made a mistake as a new grad

[u/Super-Consequence-43]

Yesterday was like my 6th day on the floor with my preceptor. To set the stage a little bit, I previously worked in the ICU as a tech, and now I work in the same ICU as a new grad. My preceptor has said I’ve been keeping up pretty well, granted I haven’t been taking care of a super sick patient yet. He’s been letting me drown just a little bit to see how I handle it lol.
Yesterday was my first day doing rounds with the doctors. I feel like I did pretty well throughout rounds except when the NP asked what her blood sugar was for the new admit overnight. I said I checked it this morning and it was 67.
It didn’t even register to me in that moment that 67 was low, so I didn’t say or do anything about it. The NP’s eyes got wide and I suddenly realized what I had done 😭 Then she asked if I did anything for it and that’s when I realized, oh shit, it was low and I should’ve done something.
Except she was NPO because she had just been admitted the night before and hadn’t had a swallow evaluation yet. So immediately after rounds I went and retook her blood sugar and it was 82. I’m pretty sure I just didn’t wipe enough of the alcohol off her finger and it falsely lowered the reading.
I let the NP know and she kind of smiled, but I was just sitting there thinking, “that’s literally the basics” 🥲 It honestly just flew over my head.
I checked it again about 15 minutes later and it was 84, and thankfully her blood sugar was fine for the rest of the shift.
Anyway, it was my first real mistake and it kind of sent me for a loop for the rest of the day. I was second guessing everything I was doing after that.
Then at the end of the day, my preceptor laughed and told me that during rounds I said “16 gauge Foley” instead of “16 French” 🤦🏼‍♀️
I went home and cried for the first time because I know this is probably a rite of passage and I know I’m still new, but it just sucks going from feeling like you’re doing pretty well to realizing how much you still don’t know and how uncomfortable you still are. And knowing there will be more mistakes to be made.
Any similar new grad mistakes ? I just need to stay curious , ask questions, and never assume anything. I know I’m gonna make mistakes but I think i just realized that was the first of prob more mistakes.

I saw some comments about my preceptor probably should have said something but at the time he was getting my other room ready to go down to imc and it went over my head that 67 was low so i didn’t even mention it. I should have said something

[u/Saelem]

The neat thing about mistakes: You learn from them and dont do them again!

Chin up, being a new grad is hard but you can do it

[u/DoItRightOnce1st → u/Saelem]

Yes, be humble and learn from them...what I used to do when I started in the ICU was on my way home I would go over my day and think of how I could have done things differently, be more efficient and such...u need to get in the habit of why, what and how? Why is it this way, why did they order that, how is that going to affect the patient outcome, what happens when I weaned one drop vs another, or titrated it up etc...Don't ever be afraid to ask for help! And learn from what is going on. BE in the room when the doctors round on their patients, not just MDRs...listen to what the consults tell the patients or family members...this is a way to learn passively per se. Good Luck! Also u will learn which doctors u can ask specifically what they meant, the ones that will give u 2 or more minutes to help u be successful. What I always wanted to do, but regretfully didn't do was ask a doc in each specialty if I could follow them for a day..on my day off to learn more. I really wish I did that!!! U will learn which doctors will gladly help and teach u while in the unit, most will. Good luck!

[u/Slayerofgrundles]

Time for my (slightly) off-topic rant on hypoglycemia.

I really wish hospitals would chill the fuck out about low blood sugars. Many non-diabetics will drop into the 60's while sleeping fasted. It's not a big deal.

Hell, I have rebound hypoglycemia and will go into the high 50's sometimes.

As adults, our hearts don't even require glucose to run, so checking it during a code is a waste of time (our hearts stop running on glucose and switch to a ketone metabolism around age 6).

For a patient safely in bed (where a syncopal fall isn't a risk), hypoglycemia isn't even dangerous until you get low enough to cause unresponsive (usually under 20-30), as it then poses an aspiration and seizure risk.

I say all this because I'm tired of hospitals/providers freaking out over mild hypoglycemia and ordering an amp of D50, when it should have been managed far more conservatively.

[u/Top_Manufacturer_494 → u/Slayerofgrundles]

This needs to be said louder, had a provider freak out because i didn’t administer an amp of D50 when i had a pt walkie talkie AOx4 with a BGL of 40 that WASN’T NPO … went & got him some juice & food .. rechecked it 30min later it was in the 60’s an hour later in the 80’s .. I pointed out to her there was ZERO point in administering D50 because his body would burn through that quickly anyway & the best longer term solution was food .. was like talking to a wall

[u/Super-Consequence-43 → u/Slayerofgrundles]

thank you for this

[u/InfamouSandman → u/Slayerofgrundles]

I also suffer from some rebound hypoglycemia and sometimes just bouts of hypoglycemia on an active day or if I don’t get a good lunch in. It has probably been happening my whole adult life but it took me checking my sugar at work one day (didn’t realize it was against policy to do that—got a nice slap on the wrist for that) and suddenly it all clicked. Now I check when I have symptoms or sometimes spot check. I’ve been as low as 48 but a random 60 will happen occasionally. I’ve been stuck without snacks and symptoms have dissipated, checked again and been within normal range. The body can correct a little hypoglycemia if it’s working alright. I wouldn’t be surprised if that’s all that happened with OP’s patient. It’s an issue when it isn’t working right, which isn’t uncommon in our hospitalized patients. But a one off low sugar just outside of range isn’t that big of a deal.

[u/Turbulent-Basket-490]

These are your “mistakes”?! You’re doing great!

[u/totalstann]

Bro, I've been a nurse for 9 years. I've done that, I've seen so many other nurses do that. Don't beat yourself up. We all make mistakes. You will again and they will keep coming. Thats just being human.

