But thankfully it wasn’t and just to learn from it. That was that. As we were leaving I asked if there was anything else I needed to think about. He said I do have a tendency to look away when I’m giving out drugs and to make a mental note to keep my eyes on the drug. And I’d leaned over a patient to give another patient medication which was rude but probably because I was nervous after the morning because I don’t usually do that. I haven’t done a drug round since so I haven’t had a chance to think about my tendency to look away any further. Although I’m sure he’s right. I do know I was nervous during the midday drug round and less aware of my interpersonal skills. I know that when I’m relaxed and fairly at ease, I’m very aware of the people around me and reasonably polite.
The day continued. I still felt awful and didn’t really enjoy the shift. At the end of the day, the same nurse pulled me to one side and said he’d heard me say light heartedly to another nurse that I wasn’t having the best day. He told me I had the makings of a really good nurse and I couldn’t afford to let things like this get me down. He also said he’d made loads of mistakes in his time and he was still standing and still working as a nurse. He said to let it go, have a good weekend and forget all about it.
The patient was absolutely fine. The team have no issues with me. If anything I feel reassured that the placement will provide plenty of learning opportunities and provide appropriate reassurance and support. The day ended with positive feedback. But I think it will take me a few days to de-stress fully. One thing my mentor did say is that I need to remember I’m a first year and only have to demonstrate the competence appropriate to a first year. I need to remember that.
