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Fumbles, or how to recover when you’ve dropped the ball

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If I were to write a book on nursing, I’d title it Everybody Effs Up.

Everybody does. From new nurses to ancient, creaky, seasoned ones, everybody screws up once in a while. Maybe it’s a patient fall that could’ve been prevented; maybe it’s a test that didn’t get entered as ordered, or perhaps it’s the wrong drug at the wrong time. The list of things that could go wrong in a hospital (or clinic or nursing home or wherever) is so incredibly long that it’s amazing that more mistakes don’t happen.

So, let’s say you’ve (to put it in the common parlance) made a romantic gesture toward the dog. What do you do now?

First, recognize the mistake. That might be trickier than it sounds, especially if the outcome is particularly dramatic—like a patient crawling between the bedrails and succumbing to gravity. If you look back at the whole scene, though, you can often pinpoint one or more things that you didn’t do that you should’ve, or actions that you took that didn’t turn out so well. In the case of the patient on the floor, maybe the bed alarm was broken or the call bell wasn’t where it needed to be. Both of those are small problems that led to a big one.

Second, figure out what it was in your routine or the overall process of the day that made you not pick up on those small mistakes that got compounded. This is the part of the equation that’s often overlooked, especially when it comes to med errors, because a large part of the responsibility lies with our employers and their processes. If you’re just plain over-assigned, or if the pharmacy is short-staffed, bad things will eventually happen. Try to figure out what systemic errors led to your own, and what you can do to fix them—or figure out workarounds.

Note: Do Not Let This Rob You Of Sleep. Tilting at windmills is a charming thing for the rebel factions of the ACLU, but you just have to get through the next day, week and month. You alone cannot change the culture of an institution. All you can do is make suggestions.

Third, come up with a simple fix. In order to do that, you’ll have to look back at Pointer Number One and remind yourself of the distilled reason for the error. Generally speaking, the simpler the problem, the simpler the fix. If your solution seems unusually baroque, or if you can see yourself spending more than a few seconds on it, reconsider your approach. The best solution in the world ain’t worth squat if it’s too difficult to implement.

Fourth and finally, forgive yourself for effing up. Everybody does it. Somewhere, I’m sure, there is a file three inches thick with my name on it, containing all the errors, major and minor, I’ve made over the last (cough) years. If you’re finding it difficult to move on from an error, or it was particularly egregious (and yes, I’ve made some of those, too), talk to a more experienced nurse about it. It’s likely that she or he will nod in recognition and return a harrowing tale of the time something on their watch got FUBARed.

Happy nursing! Remember: Everybody effs up. The trick is in clever, elegant, low-hassle fixes.

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Agatha Lellis

Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at askauntieaggie@gmail.com.
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