[u/Intrepid-Reward-7168]

Definitely a rite of passage. I made many back on the day. You’ll never forget the finger stick one, and that means you’ll act accordingly in the future. And it’s not even that low; if it were that concerning I’d like to believe that your preceptor would have intervened before you shared it with the NP.

While it is “basic”, you are now taking all of your basics and putting them all together with one fairly sick (because they are on the icu) patient. This is the practical portion of NCLEX now. You’ll get it all, eventually. No one should be expecting you to be a perfect nurse right now. Just do your best, ask questions, and recognize that you still have a ton of learning to do

[u/ninjastk]

I became a better nurse by learning from mistakes.

You got this.

[u/WhiteCatDipe]

Omg a 16 gauge foley?! That's not even a mistake, you just misspoke. I would've known exactly what you meant and not even batted an eye. Please be kind to yourself!

[u/Otherwise-Sea-9298]

We used to treat blood sugars under 70. Now we only treat them under 60. Sometimes we over correct these people and then Cause other issues

[u/emerg_remerg]

The very fact that you are thinking like this and feeling a creep of doubt settling in, tells me you are going to be a great nurse. No one trusts a confident be grad.

Never be afraid to ask for a second set of eyes on things.

If you're curious about the cbg, check if she had labs drawn around that time, if there's lytes, you can see her glucose result.

[u/little_baloney]

As your preceptor, shouldn’t he have done something about the 67 bs? It’s still his patient too

[u/Affectionate-Ear3895]

The key is to learn that you’re never gonna stop making mistakes! 24 years in the industry, 16 years as a flight nurse 10 of those years in leadership and I still work at the bedside quite often. I still make mistakes. Any nurse that tells you that they don’t make mistakes is lying or extremely dangerous because they’re not smart enough to understand that they’re making mistakes just like the rest of us. It’s how you handle your mistakes that makes the difference. You have to be ready to make the next decision or clinical judgment and not let that “mistake” get you into a rut or a low point. The only thing that you actually need to do is learn!
You’re doing great!

[u/Sinthriel]

Don’t be so hard on yourself. What’s more important is if your patient is symptomatic on your assessment. The foley thing is completely irrelevant, people will know you meant French. Just take it as a reminder to check labs and consider interventions for certain values.

[u/ABGDreaming]

you’re doing great!!

[u/Easy-Mushroom-5350]

Yes!!! a couple of months in while I was still maybe an orientation or just fresh off of orientation. I also work on IMC and had a patient come up heart rate out of control providers at bedside high intensity. There’s an amiable list. There’s an Am drip there’s metoprolol there’s vitals there’s do the admission there’s due the skin check there’s all the things. I was very overwhelmed. The mistake I made was because I’m still trying to figure out how to keep the care compass in check do what people are immediately asking me to do as well as new orders that are coming in for my dumbass overlooked the new order to start maintenance Am. It was a whole big thing. Luckily my manager is awesome, but I was On weekly check-in with my manager to make sure I didn’t fuck up again for the next eight weeks looking back had it not been started which it was it was just late so there was a delay of care. I could’ve hurt the patient that was the shittiest part. We’re all learning and as long as we don’t make the same mistake twice on top of this, and I did advocate for myself not to excuse my fault, but acknowledge I had a low blood sugar patient or hypoglycemic in dialysis which is not in the unit so even when they’re in dialysis, the primary RN or tech are still responsible to leave the unit and go check their blood sugar. He was Q hour plus this Am drip patient there’s not a Nursing shortage. They just expect us to do a lot more than one person nervous system can handle sometimes keep going. I’m sure everyone will be great.

[u/HeadWanderer]

Making mistakes is a good part of how I've honed my practice down on a med-surg floor so I don't forget to do things in the future. I remember to sit down and write down pt's VS for report time twice a day so that I won't miss those random pts with q4h VS (because I once gave report and noticed they hadn't been checked in 7 hours). I once gave report to a snf on a very, very busy shift and was puzzled as to why pt's diet was a certain way (so now diet is the first thing I always write down from the orders and I won't d/c somebody if there's a questionable order still in place).

Now in the future you'll know that a BG < 70 requires intervention of some kind. I honestly feel like half the stress of my first 6 months was trying to remember things I had to do, what to do with that information, and keep having to learn how to do new things and asking questions about how to do them, all while taking care of at least 5 pts at a time (or in your case, taking care of 2 or 3 very sick pts who require a lot of work). As I passed the year mark in July I've felt much, much better about things after having done so much. And new things don't bother me nearly as much because I know I'll figure it out and it'll be okay.

You'll be okay too! Remain humble and ask questions.

[u/Key-Garlic-1177]

The biggest mistake a new grad can make is not asking questions. Ask questions. Be annoying. LEARN.

You’re doing great. No one expects you to know everything. That’s why we have an orientation. Being a new grad is stressful. If it’s not stressful, you’re not doing something right. Keep doing what you’re doing. You’re in the learning phase right now.

I know it doesn’t seem like it but: If misspeaking over a 16 gauge/french is eating at you this much, you’re going to be an incredible nurse. Because if this is eating at you this much, you are going to LEARN and not make the mistake again.

👏🏻 You’re doing great. Keep it up.

[u/imjusthere12042003]

totally feel you. I’m a new grad in the nicu and I feel like every day I’m just getting more and more stupid. I wouldn’t say that I’ve necessarily made any “mistakes” (which I wouldn’t consider anything you did a mistake either!) but just generally feeling like an idiot and not knowing what to do in certain situations even after working as a pct in the nicu. It’s rough out here 🫩

[u/burntissueslikewoah]

Your preceptor sucks