When You Make a Mistake

Every new nurse dreads making a mistake. Any experienced nurse will tell you: It’s not “if” but “when.”

Mistakes happen in every part of life. We miscalculate how much money is in our bank account and we overspend. We don’t notice the car in front of us has stopped suddenly and we cause a fender-bender. We forget about the birthday cake in the oven until the smoke alarm reminds us.

Our careers are no different. No one has to multi-task like a nurse. Besides the many regular responsibilities of any shift, there are always unexpected events. Inevitably—no matter how organized and efficient we are—at some point, we’re bound to make an error in judgment.

There are many reasons for healthcare professionals to make mistakes. Today’s work environment is complex. Technology is always changing. Patient assignment loads are heavy. As a new nurse, you’re likely feeling anxious, stressed, and overwhelmed.

In this month’s Nurse Plus article, let’s sort out why mistakes happen and what to do when you realize you have made a blunder.

The most common new-nurse mistakes

Making the leap from nursing school clinical rotations to your first professional setting can’t be underestimated. It’s mind-boggling! Every day brings new challenging situations. Your orientation and preceptor should help ease the transition. Don’t be shy about asking others for their assistance and explanations.

Knowing the most common mistakes that new nurses make can keep you aware during your shifts, no matter where you decide to work.

1. 1

   Medication errors

   You’re probably not surprised to see this at the top of the list. Whether you’re the newest or the most senior nurse, it can happen. Every nurse knows the Rights of Medication Administration. Research shows that about one-third of all medical errors in the hospital setting occur during preparation and administration of medications.

   Healthcare organizations are constantly trying to reduce the number of medication errors. Implementation of methods such as distinct packaging, barcode medication administration (BCMA), and manual override are useful. However, nurses must be careful to avoid a habitual mentality of “I already know this drug and this patient.”

2. 2

   Infection errors

   No surprise here, either. For decades, well before the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) and the Joint Commission have been working with health care organizations to reduce infection rates in patient care settings. The CDC estimates that about 100,000 patients die from hospital infections every year. The main sources of iatrogenic infection: surgical wounds, urinary tract, bloodstream, and lower respiratory tract.

   As a bedside nurse and direct caregiver, it is every nurse’s responsibility to be diligent and minimize risk for their patients. Proper hand hygiene is essential. You may be nervous about speaking to a physician or other healthcare team member, but remember that as a nurse, you are the best advocate for your patients. Insist on everyone following standard precautions and aseptic technique. Everyone.

3. 3

   Documentation errors

   During nursing school you certainly learned the correct way to document. You no doubt remember, “If you didn’t chart it, it didn’t happen.” There may have been test items on your NCLEX about documentation. Failure to document in an accurate and timely manner can be costly: to the patient, to the organization, and to YOU.

   What you probably didn’t learn in nursing school is how much time is required to meet this responsibility. Electronic medical records (EMR) and electronic health records (EHR) are becoming standard but isn’t yet widely available as part of nursing curriculum. No matter what documentation system is used, be extra-vigilant in providing information regarding orders, medications, nursing actions, patient conditions and response to interventions.

4. 4

   Other errors

   The list of potential mistakes that a nurse can make seems daunting:

   • Failing to prevent patient falls
   • Not questioning confusing or inappropriate orders
   • Reluctance to ask for help, leading to patient injury
   • Not speaking up when an assignment is too difficult
   • Entering information in the wrong patient chart or EHR
   • Not following policy and procedure
   • Failing to comply with your state’s Nurse Practice Act
   • Working when exhausted or ill

There is so much to learn as a practicing nurse. Be “patient” with yourself, rely on the wisdom and expertise of others, ask questions, and do your best.

What is your first step as a new nurse?

This question is easy to answer. If you haven’t already, purchase professional liability insurance! (Read Professional Liability Insurance for Nurses: Why EVERY Nurse Must Have it) It’s inexpensive—about $125 a year for members of American Nurse Association--and can protect your investment in your education and career. You can be named in a malpractice lawsuit even if you didn’t provide direct patient care.

According to medical liability insurance providers, NSO and CNA, the average nurse’s malpractice claim is $164,586. Without insurance, this cost is yours. (NOTE: Nurse Plus Academy does not endorse or receive compensation from any specific professional liability insurance provider.)

What happens when you make a mistake?

The moment you realize that you have made an error, you must take action.

1. 1

   DO NOT try to hide or cover up the situation.

   You’re human and humans are not perfect. This can be one of the toughest steps, because you feel ashamed and embarrassed. But whether your error was small or big, it’s essential that you move ahead as soon as possible:

   • Follow policy for reporting a mistake. Just as you’d do with any Incident Report, simply state facts. Do not explain or interpret.
   • If you’re in a union, contact your representative.
   • Notify your medical liability insurance provider.
2. 2

   COOPERATE with the investigation.

   Depending on the mistake, your state Board of Nursing (BON) may be notified, and you may be subject to disciplinary action. It can seem harsh and humiliating, but the purpose of the BON is to protect public health and safety. Meanwhile, your goal is maintain your license. (Read: Protecting Your Nursing License: Learn Why Nurses Lose Their Licenses and What to Do About It)

3. 3

   SEEK SUPPORT from reliable sources.

   While you must own the responsibility for the mistake, remember that you aren’t the first—and certainly won’t be the last—nurse to make an error. Family and friends can sympathize. Trusted colleagues can empathize. If you’re close to a nursing school professor, you may find it helpful to get their perspective. Mistakes aren’t equal in terms of consequences and patient outcomes, but chances are that your guilt may not know the difference. Seeking a counselor, especially an experienced nurse, can be a good solution.

4. 4

   DON’T RUMINATE

   If you find yourself constantly revisiting the error, you can get so stuck in the past that you’re afraid of the future. The Harvard Business Review (HBR) reports this type of overthinking can lead to depression and ineffective problem solving. You can’t ignore what happened, but you also don’t have to stay fixated on it. HBR points out that it’s an avoidance technique—time to take a baby step forward.

The aftermath: How to learn and move on

When you have a little distance from the event, you’ll find that you’ve been given an opportunity to consider the lessons from the mistake and how you can become a better, wiser nurse.

Find time to sit and reflect—possibly journal—about these questions regarding the incident:

• What do I think caused me to make this mistake?
• What was I doing when it happened?
• Was anything else going on around me?
• What was my mood or frame of mind?
• Did a flaw in the system contribute to this error?
• Is the structure or environment of my unit safe?
• Are my colleagues and team members helpful and trustworthy?
• Does my employer provide adequate resources to avoid mistakes?

Next, do the same about moving forward with your career:

• Is this a job I love and feel invested in?
• Was my mistake a signal that it’s time for a change?
• What do I need to recover, both professionally and personally?
• How can I get organized to avoid another error?
• What would I do differently next time?
• Do I need to learn more about the topic that led to the mistake?
• Are there professional colleagues who can give me advice?
• What would I tell another nurse in my situation?

Mistakes can help you grow

It may be hard to realize at the time, but you can be sure you will never make the same mistake again. You remember it and learn to be more alert and careful. Nursing errors are going to happen. Use yours to plan better. Tell and teach others so they can avoid what happened to you.

When nurses are open with each other and willing to share their situations, the workplace becomes a better place to work. Your attitude and behavior can have a positive influence on coworkers, resulting in what every nurse wants: excellent patient care.

About the Author

Winona Suzanne Ball

Nursing Adviser, RN | MHS, Governors State University, IL
Full member of the American Nurses Association. Learn more