Nursing errors

These twelve tips represent common traps affecting nurses, as shared by JoAnn Pietro, RN, Esq, who practices employment law at Wahrenberger and Pietro.

1. New graduates should not be placed in complex clinical areas that demand more knowledge, experience, and critical thinking skills than they possess. They may find it very difficult to work in these hospital units: operating room, post anesthesia care unit, pediatrics, intensive care unit, emergency department or a very intense medical surgical unit.
2. New graduates need to work under the direction of more experienced people. They should not be assigned to be a charge or head nurse position until they have gained at least a few years of experience.
3. Nurses risk making errors when they are in a position in which they always feel overwhelmed and disorganized. They are likely to make mistakes because of fatigue, distraction and stress. An error in the beginning of their careers can have rippling effects, particularly if they lose their job or get reported to the board of nursing.
4. New graduates and new nursing hires should ideally have a preceptor assigned to them who shares their assignment. Warning signs include not having enough time with the preceptor, assigning a preceptor to a group of patients in addition to working with the new graduate, lacking consistency of assignment with the preceptor, or having multiple preceptors. These factors may set the new employee up for failure.
5. Nurses should look for a job that is in a facility where there are sufficient ancillary staff members, such as aides and technicians. It is a warning sign if the nurses have to do everything, such as transporting patients, serving trays, going to the pharmacy to pick up medications, and so on. This affects organizational and time management skills, making it harder to function, and increases the risk of errors.
6. Nurses should look at the heaviness of their assignments. Can they reasonably complete the care before the end of the shift? Short staffing is a warning sign that the unit or facility may be experiencing low morale with high turnover. Taking shortcuts with nursing care can result in patient harm.
7. Nurses should follow all facility procedures related to counting narcotics. They should not be pressured to sign off that the count is correct if it is incorrect. They should not let older, more experienced nurses cajole them into signing off on an incorrect count. Also, they should be sure to get wasted narcotics counter signed. They may be blamed for a missing narcotic.
8. Nurses should recognize there is no way to take narcotics in a hospital without being detected. It never pays to steal narcotics. Impaired nurses often make poor decisions and cannot safely function in a complex environment.
9. Nurses who are not familiar with the facility’s computer system should be proactive in getting the help they need to use it correctly. They will be held accountable if they do not have notes correctly entered into the patient’s record.
10. Nurses should not deviate from the facility’s protocols related to administering blood. Every step of the procedure, including the most important one of verifying the patient’s identity at the bedside, is designed to prevent a blood transfusion error. There can be no short cuts when it comes to giving blood. An error can be fatal.
11. Nurses should document what they told a physician about a patient’s condition. They should be specific about what they reported. A physician may forget or deny she received specific information. A medical malpractice suit filed years later may evolve into a battle about who is telling the truth about what was said. The chart will be the only thing they can rely upon.
12. Nurses should document all verbal orders immediately and ask the physician to cosign the order immediately. Envision this nightmare: a nurse got a verbal order, did not document it and the physician denied he gave it.

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